I am extremely grateful that I chose to do the Hospice/Palliative Care rotation. Throughout this month, I have learned much more than I anticipated, and it definitely wasn’t all about medicine. I learned more about families, how crucial the moment of the deliverance of bad news is, how much pain can affect a patient’s experience, and how difficult discussions surrounding death and dying are than I did about specific aspects of medicine.

I was especially struck by how variable the reaction to death is when presented to patients and their families. This tough news reverberates through families in different ways. I have seen how some families are stoic with the news and rise to action by automatically thinking about the quality of life versus quantity of life.  Other families continue to jump towards second opinions and gather records and coping with the news by rising to action in a different way.

Moreover, I learned that most patients and families fall somewhere in between those two sides of the spectrum. For me, particularly on my inpatient hospice week, I was surprised with two separate patients whose families and friends let the patient’s requests go by the wayside. These patient’s families and friends were understandably having trouble saying goodbye.  They were nearly unwilling to just spend time with their loved one, opting instead to work overtime in continuing to look for a solution and being almost disrespectful of their loved one’s choice to die as they wanted. I struggled with witnessing this as I felt for both the family’s suffering and the patient’s suffering and could see how this was playing out in real time.

As well, I have come to understand the essentiality of approaching end-of-life decisions through a goals of care lens. It makes sense to me now that what is important is 1) designating an MDPOA, 2) discussing my wishes with that MDPOA, and 3) stating those wishes in terms of values rather than in terms of specific numbers or stipulations. For me, for example, I can state now that the two aspects of advance care planning that are important to me are that if I can’t continue to do x, y, and z like I did before then it is time to say goodbye.  And that please, for the love of all that is good, don’t fight as a family and instead spend that time and energy with me.

Further, this last comment comes partially from the fact that I have been particularly saddened by the family meetings that center around fighting and distress. On the other hand, I have been particularly joyful when witnessing the family meetings that are patient-centered and filled with both laughter and tears.  I have been grateful to be present for both types of interactions.

Overall, this rotation was highly valuable to me. I feel fortunate to have been in these sacred moments with patients over the past four weeks. I feel that I have a much better understanding of hospice and palliative care and how it can be helpful for patients and anticipate calling on the team for help in my career going forward. Thank you all for being so welcoming and such amazing teachers!

About the Author:  Jessica Smith is an M.D. candidate Class of 2020 University of Colorado School of Medicine