In Patience

I am now two days into my internal medicine rotation and I am feeling somewhat unsettled. My surgery rotation, thankfully, taught me more about internal medicine than I'd thought and I arrived yesterday (Monday) spry, excited, and ready to go.

That was, until I met my first patient...

A bit of history: I became interested in Palliative Care about 5 years ago while living in Denver, CO. While doing research at the University of Colorado, I discovered that, on Christmas Eve, 12 patients died at the University Hospital. Now, I realize that people die every day and I'm not such a bleeding heart to deny that death is a natural part of each of us existing on this planet and experiencing life. But, what caught my attention was one glaring detail: Each of these patients had a terminal injury or illness--a car accident, progressive neurological disease, aggressive cancer. And, each of these patients died in their hospital room. In the middle of the night. Alone.

Palliative care is NOT end of life care. It is not hospice, although hospice is part of it. Palliative care doesn't focus on comfort care and end of life issues as much as it focuses on the individual and every aspect of their healing--spiritual, psychological, emotional, and social. Palliative care applies to any individual with an acute or chronic medical condition that doesnt necessarily have to be terminal (ie a young person with liver failure, someone with leukemia, a cancer patient exhausted and unwilling to continue with chemotherapy). It is designed to alleviate a patient's suffering while also acknowledging and enhancing the patient's quality of life.

I greatly appreciate palliative care because it doesn't just focus on the physical part of healing and pain: which we have pain meds for. When we are sick we are suffering, on so many levels that a lab slip will never pick up. I think about those 12 patients dying alone on Christmas eve--one person's family was too far away and he was in a motor vehicle accident and would die within hours, another man was estranged from his family and none of them knew he was hospitalized, yet another patient, simply, had no one.

Soon after this happened, I volunteered at the hospital to help set up a palliative care volunteer system, mostly made up of retired nurses. If a patient was on the floors and was very sick, or terminally ill, or just plain lonely, one of these "volunteers" would be available to sit with him or her, read books, watch movies, talk, cry, essentially be present.  It was a powerful offering and experience for the patients and the volunteers. And it was necessary. One of the best indicators of good health, and healing, is social support and human interaction.

It's kind of amazing that now, years later, I'm here not as a palliative care volunteer in internal medicine, but on the other side, as a consultant, a medical professional in training, a woman in a white coat faced with a plethora of pleading eyes asking me at nearly every turn--How am I? Can I go home? Will I get better? Will you help me? I have very few answers because most of the time I'm scrambling to fulfill lab orders, or follow up on a newly admitted patient, or follow up on a current patient that has just taken a turn for the worse, or--sometimes, but not often enough--get paperwork ready to discharge a patient home because they are on the mend!

But I have limits after all, because internal medicine breaks my heart in a way that nothing else ever has. It breaks my heart with its exquisite suffering...AND its insufferable hope. I vacillate all day between hope for a particular patient and his or her family, and despair. This roller coaster is exhausting, exactly like it is for the patients.

So I try to focus on the medicine, but its difficult with ill people, who are extraordinary and unique in their own right, wishing to impart a life's worth of advice in the few moments I have with them.

Advice from my patients today:

"Listen to the person who is talking to you. If you don't agree, that is okay. We all have an opinion. But don't forget to listen."

"Don't argue. I have never believed in arguing."

"It's true, laughter is the best medicine."

"My parents raised me on nothing but love and kindness."

"I may be sick and dying, but I have several beautiful sons and daughters and am rich beyond measure."

"I hope I get out of here for one more beer. You don't appreciate a good beer until you realize you can't have one whenever you want."

Tomorrow I will sit in on two palliative care consultations--for patients who no longer want to subject their bodies to harsh medical treatments for their conditions. I get that. And I get that they are not giving up by making such a decision. What I don't get is that we live in a society that allows people to die on Christmas Eve, and every day of the year, alone.

I'm going to go grab a beer now, and tell a few people I love them, and listen to the soft patter of the rain and the wind rustling outside. Because I have the time. And because this life is so goddamn amazing.