End-of-Life Care

I’d not often thought of end-of-life care as encompassing all age groups. I’d categorized hospice care as critical in the fields of gerontology or oncology. However, the heart failure specialist’s patients clearly span all stages of life. This realization makes me question why end-of-life care has not been built in as a cornerstone of standard medical education, just as doctoring or patient-doctor communication classes now largely are.

At the least, it’s comforting to know that the number of educational programs in palliative care is on the rise in hospitals. However, to think that the last weeks of many individuals’ lives, largely spent in the hospital according to the article, are largely in the hands of physicians who feel so completely unprepared for end-of-life care, is alarming. This article reminded me of the last ten days my grandfather spent hospitalized, before he passed away last winter. I spent much of the ten days at his side, with other relatives who were taking turns taking care of him day and night. This was the time when so many important conversations took place, last memories formed, and relationships consolidated. I couldn’t help thinking that, were we to weigh my grandfather’s life in terms of times of importance, these last ten days would surely represent a disproportionate portion. I found it ironic and striking that, at such a critical time in my grandfather’s life, the nurse and intern in charge of my grandfather’s unit of the ward were bigger presences than anyone else that could not be present. For example, my grandmother. My grandfather and she were married for sixty years, raised five children, and lived day-to-day with each other until my grandmother passed away seven years ago. I’m sure that the times my grandfather had with her remained alive as a significant portion of my grandfather’s memories during these ten days, but the reality was that my grandfather was interacting with the intern and nurse at a much more intimate, moment-to-moment basis. Two people that he had never even met before this hospitalization. Two strangers who were of the ages of his grandchildren. How ironic, I thought. But on the other hand, how amazing it was that this nurse and intern were playing such a big role in shaping my grandfather’s life! I almost found myself wondering what kind of people would be those to take care of me as I require end-of-life care in the future.

Through this experience, I couldn’t help thinking: what a privilege. What a privilege and huge, huge job it is to be a physician for a patient approaching the end of his or her life. In medical school and residency, we learn so much about how to keep people alive. However, I do hope that I can be better trained to be fully present for those who will remember me as one of their last friends and care-takers.