A palpable tension was present in our cab as we drove west. The taxi driver taking us to the retirement home of our patient filled the air with stories of the local prisons and the beauty of this area in the summer time. I am sure that I laughed at his light-hearted anecdotes but all I really could focus on was my heartbeat, its obvious crescendo as we drew kilometer by kilometer closer to our destination. I was feeling anxious. I had read about death, I had talked about death, I had even seen death in an emergency setting but I had never engaged with somebody literally about the inevitably of their own life’s end. I was worried that I might say, feel or do the wrong thing.
When we finally made our way to the patient’s room, I was relieved to see a relatively well looking elderly woman. Relief is a strange feeling to associate with walking into the room of a dying patient. I had never met a palliative patient before and I did not think that this is what it would feel or look like. Perhaps my relief came when I opened the door and did not come face to face with my own perceptions of death and dying.
Mrs. Jones, who was recently diagnosed with pancreatic cancer, struck me as an intelligent, engaged, oriented and well woman. Our conversation continued in a friendly way as we learned about her life, children, grandchildren, great grandchildren, hobbies and medical history. It was a nice conversation but something was missing. I tried to broach the topic of death gently by asking her what her doctors had told her about the natural course of disease and what she would be experiencing in the next couple of months.
Instead of talking about illness or death, Mrs. Jones surprised me by explaining that she would be up walking and feeling better in no time. Again, I felt relief. It seems that she was working to convince us that this recovery would be the case, and in doing so she could also believe that it was true. I pushed no further. I now know Mrs. Jones to be more confused and unwell then I initially thought. This misunderstanding may have stemmed from a mental incapacity or her unwillingness to accept death but it certainly was mitigated by my own relief at seeing a “well” patient when I walked in the door and at her positive attitude about her illness. I wanted her to be fine so I did not engage more deeply when on the surface that appeared to be true. Death never did make it into our conversation.
I imagine that gravitation towards believing and engaging in stories from patients that provide us with relief is a normal instinct but it certainly is not patient-centered, nor particularly helpful. To best support the medical, emotional, social and spiritual needs of a dying person one cannot be pre-occupied with a selfish desire for things to be okay in our own personal frame of reference. Like any patient, dying patients have their own unique frame of reference, perceptions and needs, all of which deserve to be recognized and addressed by the health care team. Though the notion of patient-centered care permeates every aspect of our curriculum I too easily forgot this most basic foundation as I grasped desperately for my own relief in a new situation.
We drove back towards the city with the same cab driver that delivered us. I sat in the front seat somewhat disappointed with my inability to interact on a meaningful level with Mrs. Jones. I listened as conversation in the back seat drifted towards the nature of palliative care, caring for dying patients and death itself. I thought it was beautiful; an experienced professor and curious students engaging on a deep level. I was listening attentively until the driver turned and whispered to me, “I don’t like this conversation.”
I was reminded in that moment that death is not supposed to be a comfortable subject. Perhaps Mrs. Jones efforts to avoid talking about her prognosis and certainly my reaction to seek relief during our interaction stem from the fundamental uneasiness that we all feel about dying. Though I cannot imagine a time when that uneasiness will or should fully subside, I am hopeful that by recognizing and exploring my own reactions I will grow more capable in my efforts to truly care for patients at all stages of life.
I turned back to the taxi driver with a new, shared sense of understanding and asked, “Who is going to bring home the Stanley Cup this season?”
Eve Purdy is a medical student in Canada who blogs at Manu et Corde.
