Despite my interest in medicine and treatment of the ill throughout most of my life, death and dying have always been fairly distant concepts. When I once imagined medicine I fell into the trap, one that I believe is very common in society, that medicine is all about life: treating illnesses that challenge life, prolonging life and increasing quality of life. While there are lots of areas of medicine that do fall under this umbrella of objectives, there is also a large part of medicine that must interact with the inevitable death of all patients. Despite this interaction I have come to understand that in much of medicine, death is avidly avoided and not discussed. This lack of acknowledgment of death can be unfair and potentially harmful to patients. The Pre-Med Hospice Program has continued and built upon my interest in the process of death and dying, especially in the way that parts of society so avidly avoid death. I have been able to witness the acknowledgement of death that comes from committing to hospice and have found it motivating to approach death in a constructive manner in my future in medicine.
My time volunteering with hospice patients has been an interesting addition to my perspective on medicine’s approach to death, as my patients have already chosen paths that acknowledge death. They approach it in such a way that allows individuals to feel the most independent, and therefore in my opinion alive, leading up to death. While I have grown in my understanding of death and dying throughout the program, during much of my time spent volunteering, death was not on my mind. I visited two patients most frequently. While both did not remember me each time I returned, when I spent time with them it was not usually apparent to me that I was interacting with someone who had a very limited life expectancy and was therefore put on hospice for comfort measures. I often forgot that my patients were terminally ill despite my name badge that clearly stated I was a hospice volunteer. Although it took me some time to interpret this phenomenon, I have come to understand it as one of the great benefits of hospice and the acknowledgement of death in general. Despite death’s continual presence as a part of humanity, the loss of life, from the perspective of both the dying and those close to the dying, it is an extremely difficult separation. I do not think this emotional experience will change, but, I do think that the additional burden of not truly living leading up to one’s death can add pain to an already painful experience. This has been one of my main takeaways from the Pre-Med Hospice Program. My interaction with patients has shown me the possibility of life close to death even for the very ill. I think this is only possible with the acknowledgment of death. A continual fight for life leading up to death that occurs with painful or exhausting treatments for the elderly, excessive breathing and eating assistance or living in a hospital, takes away this possibility.
One of my most meaningful visits this year took place after I received notice that one of my patients was rapidly declining. I could tell by his appearance that he was not as well as during my previous visits but I was still able to have a very meaningful conversation with him. During this conversation, he expressed extreme gratitude for many experiences and people in his life. The combination of sadness and joy he expressed in this conversation showed me a glimpse of the process of acknowledging death. The struggle to balance these emotions will undoubtedly always persist surrounding the death of someone who can joyfully recall their life. However, I think much can be done to assist individuals, starting from the preparation of physicians, that will allow more people to have time and be in an emotional and physical place of comfort to come to terms with their death.