The Present of Presence

Upon joining the Pre-Med Hospice Volunteer Program, I was asked the question: What happens when we die? Profound and spiritual answers flowed from my peers as if they had thought about this question every day. When the spotlight fell on me, I replied, “Nothing.”

My intention was not to be rude, insensitive, or insincere. I truly don’t think anything happens when someone dies; they simply cease to exist. Much in the same way that we cannot remember or feel anything from before we were born, it is the same when we die. The cycle of life starts and begins with nothingness, and I still believe this to be true.

One of my first hospice interactions was unplanned, with a patient I’ll call Mr. M. I was planning on visiting other patients that day when someone approached me and informed me that Mr. M seemed like he really needed a friendly visitor. When I entered the room, Mr. M was very inviting, in spite of the fact that his son had just cancelled his upcoming visit that afternoon. Mr. M suddenly became very talkative, and I tried my best to listen intently. He rattled off all of the illnesses that had landed him first in the hospital, then in hospice care. Then, he stated that he knew that all of these illnesses meant he was going to die, and soon. I was frozen for a few moments, unsure of what to say. This was my first interaction with a patient who was lucid and honest enough to freely converse about his reality, and I didn’t want to say the wrong thing. I must have taken too much time contemplating, because Mr. M abruptly sat up from his bed and told me he had to get going.

I have spent many hours going through what the appropriate response should have been. In my mind, I was thinking about the nothingness I described above, and I let my discomfort get in the way of supporting a patient who needed help. I wasn’t sure if he was even looking for a verbal response at all; maybe he needed a reassuring hug or squeeze of the hand. But I gave him none of those things, which continued to disturb me long after he had left.

It wasn’t until after going through the hospice volunteer program that I realized that it does not matter what I believe happens after death. No one knows for sure what happens when we die, and we do not find out the truth until it happens to us. In that moment, I should have been with Mr. M, in his reality, which included the upcoming certainty of death. I should have been present with him in that moment instead of inside my own thoughts.
The hospice program has taught me to become more selfless, existing in the moment for others rather than just myself. As a doctor, I hope to do the same for my own patients one day. Too often doctors think only of what happens next: the next treatment, the next procedure, the next intervention. How often do they think about the patient’s needs in the present? Death is lonely; one can only experience it in solitude. However, before that moment, we can be present, and we can exist in our patients’ realities as much as they may need us.