Why I love my job

[ForamenMagnumPI]

I met with an elderly patient and his wife today in the nursing home. The man has agitation and experiences delusions, some of which are quite vivid and upsetting to the patient, his wife, and the nursing home staff. I was consulted in order to "stop the delusions".
During the course of our conversation, I asked this very confused patient how he feels things are going. He told me that he spends his days shearing sheep on a ranch in Australia. He went on to describe in great detail the shearing process and his daily chores. As he talked, his drawn and anxious face became relaxed and his eyes gleamed. However, with each word he spoke, his wife became visibly more distressed and tears welled in her eyes. She whispered, "It's not true. I never argue with him, but none of it is true. He's never even been to Australia. He has never sheared a sheep in his life".
I steered the conversation to his diagnosis and the toll it has taken on his wife and family. After a time, I asked the patient, "What brings you comfort? What keeps you going?"
His response:
"Some nights, I lie on the cold ground after a long day on the ranch, and I look up at the stars in the sky. I think that I would like to go to sleep and never wake up. But then...then I hold a little lamb - a baby sheep - in my arms and I feel its warmth and I know I have to keep going, just so I can take care of it."
After a few moments of silence, I said, "You keep going then...for your children. Those baby sheep are like your children". And this man who had forgotten every aspect of his former life except for his name looked me right in the eyes and nodded. And then he smiled.
His wife began crying in earnest then, and she told me that she has learned more about her husband's illness in our twenty minutes together than she had in the past two years of going from specialist to specialist.
Just so you know, I hated medical school. I wanted to quit every day. I used to think, "If this is what being a doctor is going to be like, I don't want any part of it". I have since learned that being a good physician has very little to do with USMLE scores, the ability to memorize lab values in order to impress attending physicians on morning rounds, or the unique honor of securing a coveted residency/fellowship/faculty position. Those things are nice, but, in my mind, being a good physician has everything to do with being willing and able to sit and be truly present with patients and families during pivotal life transitions. Sure, we try to put out fires. But, if we can't put out the fire, a good physician takes the patient's hand and walks with him through the flames.
So that's why I love being a hospice and palliative medicine physician. How about you? What is your story?

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[C5toC9]

Great story

 

[PharmaTope]

i envy your position!

 

[Apollyon]

I moved from the east coast of the US to Hawai'i, and am an EM-trained doc. I work with a group that covers two hospitals - one "busy" (by Hawai'ian metrics), and the other (where I am now) is much less busy, but, when people come in, they are sick. The good thing, though, is that I get to talk with the patients. I like to talk - and, moreso, the patients talk to me. I've always relished the opportunity to cross the gulf of cultural disparity, and show patients that, even though I may not look like you, and, when I talk, we do not sound the same, my heart is there, and it's there for you. The guy I had tonight is native Hawai'ian, and a genuine nice guy. I find out his son is quite a big-name entertainer here. But, to me, he's just "Mr. Aloha". He trusts me, and that lets us find a much richer environment within which we can seek the answers.

It's really true - "no matter where you go...there you are!"

 

[namethatsmell]

thank you for sharing that--just awesome

 

[Abby Normal]

It's stories like these that keep me going though my last year of residency (psych) and looking forward to fellowship in a few years, once I get my family reared and off to college.

I would also like to do psychotherapy with those who wish to say the hard things they feel is necessary before dying as it is a last opportunity to do so.

I also LOVE working on an interdisciplinary team and spending more time with patients. To my knowledge, this is the only area of medicine where this is THE model from the ground up. There's no issue of needing to reform delivery of care and pay more attention to the patient as a whole person.

What's not to love about this kind of work?

 

[jsaul]

I met with an elderly patient and his wife today in the nursing home. The man has agitation and experiences delusions, some of which are quite vivid and upsetting to the patient, his wife, and the nursing home staff. I was consulted in order to "stop the delusions".
During the course of our conversation, I asked this very confused patient how he feels things are going. He told me that he spends his days shearing sheep on a ranch in Australia. He went on to describe in great detail the shearing process and his daily chores. As he talked, his drawn and anxious face became relaxed and his eyes gleamed. However, with each word he spoke, his wife became visibly more distressed and tears welled in her eyes. She whispered, "It's not true. I never argue with him, but none of it is true. He's never even been to Australia. He has never sheared a sheep in his life".
I steered the conversation to his diagnosis and the toll it has taken on his wife and family. After a time, I asked the patient, "What brings you comfort? What keeps you going?"
His response:
"Some nights, I lie on the cold ground after a long day on the ranch, and I look up at the stars in the sky. I think that I would like to go to sleep and never wake up. But then...then I hold a little lamb - a baby sheep - in my arms and I feel its warmth and I know I have to keep going, just so I can take care of it."
After a few moments of silence, I said, "You keep going then...for your children. Those baby sheep are like your children". And this man who had forgotten every aspect of his former life except for his name looked me right in the eyes and nodded. And then he smiled.
His wife began crying in earnest then, and she told me that she has learned more about her husband's illness in our twenty minutes together than she had in the past two years of going from specialist to specialist.
Just so you know, I hated medical school. I wanted to quit every day. I used to think, "If this is what being a doctor is going to be like, I don't want any part of it". I have since learned that being a good physician has very little to do with USMLE scores, the ability to memorize lab values in order to impress attending physicians on morning rounds, or the unique honor of securing a coveted residency/fellowship/faculty position. Those things are nice, but, in my mind, being a good physician has everything to do with being willing and able to sit and be truly present with patients and families during pivotal life transitions. Sure, we try to put out fires. But, if we can't put out the fire, a good physician takes the patient's hand and walks with him through the flames.
So that's why I love being a hospice and palliative medicine physician. How about you? What is your story?

I wish more young doctors think like you

 

[sunlioness]

This is an awesome thread. Palliative/Hospice was my favorite elective as a fourth year medical student and then again as an intern in internal medicine. I ended up not much caring for internal medicine and switched to psychiatry after my internship and kind of forgot about palliative medicine. Then one of my close friend's nephews had terminal rhabdomyosarcoma and her family's experience with hospice reminded me of how much I really did love this kind of work. I thought I probably couldn't get there from psych, but then I had the thought to look it up and apparently I can. I am starting a new job as an inpatient psychiatry attending soon and will be doing that for the foreseeable future. I need to pay down my loans and at least start some sort of retirement planning. But I am going to keep this in the back of my head and if the urge doesn't go away, I very well may start looking into fellowships.

Thanks for sharing your stories.

 

[Ragman]

Well I guess I'm the black sheep in this discussion, then, because I don't want to go to medical school just so I can hold some old couples' hands. They have touchy-feely people who can't cut it in medical school for that stuff.

 

[abwal314]

Great post. ...so did you try to treat the hallucinations or leave the patient in his blissfull state -- i mean, he seems pretty content as he is ?

 

[Isoprop]

Sure, we try to put out fires. But, if we can't put out the fire, a good physician takes the patient's hand and walks with him through the flames.

This is the best quote I've heard on SDN.

 

[mjl1717]

This is the best quote I've heard on SDN.

Agree!

 

[brimcmike]

I was on home-call one weekend, and one of the patients on the service had been diagnosed with a fatal neurodegenerative disorder a few months earlier. He had come in for evaluation and training for adaptive equipment, in anticipation of his decline into end-stage disease. The plan was for him to go home Monday morning.

He had been ambulating upon admission, but over the course of the week he had precipitously worsened, becoming bed- and wheelchair-bound. Now on Sunday, he was becoming short of breath and beginning to have difficulty speaking. I was called in to address this unanticipated deterioration. He was DNR/DNI. His wife was in the room.

I introduced myself and quickly established rapport with the patient and his wife. I clarified with them that the medical decision-point about respiratory support was arriving earlier than anyone had expected. We revisited the common interventions pursued in the end-stage of this neurodegenerative disorder. I described the course he would eventually take without invasive intervention, i.e., increasing drowsiness progressing to coma and death. They were both clear and calm, though deeply saddened. In the end, the patient remained committed to his earlier end-of-life decisions, with his wife in support.

We went over options for symptom control, and the risk of double effect. The both expressed understanding and agreement. We then implemented a rapid change in the goals of his care. Perhaps most importantly for this patient and his family, I was able to affirm, while he was still himself, that the time was now to have any conversations he wanted to have before he died. We quickly mobilized support and services, including a transfer to a private room, as well as an urgent visit from his clergy, and gathered family and friends for mutual support and communication, while this dwindling option lasted. The patient was deeply grateful for the respect of his wishes and for the attention to detail was given as we started down this new, inexorable path. Nursing was on-board and very satisfied with the careful plan. As I rounded on him again for the last time that night, the room was full of family and friends who warmly and gently greeted me. The patient and his wife were obviously exhausted, but contented.

The patient made it to discharge home with hospice the next day. He died the following day, peacefully at home, with his wife present, as he had wished. I also followed up with the patient's wife in bereavement; she to was deeply grateful for the care her husband received and for the support she had been getting.

This experience is my most deeply gratifying as a physician to date, and has become an assuring touchstone for me that the culmination of my vocation to medicine lies within hospice & palliative medicine.

 

[Dral]

Well I guess I'm the black sheep in this discussion, then, because I don't want to go to medical school just so I can hold some old couples' hands. They have touchy-feely people who can't cut it in medical school for that stuff.

Right, but remember that when a family is in a palliation session and ask 'What really is a rhabdosarcoma?', one is ready to explain. Plus, palliative medicine is a lot more than just hand holding.

 

[loveoforganic]

Foramen and mike - thank you both for your posts. Palliative care is a big interest of mine, though I'm still quite early in the game.

 

[Iapyx]

I met with an elderly patient and his wife today in the nursing home. The man has agitation and experiences delusions, some of which are quite vivid and upsetting to the patient, his wife, and the nursing home staff. I was consulted in order to "stop the delusions".
During the course of our conversation, I asked this very confused patient how he feels things are going. He told me that he spends his days shearing sheep on a ranch in Australia. He went on to describe in great detail the shearing process and his daily chores. As he talked, his drawn and anxious face became relaxed and his eyes gleamed. However, with each word he spoke, his wife became visibly more distressed and tears welled in her eyes. She whispered, "It's not true. I never argue with him, but none of it is true. He's never even been to Australia. He has never sheared a sheep in his life".
I steered the conversation to his diagnosis and the toll it has taken on his wife and family. After a time, I asked the patient, "What brings you comfort? What keeps you going?"
His response:
"Some nights, I lie on the cold ground after a long day on the ranch, and I look up at the stars in the sky. I think that I would like to go to sleep and never wake up. But then...then I hold a little lamb - a baby sheep - in my arms and I feel its warmth and I know I have to keep going, just so I can take care of it."
After a few moments of silence, I said, "You keep going then...for your children. Those baby sheep are like your children". And this man who had forgotten every aspect of his former life except for his name looked me right in the eyes and nodded. And then he smiled.
His wife began crying in earnest then, and she told me that she has learned more about her husband's illness in our twenty minutes together than she had in the past two years of going from specialist to specialist.
Just so you know, I hated medical school. I wanted to quit every day. I used to think, "If this is what being a doctor is going to be like, I don't want any part of it". I have since learned that being a good physician has very little to do with USMLE scores, the ability to memorize lab values in order to impress attending physicians on morning rounds, or the unique honor of securing a coveted residency/fellowship/faculty position. Those things are nice, but, in my mind, being a good physician has everything to do with being willing and able to sit and be truly present with patients and families during pivotal life transitions. Sure, we try to put out fires. But, if we can't put out the fire, a good physician takes the patient's hand and walks with him through the flames.
So that's why I love being a hospice and palliative medicine physician. How about you? What is your story?

Thank you for the fantastic post. This is why I want to go into medicine.

 

[rmbsstock]

brimcmike
Wow, what a great honor to be able to do this kind of work.
Help me Live 20 things people with cancer want you to know.
Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying by Maggie Callanan and Patricia Kelley
How We Die: Reflections of Life's Final Chapter, New Edition by Sherwin B. Nuland.
Grieving the Death of a Mother by Harold Ivan Smith.
And many other books I have been reading lately on Death and dying. I work in the mental health field and since my Dad died, big part of my heart died with him. Therefore, I stayed away from hospice and this subject. Then, my friend a 41 year old, English teacher, mother of three children has terminal cancer. We meet every Wednesday for lunch, I try to make her happy, and I try not to mention this damn cancer thing. I love to see her laugh, and I try to make her laugh as much as I can, especially, when she shows me how she is hiding the bald areas with her thinning hair. We laugh when I tease her about her tricks trying to sneak some sweets and regular food she is not allowed to eat. However, I always think if I am going to be close to her bed in her last hours? I want to be there to make her transition emotionally easier for her and her husband and children. And I wonder sometimes if she travels to a farther place towards the end where the hospital is better equiped for cancer patient, I might not be able to be there for her. I wish a doctor like you or like ForamenMagnumPI will be there for her. :cry:
You are GREAT Doctors for choosing to work with this population.

 

[Isoprop]

I just wanted to say that whenever I feel burned out from my M1 studies, I re-read this thread. It gives me hope that there's light at the end of the tunnel. I may not end up going into hospice, but it still gives me perspective on why I decided to go into med school in the first place. So thanks.

 

[Jack is Back]

...

Although I don't have interest in this field, great story and glad you are happy.

 

[nitemagi]

Great story. Reminds me of training I had prior to med school at The Zen Hospice Project in San Francisco. Challenging the notion that in medicine we don't always have to "fix" something, or become apathetic, but can sit with them during suffering without getting overwhelmed by it or shoving it away.

 

[Will2Survive]

i totally love ur story. omg. i almost cried. thanks for sharing.

 

[DrDrToBe]

Awesome story! I am on my sub-i and just finished a grueling week. I needed that pick me up reminder of why I am in medical school; it's great to see an attending still maintaining and willing to share that perspective.

 

[Dusn]

The biggest problem preventing me from enjoying medicine, I think, is the number of patients that we have to see in such a short amount of time. There's no time to have these discussions with each patient. I consider myself lucky if I have the time to have a short chat with a single patient. The days can often consist of 110+ patients split between 2 fellows and a single attending. The biggest complaint from patients is how long they've had to wait to be seen (usually several hours).
Granted, up until this point I have been in training and have had no control over the number of patients scheduled by the hospital for me. But I don't see any trends toward improvement in this matter. In fact I worry that, the way healthcare is going, the pressure in the future will be to see even more patients per day.

 

[Cellfie]

I just read this and I LOVE it! Thank you ForamenMagnumPI!

 

[notinkansas]

Well I guess I'm the black sheep in this discussion, then, because I don't want to go to medical school just so I can hold some old couples' hands. They have touchy-feely people who can't cut it in medical school for that stuff.

Another "black sheep" here, I guess. What is described here would make me want to gouge my eyes out it that is what my day is like. I LOVED medical school and the intellectual challenge of it. I HATE having to listen to people ramble. In residency, I couldn't stand it when I'd go into a room on evening rounds and it would be packed with every distant relative and church choir member and the patient would want to introduce me to everybody. Gak. I just wanted to make sure everybody on my service was OK, that all ordered tests were done and go home to my life, already. Every rambling conversation, every question answered with "Well, 20 years ago...", every additional body in the room was an obstacle between me and my own life. I'll be polite but I don't like this touchy- feely stuff either.

 

[deleted92121]

Well I guess I'm the black sheep in this discussion, then, because I don't want to go to medical school just so I can hold some old couples' hands. They have touchy-feely people who can't cut it in medical school for that stuff.

And there are a lot of people who could and did cut it in medical school and still want to hold the hands of their patients.

I don't think either way is right or wrong. Different strokes for different folks. Not everyone has the desire or personality to be touchy-feely. Doesn't make them bad physicians and being cuddly, soft, and warm doesn't make you a good physician.

 

[Doc Martins]

To the OP, what a beautiful story. Hope you're still loving your job each and every day. I'll be pursuing a Palliative fellowship myself.