As a community of physicians, I’m sure we have heard the phrase, “I just want to get well, doc,” from our patients. Have you ever wondered what does “get well” really mean to them?
As a third-year internal medicine resident, I had an unforgettable experience during my intensive care unit rotation. He was an elderly patient with HIV, stage 4 colon cancer with metastasis throughout the abdomen, who was being treated for septic shock. He was under my co-resident’s care and was about to be transferred out to the hospital floor after being adequately resuscitated. He had filled out physician orders for life-sustaining treatment form (POLST), stating that would like to be a full code and had vehemently expressed his desire to receive all available treatment for his condition since the beginning of his admission. My co-resident said, “Maybe you should go talk to him before he’s transferred since you’re interested in palliative care.”
With an open mind and heart, I decided to face the fear of uncertainty. I sat next to the patient, introduced myself with my first name, found out about who he was before his diagnosis, aiming to figure out the human being within him.
After a couple of minutes of conversation, he vented saying, “I’m gay, I have HIV, the people who brought me into this world have abandoned me for being gay, and now I have cancer, and it’s everywhere!” I empathized with him and said, “Sir, I’m sorry, and I know this is all too much for you. I’m here to know what your wishes in life are. What will make you happy?” He replied, “I just want to get well soon, you know.”
The words “get well” resonated with me, so I asked, “What does get well really mean to you, sir?” He replied, “I just don’t want to have any more pain, ever. I can’t take this anymore.” I said, “Sir, I want you to know that we are doing everything we can, but I’m afraid there is no definitive cure for this cancer. If you were my relative, I would tell you the same truth. We sure have pain meds for you, and we can make you more comfortable.”
Very distressed, he suddenly reached out to me, saying, “Can you please hold my hand?” I held his hand, and he squeezed it tightly as he told me that he no longer wanted to be “poked with needles or be connected to wires.”
We discussed his goals of care, including what CPR and intubation entail. With a weak voice and tears in his eyes, he said, “I just want to go home, be pain-free and spend time with my partner. He will take care of me and give me my meds.” Slowly, I then introduced to him the concept of home hospice, clearly explained what they do, how they can take away his pain. He agreed and said, “If you can arrange hospice for me at home today, then I want to go home to my partner right now. I don’t want to waste any more time. I don’t care about antibiotics or anything else.” He decided to change his code status to do-not-resuscitate and chose home hospice. A few days later, I heard that he had a comfortable death, with his partner right beside him.
That day, it felt like I “saved” his life from more torture and suffering. I allowed him to have a dignified death next to his loved one, just the way he wanted. His partner and the entire medical team was grateful that we were able to ease his fears and preserve his integrity. I had never felt more satisfied in life and being able to advocate for my patients until the very end, became my real passion.
Sometimes as physicians, we need to embrace death with open arms. We need to remember that it is not the enemy, but a natural and unavoidable process, which can be made into something beautiful. It is time that we put humanity back into medicine, as it is a concerning crisis in our fast-paced, digital age of health care. And it is highly imperative that we take a few minutes from our precious time, to sit down, and carefully understand the end-of-life wishes with all our patients. Let us not change the subject or procrastinate it, just because it is challenging. It could turn out to be the most memorable, honest, and rewarding conversation, that you may have ever had with your patient.
Rosmy Jimmy is an internal medicine resident.
.Image credit: Shutterstock.com
