I was paired with a patient for whom I will use the pseudonym Jane. When I first met her, she would not respond to my questions and even turned her head away from me in frustration when I spoke. So for our first meeting, I just watched an old Western movie with her before she fell asleep. During our second visit, Jane was more alert and was able to nod or grunt to answer yes or no questions. I wanted to make sure she was comfortable, so I asked her if she wanted me to open the curtains, straighten her blanket, or change the channel on the TV, all of which she mildly nodded ‘yes’ to. Beyond taking care of her physical comfort, I was unsure how to connect with her. I started by asking surface-level questions, like who had painted her nails, and if she was looking forward to Easter, which was listed on her calendar, but she would not respond. Then, I asked her if she had a favorite pet as a child when she was growing up and she finally smiled. She said she had a small dog named Peppy. I drew her a picture of a small dog and wrote “Peppy” in big letters above its head so she could read it easily. When I showed it to her, she slowly smiled and said, “This is nice!” I folded the drawing to prop it up on her bedside table. This was a meaningful experience for me, because it showed me what was really important to Jane at the end of her life. While physical comfort was important, she was not most interested in communicating with me about those needs. And while casual small talk can sometimes lighten the mood in a heavy situation such as the end of life, Jane was not interested in that either. What was most important to her was thinking back on happy memories from her childhood, such as those she shared with Peppy.
In my following visits, I tried to speak with her more about happy memories from her past, such as those she shared with her family, friends, and Peppy. However, I noticed it was becoming increasingly difficult for her to speak, or even grunt affirmatively to my questions about changing the channel or opening the curtains. She would often experience intense tremors when trying to muster the energy to speak or make a sound, so I stopped prompting her to speak or gesture at all. In her last weeks of life, I just switched on the channel that played Western movies since she seemed to like that channel the most, and told her funny stories about things that had happened to me that week. During our last visit, she was asleep nearly the whole time. She only woke up when I got up to leave, and I told her I would see her next week. Sadly, she passed away before I could see her again.
My experience with hospice care has greatly informed the type of physician I will be one day. In Being Mortal, Dr. Gawande discusses how it is so difficult for doctors to stop fighting death, because they are taught to focus on problem-solving instead. Dr. Gawande describes a patient named Sarah Monopoli who he had a very difficult time letting go because she was a new mother with a loving husband. So, he advised her to undergo additional treatment, knowing it would not cure her. Thus, she suffered from the effects of the treatment and was not able to muster the strength to hold her newborn in her last weeks.
I am grateful that Jane was not subjected to that kind of death. I believe Jane had a death experience that was filled with emotional comfort, which she must have valued so much. I am glad that Jane was able to spend her last months of life reflecting on memories from her past, seeing her family members, and watching her favorite movies instead of suffering through treatment like Sarah. As a physician, I will keep in mind the idea of a graceful and emotionally comfortable death, rather than maintaining a constant fight against death to push patients through additional painful treatments near the end of their lives.