beautiful day - a reflection on year three

I prayed with a patient and her family today and it was one of the single most gratifying moments I've had throughout all of medical school.  She is a lovely elderly woman whose time is being cut short as she is dying of metastatic pancreatic cancer.  Day by day her health escapes her and she suffers with horrible diarrhea that we have yet to assign a cause to.  We've sent test after test...tests for bacteria and parasites, various imaging studies...you name it, we've ordered it and it's come back negative.  We fear that her symptoms relate to the progression of her cancer and worry that it heralds the need for her medical treatment to stop.  Her family is always by her side, and every day despite her dismal prognosis, she greets the team with the warmest smile she can muster.  Her voice is soft but her spirit is as strong as the 6'4 250 pound man, her husband of 46 years, who sits by her bedside and holds her hands for hours at a time.  I remember the day we showed up for rounds and were greeted doorside by the cutest little ball of black hair you'd ever laid eyes on.  Her husband had brought her beloved poodle, Tasha, in for a visit.  Being quite the little performance artist, Tasha spun around in circles, laid down on the hospital floor, and then jumped up on the bed and drenched her owner in a wealth of kisses.  It was the best I'd seen her look since starting on the service...her pale skin almost as white as her hair, always brushed and styled to perfection and her blue eyes sparkling with the fleeting feeling of being home.  For some reason, it was in that moment that I knew we wouldn't be performing any medical miracles here.  We wouldn't be writing new orders, prescribing fancy medications, or laying our hands on her and magically curing her of the raging disease inside.  We would be praticing a different kind of medicine...one that I've come to realize is every bit if not MORE important than what we've spent years learning in class...one that can't be captured via elaborate PowerPoint presentations or small group sessions...one that I've come to know as the ultimate reason I can think of no job for myself more satisfying than that of physician.

We sat with her family today, her son and husband, and answered questions about hospice and about just how long we thought she had left.  Some things get easier with time....physical exams, taking histories, writing orders....but never this.  Forever a difficult question to answer, we told her honestly that she was probably looking at 6 months to a year and that our main priority now as to keep her comfortable and symptom free.  Our white coats melted away as we talked and it was clear that she had known all along what we were just now telling her.  As we spoke, a member of her spiritual family walked in the room, a brother from her church of Jehovah's Witnesses and he listened intently along with the rest.

When we were done explaining the intricacies of her medical situation and all the questions had been answered....the world stopped for a moment.  We all joined hands and listened as the brother shared a prayer with us.  As her husband wept beside me, I fought to hold back my own tears.  Tears for her time lost, tears for the future of her family and the pain her loss would bring them, tears for the heaviness in my own heart, and tears for the simple beauty of the moment.  I stole a glance at her as we prayed and the peace on her face brought a smile to my own.  Raised in the Christian church - Methodist by trade- I have never been a truly religious person.  As I grow, I struggle with my own conflicts with organized religion.  I see tremendous beauty in many different religious teachings but have never subscribed myself to one in particular.  I find great comfort in the personal belief in something higher and greater than myself - a God if you will - and I believe that this god has a plan for all of us.  Most of all, I believe that we each find God in everyday moments and within ourselves and others.  A good deed done for no particular reason...God is there.  A family gathered in a hospital room comforting an ailing loved one...God is there.  This simple prayer circle...God was definitely there.  I walked out of that room more whole of a person than when I walked in.

Throughout this year, I have been struck by the way that our patients are constantly thanking us for the smallest of things.  I am continuously amazed at the appreciation a simple 5 minute visit can bring.  But in this particular moment, I was met with the overwhelming feeling that it was I who should be saying thank you.  In all honesty, though, "Thank you" doesn't even begin to capture the gratitude I feel for having been a part of that moment in her life's journey.  Words truly fail.  All I can say is that what happened in that room is the best tangible example I can present for why I chose a career in medicine.  I think all any of us can hope for career-wise is to find one that is not only intellectually stimulating but also gives us the daily opportunity to make real and positive impacts on other people's lives.  For me, moments like this one represent a reason to get up and come to work in the morning and a reason to be proud of the work that we do...not just as medical students or physicians...but as human beings.

My patient will go home tomorrow under the care of home hospice.  She will leave this earth before the year is up and her family will try and pick up the pieces that are left when she is gone.  I pray that her transition is completely pain free and that her time is filled with the love and presence of her family, both spiritual and personal, and with lots and lots of kisses from Tasha :)