Washington, D.C., USA
|Our obligation to our patients continues into the sunset of their lives. The sun sets on the cherry blossoms of Washington, D.C. in springtime.
Photographer: Rami Halaseh
“You are on holy ground. Time is sacred, and the veil is thin.” The chaplain left the newly-oriented volunteers with these words as we completed our training. My mind was spinning with the implications of this experience. Each patient we interacted with would have a prognosis of six months to live or less. They were dying. This was hospice, and we were witnesses to these final experiences of being human. How would I ever be equipped for this?
Death is to be avoided and staved off at all costs according to every instinct we have and most of the fears we harbor. We try to trick death into passing us by with exercise regimens and healthy diets, cure-all vitamins and SPF 100 sunscreens. We praise technological advances and medical marvels, sharing internet articles about how Jennifer woke up from her coma after six years in a vegetative state, and how, thanks to modern medicine, Carlos has a new face after being the victim of a chemical explosion. We are fascinated with twists of fate that send us hurtling towards death on a trajectory much faster than the one we were on before; and the heroes who wrench us from the grasp of fate, changing the speed of that trajectory once again as they slam on the brakes.
Physicians jump at the chance to be these heroes, to prove their worth by intervening, sometimes to an extreme, all in the name of thwarting the ultimate “bad outcome.” They throw themselves between their patient and the Reaper in a valiant effort to prolong life for as long as possible. Physicians and patients alike despise death, albeit for different reasons and in different contexts.
Hospice is a very different world from all of this. It is not loud and urgent. It lacks a clear divide between the heroes and the people who need saving. It lacks the solid black line between life and death perceived by most of us when we think about the end of our lives. Death is not the enemy. It is simply an event that will come sooner for some rather than others, not to be fought against, but eased into with compassionate care.
I expected to find an uncomfortably close encounter with death during my time as a hospice volunteer. Instead, I found meaningful relationships with people who were very much alive. Some patients were energetic and talkative, while others were weak but still aware of my presence. It took time to learn how to effectively and appropriately communicate with patients at varying levels of awareness, but I came to learn that my presence and theirs was truly all that was needed for a connection to be made. All of them had something to offer me, and I, them. I learned that the dying are not people so very different from myself, and that death, while daunting, was not the worst thing that I could face.
The nurses and doctors in the facility were watchful, calm, and chiefly invested in the comfort of their patients. They sought to understand the desires of both the patient and the family above all else. Unlike other healthcare settings, death was not the enemy here, but rather pain and strife — and this made all the difference. In my future endeavors, I hope to be a source of knowledge and comfort just as these providers were, privileged to see people at their most vulnerable and walking with them through healing.
My time spent with hospice patients changed my view of life, of death, and what it means to practice compassionate and excellent medicine. Loved ones try to keep up with patients, chasing after them and begging them to return to the life that they were living. Heroes stand firmly in front of them, ordering them to halt in their paths towards death. True compassion, however, lies in the physician who simply walks beside the patient — helpful, but not imposing; skilled, but not proud. Physicians are neither the givers nor takers of life — they are only chaperones slowing the speed or changing the direction of a patient’s trajectory towards death, and therefore, they are ultimately ushers towards a better life.
In my medical career, I do not need to be a hero. But I do need to be a compassionate witness to life, death, and all the blurred lines in between.
GENEVIEVE KUPSKY is a rising second year medical student at The George Washington University in Washington, D.C. After studying Medicine, Health, & Society in college at Vanderbilt University, she discovered an interest in medical humanities; specifically, writing and music. Other interests include violin, health policy, social justice, emergency medicine, bioethics, and end-of-life care.