On laughs and tears (or Hospice and Palliative Medicine: a post-mortem)

About two weeks into this rotation, I had a question burning in the back of my mind. I wondered, of the people that die in this hospital, how many of them do we see?

This question reframed things for me. Everyone knows that people die in the hospital everyday. And everyday on the consult service, I see patients mere days before their death.

But was I seeing all of the dying people? A small percentage? I asked around no one had a good answer. Some hunches, of course, but nothing conclusive.

Eventually, I was pointed to a very interested patient list in the EMR: the deceased discharged patients. A running list of every patient that died in this hospital over the past 4days. Of the 20-25 listed for our hospital, we saw about a quarter of them. The rest? Dead on arrival or dying quickly in the emergency department. I developed an immediate appreciation of the EM physicians and staff, those on the front lines.

With that question answer, I understood more deeply our role on the consult palliative service. When a team sees the end approaching for a patient, they call us. We read through the chart, develop an understanding of their medical conditions, and head into the room to find out who they are and what they want as they die.

And we do a damned good job.

I have deeply enjoyed my time with the Hospice and Palliative Medicine service. I have learned how I act in the face of grief. And I have seen a different way to practice medicine as a team.

I have reveled in the growth over the past four weeks, speaking with patients while they experience the worst days of their lives. The conversations have true stakes. A lack of presence or a misspoken word could add trauma on top of grief.

I haven’t developed all of the skills necessary to conduct these meetings on my own, or maybe just the confidence, but I felt that I added to the encounters as a part of the team. I remember sustaining deep and profound eye contact with a heavily-muscled and grief-stricken son as he weighed the options for his mother.

She had retired from her long career of nursing only this past summer, at the ripe age of 85. He had planned to enjoy her retirement caring for her, sitting with her by the pool and watching the kids play. Instead, he sat in a dark hospital conference room with his mother barely conscious after a massive stroke.

I remember speaking words that didn’t go through my brain, but my heart, as we connected through our eyes. I saw the tears in his eyes and I felt mine welling with emotion. Afterwards, he gave me the handshake into half-hug, which I believe a deep show of affection from him.

And finally, I have truly enjoyed my time with the team. The consult palliative service is an odd bunch of humans. They work well together. They laugh more than any other hospital service I’ve rotated through. A necessary adaptation to the work.

They earnestly care about the emotional well-being of one another. They sit together for lunch every day and talk like a bunch of college students at the dining hall. They reference death and dying casually and without the taboo-filled weirdness of almost every other group of people I’ve met.

As I mentioned above, we talk with these patients on the worst days of their lives, but for us it is Tuesday. And thankfully, they don’t take themselves too seriously but they take their work very seriously. I wish more services in the hospital could feel like they do, but I am glad that the humans having the hardest conversations in the hospital are the ones that feel like this.

I go forward into my residency training with this valuable knowledge: that a group of highly trained medical providers can not only act as a team, but as a family.


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5 thoughts on “On laughs and tears (or Hospice and Palliative Medicine: a post-mortem)

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