I have gotten the chance to visit with three different patients through the Pre-Med Hospice program since the end of last fall. One of my more meaningful hospice patient relationships is with the patient I am currently seeing. Jerry is a senior who loves to talk and make friends with people, however, he has both short- and long-term memory impairments, in part because of the medications that he is on. Consequently, my routine visits with him become first-time visits in his eyes. This has resulted in a unique kind of situation compared to my visits with the other two patients that I have seen: I am befriending Jerry–-and he is befriending me–-every week. To diverge for a moment, and to try and help convey why my visits with Jerry have been so meaningful, I want to briefly mention that I have had–-and currently have–-family members with dementia. My great-grandmother was the first person I saw endure the dilapidating disease, with her personality completely transforming itself. Something that never wavered, however, was the joy she received when she had visitors. I can still picture the delight she got when she had company, regardless of who it was or whether she would remember the encounter. Returning, now, to my visits with Jerry, they tend to resemble each other each week very closely. Being that he enjoys talking, after we introduce ourselves I will ask Jerry what he wants to talk about. Without much hesitation, he always elects to tell select stories he has from when he worked. As he is talking, I ask questions and he does his best to answer them. And by the end of the hour-long visit, we’re friends. That is, until the next time I see him, when I am just a new face again. What has been instilled in me–-even more so than it was going into this volunteering experience–-through my visits with Jerry is the importance of companionship, regardless of one’s cognitive state and regardless of whether someone will remember you or not. For me, I have heard Jerry’s stories over and over again, but for Jerry, he is telling them to me for the first time. Each joke he or I make, even if it was a joke repeated from previous weeks, still elicits laughter from Jerry, and still causes his brain to release endorphins and make him feel good. In other words, each visit is a first-time meeting for Jerry, and yet despite not being able to remember me, this does not prevent him from finding joy and experiencing comfort when I visit him. He is simply making a new friend every week. This has helped reaffirm that companionship–-including for people like Jerry and my great-grandmother–-can go a long way in bettering people’s quality of life.
This program has first and foremost provided invaluable experience working with patients, including getting to directly talk with them as well as contribute to improving their well-being. It has also provided space to talk about death and the process of dying, two things that are important to have a well-rounded perspective on. Specifically, the program has helped reiterate that death is not something that patients have to fear, but rather can be embraced and seen as a natural part of life. It has also helped show me that doctors should not fear death for their patients. So often it seems that doctors fight death, avoiding it at all costs. They are sometimes made to think that in order to make a difference in their patients’ lives, they have to be actively doing something to/for their patients, like operating on them or giving them medication. Further, physicians are often optimistic and therefore looking for ways to push diseases into remission rather than discussing longer-term pictures of mortality. This results, in part, due to anxieties that doctors experienced, such as that they are supposed to be able to fix health-related problems and that there is often a kind of implicit promise that they will be able to fix the problem and give their patients the best shot of surviving and at good health, as Atul Gawande mentions. While doing all that can be done to try and prevent the death of one’s patients is oftentimes admirable, I do not think this is always the right approach, as sometimes the very treatments meant to help a patient fight a disease cause more harm than they are meant to. Through attending our reflection meetings and volunteering with patients, I have observed certain traits that help make a good physician. One such trait is having a complete understanding of one’s patient’s wishes and priorities, and this means that when the physician is faced with the tough situation of them knowing their patient’s disease might not improve with any further treatments, they need to know when is best to inform their patient of this–-while in the meantime ensuring their patient and their family have a constant understanding of their disease progression–-so that they can begin to think about things like end-of-life options for care to maximize their quality of life. In this way, the program has reminded me that the idea of fighting death at all costs is not the sole purpose of medicine, as Dr. Sunita Puri discusses.
My hospice work has been an incredible experience that has helped me better see and think about these aforementioned topics. There have been difficult moments, including getting news that a patient I had been seeing for a couple of months had passed away as well as being present in the room when a patient was passing, but our assignments and our reflection meetings have helped me become more comfortable with the idea of embracing death and seeing it as what it is: a natural part in the course of life. Further, while having a patient pass before my eyes was a new experience and a difficult one, I took comfort in knowing that the patient did not die alone, as no one should. During my time volunteering, I have found myself getting a lot of satisfaction and joy in spending time talking with patients and checking in with them to see how they are doing. I am grateful for the opportunity and have already talked with my volunteer coordinator and am planning to continue volunteering with ProMedica next year.