It’s one of the last weeks in December. If it was any other year, I would have realized that Christmas is around the corner, the air would be filled with a different, radiant, joyful kind of energy, and most of us would be focused on all the lessons this year has taught us. Unfortunately, this year is not like any other year. The air feels dense and heavy. You can’t see the pain and fatigue on people’s faces because they’re covered by the masks we wear—but you feel it every time you exchange glances when you walk by. Happiness feels forced. Christmas seems forgettable. Optimism seems fake. We’re tired. Everyone is so tired. In every possible way. I make my rounds in the morning like I always do before the sun is up—too early for any sick patient to be reasonably awake. I meet my 70-something-year-old patient who is here for symptomatic anemia from vaginal bleeding. It is not the first time she has been faced with this problem, and it is certainly not the first time she and I have discussed this very issue. I’m not sure what to say to her. She doesn’t want any formal evaluation. She doesn’t want a higher level of care. She just wants to go home. Many physicians before me have already told her that her bleeding is most likely from malignancy. Even still, her mind isn’t changed. Today, she wants me to meet her husband and talk with both of them about the whole situation and where we go from here. At table rounds, I am told that I need to discuss goals of care with my vaginal bleeding patient. I even need to mention hospice care as the most viable option at this time. Nothing can really prepare you for that kind of conversation. Medical school certainly did not. I’m only 27. I haven’t thought about the ending of life. I barely know how to take care of myself. I’m living off of burnt coffee and crackers I shoved in my mouth this morning. How am I supposed to have this conversation with them? I patch the advice I am given by my attending and upper levels together as I head back upstairs to have this dreaded discussion. I meet her husband at her bedside. He seems much younger than her. Maybe time has been much kinder to him. I open up with open-ended questions. What do you understand about the situation? What thoughts and concerns are running through your mind? I take a seat on the other side of her bed and do what I do the best in this world—listen. They tell me about their marriage. Thirty-eight long, beautiful years that have been full of happiness but also great struggles. Her husband tells me about their financial troubles; they are close to losing their land and house if they can’t make the payments they need to this month. He barely has money to buy the medication he needs to take due to his serious history of heart disease, let alone provide for his wife. They talk about disability, Medicare, Medicaid, and my heart begins to feel so very heavy. We talk about goals of care, with my patient being at the center of the discussion. She again tells me what she wants. No procedures. No specialists. She wants to go home. Her husband has agony etched on his face, but he supports her. She then asks me a question I was woefully unprepared for. “What would you do if you were me?” My ears start burning. My heart rate skyrockets. What would I do? Me? 27-year-old me? Me, who spent all of last night contemplating escaping to Cuba instead of doing whatever I am doing now? I breathe and calm down and tell them both plainly that I haven’t had to think about these decisions for myself. However, I have had endless discussions with my parents about these very same things. I put my mom in her shoes. I tell her how I would feel as her daughter. I tell her that my mom values quality of life over quantity of life, and I would have to support her in whatever decision she makes. I tell her that autonomy, even in such situations, is a powerful thing. This sits well with the both of them. They thank me for my time. Tell me how much I am appreciated. My heart feels warm and fuzzy but also so broken at the same time. I leave them alone together as I make the arrangements I need to. I walked away thinking that I helped my patient make an empowering decision in a destitute situation. The next morning, I make my rounds and see her again. I find her resting flat on her back, staring at the ceiling. I ask her how she is doing. If she could rest any last night. All I get from her is, “I don’t know.” No eye contact. No nothing. She’s different. I try and probe further, but she resists. She now locks eyes with me and tells me bluntly to go away. I feel numb all over. I feel the nurses’ eyes behind me burning into my back. What happened between now and yesterday? She hates me now. The nurses probably think I am a horrible person. A terrible doctor. What have I done? I gently touch her hand and walk out of the room. The last time I will probably ever see her again. I can’t blame her, though. One of the five stages of grief is depression. People push others away as a defense mechanism. They lash out. It’s human nature. I can’t blame her. But for some reason, I blame myself entirely. I’m not one of those people who went into medicine wanting to “cure cancer” or to “save the world” with some heroic measures. I never wore that wool over my eyes. I did, however, want to feel like I could help people. Take away the pain. Abolish some suffering. Medicine, and the practice of it, only goes so far. I know this. Practically, I know this. In my heart, though, I feel like a failure when I cannot fix every broken situation that comes my way—but perhaps, they are never really mine to fix in the first place. Source
