It's time to talk about death. The elephant in the room. The inevitable fate of everything alive on this earth. Someone once said life is a sexually transmitted terminal illness. In today's visit at a palliative care unit, I had the opportunity to explore the edge of the universe, the end of life that everyone feels so uncomfortable talking about. It was beautiful, heavy, and made me look inside myself in ways that I never expected.
From the moment I walked in, I immediately felt this odd sense of calm and peace, and I certainly hoped that the residents on that floor felt the same way. The walls were pastel colors, decorated with art. The staff were jovial and smiley as they bounded through the hallways. As I made my way to the conference room, I could see into the patient rooms that had the doors wide open. I passed by dozens of patients, mostly lying motionless in bed. Some had family members around them, tears streaming down their face. I tried to avert my eyes out of respect, and walked quickly to my destination and sat down.
Our preceptor arrived and began to debrief us on what is palliative care. And to know about palliative care, you need to know what health is. According to the WHO, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. But really, health is subjective; its definition varies from person to person. But from what I can tell, what health means in this context is giving people the opportunity to participate in as many activities that they find meaningful as possible. The goal of palliative care is to really give people the best possible quality of life during their last few moments by minimizing pain/symptoms, and giving people as much autonomy as possible. Non-pharmacological treatments are of utmost importance - you cannot use medication as a substitute for human care. It is really the little things, like having that cup of coffee every morning or spending time with a pet that play a critical role in helping patients die in peace. It is the one time where you really can't sweat the small stuff, because the small stuff is sometimes all you've got.
Fidgeting in my chair like an antsy child waiting for recess, I mustered up the courage to ask a few questions. What made you go into palliative care? I asked unblinkingly, my pen and pad in hand. Our preceptor said it was the honesty that captivated their interest, and the complete acceptance of death unlike in any other specialty in medicine. After my visit today, we learned that there are many positive things about death, namely that it is an opportunity to look back on your life and acknowledge everything you have accomplished. An excuse to resolve fights and salvage relationships with the people closest to you.
A lot of patients, unable to accept their own impending mortality put so much time and energy in trying to prolong life, that they miss out on really good quality time doing the things they love and making amends with the people they love. People who have accepted their fate may take the time they have left to fulfill things on their bucket list like skydiving. Towards the very end, they may have one last party with their loved ones and then die peacefully in the sleep, still with bits of confetti in their hair. Remnants of a life well-lived.
We were told that we were going to have the opportunity to talk with one of the patients dying of cancer. My heart sank. Of course it had to be a cancer patient. And of course the patient was dying of the exact cancer that I am at risk of getting, and have been worrying about the last few weeks. It was time. My hands clenched and clammy, I entered the room and sat down in front of the hospital bed. The patient was propped up in bed, seemingly alert. Their voice was soft, their breathing labored, but full of life nonetheless. We were able to ask a few questions and get a sense of the shell of this person's life. Their sense of humor when answering questions was delightful and really helped calm me down and make me feel at ease. Laughter is the best medicine, even for ailments that one cannot cure. All in all, the patient seemed satisfied, accepting of their condition, and taking it day by day. We asked if there was one piece of advice for us aspiring young doctors, and we received the following: Live your life the way you want. Don't let anyone tell you what you can and can't do. The patient then asked us to turn off the lights and rearrange the room exactly as they wanted it. I couldn't help but smile; never too late to live life the way you want to.
When I got home, put my stuff down, calmly sat down, and burst into tears. Every fiber of my being was accepting that my death was inevitable. The tears of the realization of my mortality came splashing down onto my lap, rhythmically, like the labored breathing of the patient I spoke with earlier. As I sobbed, I felt consumed by loneliness and emptiness. God I hope this isn't how I go, especially not in my early 40s or 50s. One can never really know when and how death is coming. Only that it is coming.
In medical school, not only do we have to come to terms with our own human weakness and the vulnerability of our individual self-discovery, but we must come to terms with our own death, and at a much earlier age than most. Before leaving the unit, I had asked our preceptor what helped them sleep at night and they said accepting that they too will die one day. Being fully accepting of their own mortality. I guess I have a little while to continue grappling with insomnia before I sleep easy. But when I do, boy will I ever sleep.
From the moment I walked in, I immediately felt this odd sense of calm and peace, and I certainly hoped that the residents on that floor felt the same way. The walls were pastel colors, decorated with art. The staff were jovial and smiley as they bounded through the hallways. As I made my way to the conference room, I could see into the patient rooms that had the doors wide open. I passed by dozens of patients, mostly lying motionless in bed. Some had family members around them, tears streaming down their face. I tried to avert my eyes out of respect, and walked quickly to my destination and sat down.
Our preceptor arrived and began to debrief us on what is palliative care. And to know about palliative care, you need to know what health is. According to the WHO, health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. But really, health is subjective; its definition varies from person to person. But from what I can tell, what health means in this context is giving people the opportunity to participate in as many activities that they find meaningful as possible. The goal of palliative care is to really give people the best possible quality of life during their last few moments by minimizing pain/symptoms, and giving people as much autonomy as possible. Non-pharmacological treatments are of utmost importance - you cannot use medication as a substitute for human care. It is really the little things, like having that cup of coffee every morning or spending time with a pet that play a critical role in helping patients die in peace. It is the one time where you really can't sweat the small stuff, because the small stuff is sometimes all you've got.
Fidgeting in my chair like an antsy child waiting for recess, I mustered up the courage to ask a few questions. What made you go into palliative care? I asked unblinkingly, my pen and pad in hand. Our preceptor said it was the honesty that captivated their interest, and the complete acceptance of death unlike in any other specialty in medicine. After my visit today, we learned that there are many positive things about death, namely that it is an opportunity to look back on your life and acknowledge everything you have accomplished. An excuse to resolve fights and salvage relationships with the people closest to you.
A lot of patients, unable to accept their own impending mortality put so much time and energy in trying to prolong life, that they miss out on really good quality time doing the things they love and making amends with the people they love. People who have accepted their fate may take the time they have left to fulfill things on their bucket list like skydiving. Towards the very end, they may have one last party with their loved ones and then die peacefully in the sleep, still with bits of confetti in their hair. Remnants of a life well-lived.
We were told that we were going to have the opportunity to talk with one of the patients dying of cancer. My heart sank. Of course it had to be a cancer patient. And of course the patient was dying of the exact cancer that I am at risk of getting, and have been worrying about the last few weeks. It was time. My hands clenched and clammy, I entered the room and sat down in front of the hospital bed. The patient was propped up in bed, seemingly alert. Their voice was soft, their breathing labored, but full of life nonetheless. We were able to ask a few questions and get a sense of the shell of this person's life. Their sense of humor when answering questions was delightful and really helped calm me down and make me feel at ease. Laughter is the best medicine, even for ailments that one cannot cure. All in all, the patient seemed satisfied, accepting of their condition, and taking it day by day. We asked if there was one piece of advice for us aspiring young doctors, and we received the following: Live your life the way you want. Don't let anyone tell you what you can and can't do. The patient then asked us to turn off the lights and rearrange the room exactly as they wanted it. I couldn't help but smile; never too late to live life the way you want to.
When I got home, put my stuff down, calmly sat down, and burst into tears. Every fiber of my being was accepting that my death was inevitable. The tears of the realization of my mortality came splashing down onto my lap, rhythmically, like the labored breathing of the patient I spoke with earlier. As I sobbed, I felt consumed by loneliness and emptiness. God I hope this isn't how I go, especially not in my early 40s or 50s. One can never really know when and how death is coming. Only that it is coming.
In medical school, not only do we have to come to terms with our own human weakness and the vulnerability of our individual self-discovery, but we must come to terms with our own death, and at a much earlier age than most. Before leaving the unit, I had asked our preceptor what helped them sleep at night and they said accepting that they too will die one day. Being fully accepting of their own mortality. I guess I have a little while to continue grappling with insomnia before I sleep easy. But when I do, boy will I ever sleep.
