Last Thursday, a good classmate and I had the privilege of visiting a patient with metastatic cancer for our mandatory “palliative care experience.” Under the guidance of an attending physician, we explored how the patient coped with her diagnosis and subsequent therapies and probed her plans for the future.
After briefly reading through her chart, we initiated the encounter in the usual manner – introducing ourselves as MS3s, thanking her for her time, and asking how she was feeling. She elaborated on the feelings surrounding her initial diagnosis, the tribulations of chemotherapy and radiation, and why she still has hope for a “miracle cure.”
As my colleague asked most of the questions, I was taken back by the mature defense mechanisms, namely humor and altruism, she utilized in coping with her condition. In retrospect, it’s amazing how a terminal diagnosis can really bring out the hero/heroine in all of us. Analogous to the courageous firefighters of 9/11 or the valiant warriors of civilizations long forgotten, she continued plowing forward in life knowing that death is approaching more quickly for her than most. She noted that it was the prospect of having a grandchild this November which gave her “strength and purpose”, but with an innocent smile, she remarked that the degree of her resolve still won’t “cure” the cancer. 😕 At this point in the interview, I knew (well, at least strongly hoped) that her remaining days would be filled with peace and happiness alongside her family (and Nintendo DS which she loved playing… go figure). 😀
After gathering histories and doing physical exams, I’ve become accustomed to asking my patients about points in their prior admissions where things could have gone better. Perhaps more education about the disease or therapy? Wishing the nurses would pay more attention to her comorbidities? When I presented this question, our patient’s one piece of advice was to “be sincere to your patients… they can always tell when you’re being ingenuine.”
As a medical student, we’re here to learn. We carry a maximum of 4-5 patients at any one time. We don’t have any responsibilities which go unsupervised. Yet in the midst of our clinical responsibilities, we have the opportunity to educate and genuinely comfort our patients often to a degree beyond what the rest of the treatment team can provide. We’re their confidant, their advocate, their cheerleader and messenger. Palliative care is a multidisciplinary approach to alleviating the pain, symptoms, and stress associated with any stage of disease, and as a medical student, we are blessed to have the opportunity to provide comfort in so many ways on a daily basis. If done properly, every encounter can be palliative in some sense. 🙂