Last week, I spent a few hours in a palliative care unit.
As medical students, we’re fixated on the living. What drug can cure that symptom. How surgery can remove the cancer. Where we can find a bed so that the patient with diabetes can have her complications managed.
Rationally, we know that everyone dies. We dissect cadavers in our anatomy classes. We read about fatal diseases in our textbooks and see pictures of brain tumours and mangled hearts cut open.
But still, we believe we can save everyone.
The last patient we saw was a little old lady, pictures of her family on a pinboard next to her bed, fresh flowers on her bedside table. A blanket was drawn to her chin, and she smiled at everyone in the room, desperate for some recognition of her existence. I don’t know how much she knew about her prognosis; I doubt she knew what the doctors thought yet.
To me, she looked well. To me, she didn’t look like a woman predicted to die within a fortnight.
I couldn’t look many of these patients in the eye as I walked through the wards, all I could say was a muttered thank you as I left one patient to attend to the next. I didn’t know what to say. I’m lucky. I haven’t experienced much death in my life. I’m yet to see a patient die or a patient code. I know these to be inevitabilities, but I still look at each patient with hope.
Perhaps the hope to live isn’t universal. Perhaps, for those for whom death is imminent, the hope to live is replaced by the hope to die peacefully, in a way that is the least confronting and the least horrifying for their loved ones. Perhaps they want to stay as calm as possible, as coherent as possible, and without the pain that has plagued them for their entire illness.
Perhaps medicine isn’t about operations and pharmaceuticals. Maybe it’s just about helping patients and their bodies survive, and die, in peace.
Tagged as: palliative care. med school. med students. placement. death. musings. med life. medical school.
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