Rosemary Bailey-Pridham: Palliative Care Lessons BACK

Published by AFAR

The first thing I noticed from the door of the patient’s room was her little feet sticking out from under the covers; I will always remember her sheer will and grace. She was slight; I suspected 5 feet tall in her prime. Even in sickness she put on a strong front and a smile for her family. Following several chemo treatments she wore a wig that never would sit quite straight while laying in that hospital bed. I learned from one of her sons that she was a woman of great faith and later heard about her gratitude when the chaplains prayed with her.

After a family meeting and transition to comfort care, I went with our palliative care nurse to check on the patient and her family. The shades were drawn and she was sleeping, her sons keeping watch. I stood quietly at the foot of her bed, trying to blend into the background so as not to draw any attention during my observations. The patient, who had reportedly never complained in life, was determined not to complain even in her decline. She had been refusing pain medication because “she didn’t want to make it a habit.” Her nurses had been trying to help her understand that she was at no risk for addiction to pain medication at this point.

I have never found the idea of death to be scary and this was not death under sad circumstances. This woman felt that she had lived a full life and found relief in the acceptance of her illness. She was surrounded by her family and they only desired to carry out her wishes in her final days. She had no unfinished business or family disputes, no last minute confessions; she was at peace. She was in pain, but also seemingly equipped with an inner strength that allowed her to bear it with dignity.

She awoke during our visit and her family again inquired about her level of discomfort: wouldn’t she please just take something for the pain? She responded, “I don’t need medicine for this pain. I just need my Lord and he is ready for me to come home.” I was surprised to find myself looking out the window for any distraction that could keep my eyes from tearing up. I scolded myself for thinking of my own mother, 30 years in the future with me at her bedside, and prayed that I would have the strength to carry out her wishes and give her dignity in death the way these sons were doing for their mother. How do you say goodbye to your mother? These thoughts took only a few seconds, but as I turned my gaze from the window back to the patient, I noticed one of her sons looking at me. I was instantly embarrassed; worried that it would seem I was not paying attention to my preceptor and to the patient. That’s when he picked up a box of tissues, walked across the room, and said “How are you doing?” At these few words, I took a tissue and began to cry quietly. He hugged me and I willed myself to regain control, horrified at my inability to keep my emotions tucked away.

Later, our nurse explained that seeing emotion in healthcare providers can in itself be cathartic and healing for those we serve; I was busy berating myself for what I saw as a lack of control. Still, I knew that I had just witnessed a profound moment in my education and career. My thoughts remained with that patient for several days as I continued to ruminate on what made this experience so different from others.

Upon reflection, I continue to be amazed at the absolute peace and faith of that patient in her religion and her God. It took several days for me to realize why I had been so profoundly touched by this patient and her family. A man, so evidently in pain and grief over the illness of his mother, had the incredible compassion to recognize grief in, and to reach out to, a young medical student. I know this will not be the last time that I am moved to tears by a patient; I just hope that the next time I will recognize it as a way to connect with patients and families. I will appreciate that ability to empathize as a gift and not as a weakness. Patients place an incredible amount of trust in physicians and nurses when they allow us to guide them on this final journey; it is an invaluable lesson to learn that sometimes in these moments, patients have the capacity to heal us too.

Rosemary C. Bailey-Pridham
University of Cincinnati College of Medicine
 

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.