I find myself at a complicated stage in my life where I ponder about what brings meaning to my existence. I spend more than fifty percent of my life working or doing something related to the medical field. Being on the front line during the pandemic and continuing to care for people who are now my age or younger with end-stage illnesses, I question what it will take for me to slow down and appreciate the simpler things that once brought me joy…  before it’s too late. A few weeks ago, my fellow hospitalist said he felt “off” one Saturday morning in our huddle. We all failed to recognize that he was having a heart attack because we were exhausted and busy dividing the extensive patient list. Work took precedence over recognizing what his body was telling him. Another former colleague had a cardiac arrest and died at the airport this week. I am left in shock and sadness. Who are we without our health? The more time I spend contemplating about my own mortality, I notice that I am searching for answers in conversations with my seriously ill patients.

I have been caring for a middle-aged man in the hospital who is diagnosed with end-stage pancreatic cancer. He undergoes chemotherapy that likely is not halting the progression of his disease, is frequently admitted to the hospital for pain, nausea, vomiting and bacteremia. We talk, I treat his symptoms and infection, he feels “better”, he leaves the hospital and like clockwork, I see him again after his next infusion. Every day, I enter his room and he is on his laptop endlessly working. He would tell me how stressed he was about training the next person who will take his job. It sometimes feels like we are all on autopilot.

One morning, I decided to simply sit with him. I had no agenda and no new information to offer, yet I wondered about his life and what matters most. I asked him. “My daughter”, he replied. His fifteen-year-old pride and joy. I learnt that my patient with pancreatic cancer is a divorced middle-aged man who continues to have a friendly relationship with his ex-wife with whom his daughter lives. “I want to leave my job. I want to take my daughter on a road trip along the pacific coast in California for a week. I don’t want to plan anything; I just want to see where the road takes us. Can I hold off on my next chemo? Can you make that happen, doc?”

He values time with his daughter and wants to leave a legacy for her. That’s what matters most; not life prolongation, not his work, his laptop, or what his boss thinks of him. My training starts to creep up and I verbally regurgitate all we can do for him to help with legacy building and getting help from our social worker in providing resources on discussing serious illness and death with his teenage daughter. I start to formulate a plan in my head about how I am going to discuss his wish with his oncologist and then I look up and see him crying. Have I said something to offend him? No. These are tears of relief. I stop talking and trying to fix the problem. I sat back, I was present and entered that dark place with him. The place I find myself thinking about more often these days. I started to cry with him. We formed a trusting relationship in that moment, and I learned more than I had in days.

As a palliative care community specialist and hospitalist, I try to feel with the patients for whom I care.  As I practice this, it brings me back to questioning what matters most to me. Do I do enough of that which brings me joy? What brings me peace when I am having a difficult week? My job is to listen and allow people to come to the realization of what they value and try to align their wishes with what is medically possible and yet, it is difficult to look at my own life and prioritize what matters most. We want to help those who suffer and yet we sometimes cannot recognize our own suffering.