Serving as a hospice volunteer this academic year has been a valuable experience in my development as a future healthcare provider. My experience in the program was atypical in many respects, but it raised my awareness of palliative care in ways that I could not have imagined. My experience was partly atypical because I began the program with mortality and death already on the top of my mind, having just lost my beloved grandmother and family dog within a span of less than two months during the summer. Both of these losses rocked my world in a way that I had never experienced before, but witnessing the process of my grandmother’s gradual decline as a hospice patient in the months leading up to her death especially made me feel that I already had a high degree of awareness concerning mortality and palliative care.
Though my sense of comfort in navigating issues surrounding death may have been partially merited, as I switched roles from family member to caregiver in the hospice dynamic, I quickly realized that there was much more to be learned from the other side. The first of these revelations was that my grandmother’s story was quite unusual and potentially misleading. Having seen aggressive treatment and chemotherapy give my grandmother the opportunity to be a great-grandmother and to enjoy four years of quality life following her diagnosis with extensive stage small cell lung cancer, I had a distorted view of the effectiveness of intensive medical intervention. I quickly realized in training and through watching Being Mortal that in the vast majority of cases, aggressive treatment does little to improve quality or duration of life; it often does no more than cause dying patients additional undue suffering in their final days. This insight was valuable as an aspiring physician, as it enabled me to see the potential advantages of having a discussion with a patient and his or her family about an earlier transition to palliative care.
Another lesson that I took away from the program is that each individual and family experiences the process of death differently. I have watched the dying process unfold for three humans in the past year, two of which were within the hospice program. Each person had a different attitude toward death, ranging from my grandmother’s spirited defiance to my first patient’s passive sense of resignation. My second patient fell somewhere in the middle, still possessing a vibrant energy but ultimately at peace with the end. Another atypical aspect of my experience in the program was that both of my patients still had their spouse with them for companionship, meaning that I did not see the same degree of loneliness as my peers who visited patients that were dying alone. However, it was informative to see how the spouses were handling the dying process, particularly how they exhibited the same sense of denial that my grandfather had until the very end with my grandmother’s passing. It was especially saddening to hear from my second patient’s wife about how she wanted to move out of the senior living community and regain their independence once her husband got better, knowing that her wish was highly unlikely to come true. Furthermore, it was eye-opening to observe that despite having a spouse present and living in expensive, up-scale facilities, both of my patients still seemed to be grappling with boredom and loneliness.
Volunteering with hospice has felt like an important stepping stone in my path to becoming a physician. Through the program, I have become more comfortable interacting with unfamiliar people in emotionally sensitive situations, an important skill that can’t be learned from a medical school textbook. Though my current aspiration is for a career in orthopedic or eye surgery, I hope to carry what I have learned about palliative care with me to become a more holistic doctor.