by Prachi Thapar, TCOM 2021
It was my surgery rotation. I was still adapting to the rotation life, attempting to appear confident while trying to recall minute details from first year anatomy to impress my attending. As we rounded on patients, my attending informed me that one of our patients had an extremely poor prognosis as surgery was unable to completely resect a tumor. When we approached the patient’s room to break the unfortunate news to her and her family, my heart was pounding, and I clumsily grasped my clammy hands in front of me. Thoughts were racing through my head – how were we going to break the news? Will I be able to keep my cool? What was the right thing to say in this situation? Where did one even start when talking to a patient about dying?
As a child, my first impression of doctors was akin to that of superheroes. I saw them as healers whose profession was dedicated to helping patients lead quality lives against adversity. To my simple mind, I found it astounding as doctors worked with their team to do the impossible from putting broken bones back together or performing delicate surgeries to remove a malignant tumor. The doctors with their team were Avengers donning white coats, always there to help save the day. While I shed my idealistic perspective as I grew older, I continued to hold on to the essence of my initial view of doctors as healers who worked diligently to do everything they could for their patients.
When I began volunteering with a hospice, I realized I had yet to uncover and consider a vital concept in the patient-provider relationship – death. It was an obvious and inevitable experience within the healthcare field, but somehow, I had never given pause to what it meant. In my classroom years of medical school, I was constantly focused on the treatment. The end goal was “what can I do to help this patient get better?” or “how can I get this patient discharged?” But here, I was faced with patients who were terminally ill and had accepted their outcome in life. These patients were not necessarily looking to get better but instead wanted to comfortably live out their remaining days. The care team was doing their utmost to ensure the patient felt no pain and helped empower the patient in the face of death. They worked alongside the patient to ensure their wishes were clearly expressed and would be fulfilled upon their death. As I spent time with the patients, listening to their life stories and dreams, I started to refocus my understanding of medicine and what it meant to be a doctor.
As doctors, it is an unfortunate truth that we cannot save each and every patient. It is a difficult and bitter fact, especially considering the motivation for many of us entering the healthcare field stems from a want to help people. At first, I felt insecure, scared, and anxious when approach the topic. I was afraid I would somehow offend the patient, or they would be angry with me thinking that I had failed them. However, as I watched my surgery attending, I realized talking about death while an unfortunate topic, could be liberating. My attending quietly sat next to our patient, held her hand, and talked with her honestly. He assured her that while we would be doing as much as we could to help her, we wanted her to start considering her end-of-life wishes. The patient turned to my attending with tears in her eyes and told him she was thankful for his honesty. She appreciated that instead of leaving her in the dark to incessantly worry and question her future, his guidance allowed her to maintain her autonomy in death.
As I continue my own journey in medical school, I hope to continue to face my own insecurities regarding the topic of death so I can be a better doctor for my patients. Rather than superheroes who go around fixing and saving everyone, I now see doctors as companions who guide a patient on their journey of healing and empowerment through emotions of joy, relief, and grief… even in death.
Tarrant County Physician Online 