I spent all of my time during the hospice program with one patient, Mrs. M. Some days she was mobile, and we would walk around the nursing home together. We would sit and rest when she needed to, but I was often amazed by how much she could walk. She spent other days laying in bed, unable to move by herself. Her mood changed just as much as her physical abilities. There were multiple visits when she said that she did not want to talk to anyone, and she yelled at me to leave. I would honor her requests on those days and leave after asking her if she wanted me to get anything before I left. Some of my visits with her were great. I remember that the first and last were particularly delightful. She was in bed for both occasions and thought that I was a doctor when I first walked in. Even though I told her I was just there to be a friend and visit, she did not quite understand who I was. We talked about her children and her late husband. She loved telling me stories about her childhood.
I will cherish the memories of the good visits with her, and I am glad for the lessons that I learned from the not-so-nice visits. This program helped me to understand the value of seeing patients as whole people and not just cases. I was not involved in the medical treatment of Mrs. M, so I only saw her as a person. I hope to have the same attitude towards my future patients.
The reflection assignments that accompanied the volunteer hours helped me process what I was learning from my visits with Mrs. M, like when one of Dr. Puri’s coworkers told him, “This is difficult work.” I only spent about an hour a week doing hospice work, but there were days when I dreaded going in because I did not know what mood Mrs. M was going to be in. On her good days, I would not want to leave, but I would have to get back for classes. Aside from the emotions of coming and going, I often would not know how to respond during the visit.
However, Dr. Gawande advised that doctors need to know how to talk to patients about difficult topics. When of the hardest conversations for me was when Mrs. M talked about how badly she wanted to go home. She would ask me when I thought she would be good enough to leave the nursing home. I would respond by just saying that I was not sure, but that she was exactly where she needed to be. It was hard to listen to her longing to go back home when I knew that she was not going to get better, and she was never moving out of the nursing home. I also did not know what the use was in telling her that because it would just make her sad, and with her dementia, she would forget and move on eventually. Instead, I would try to redirect her attention and ask her what it was about home that she missed and then direct the conversation to happy memories of the past. I loved hearing her stories, and I hope that I never lose the appreciation for hearing people’s stories to get a better understanding of who they are.