27 April 2010


this morning i met a patient. she's 92. she is blind. she reads rolling stone magazine in braille. she loves hip hop music. she's dying.

her next-door-neighbor is a patient who is 85 and loves country music. he has 50+ tattoos, some of which he has given himself. the nurses report he even has a tattoo on his you-know-what, although he certainly didn't give himself THAT one. he is also dying.

down the hall is a 55 yr old who is the primary caregiver for both of his parents who suffer from Alzheimer's dementia. he is angry at the world. he has six weeks to live.

yesterday, i met an 82 yr old patient whose daughter was by her bedside. she was sleeping, but i admired her freshly manicured nails. her daughter had painted them a deep pink, and completed the look by adding some flower decals. the patient died today.


where am i and what am i doing? i'm spending a week on the palliative care units at the VA and university hospitals.

palliative care is the type of care patients can receive when they have a terminal, incurable disease. many of these patients have cancer or other end-stage organ disease, and they attempted curative treatments without cure. many of these patients have multiple disease processes. palliative care focuses on the patient's comfort and symptom relief. dying is a natural process, and the focus is not to prolong it unnecessarily once it is imminent.

it's hard to simplify what i'm doing and seeing, and here's why: death is taboo in American society. we watch "shoot 'em up" movies all the time, but when it comes to someone we know dying, people are incredibly uncomfortable with death.

even in medicine, it is our goal as physicians to "cheat death" or at least prolong its inevitability. we constantly talk of "adding years to our lives" or "preventing mortality." we prescribe treatments to asymptomatic patients to prevent long-term consequences of high blood pressure among other things.

the premise of palliative care, then, where we basically say, "death, you win" has been paradigm-shifting for me. all bets are off. in a patient who has 6 weeks to live, he may eat whatever he chooses. there's happy hour on the palliative care unit. pain medicine is given out liberally. this is not "traditional medicine" as we are taught in medical school, but a hybrid of symptomatology and compassion.

i chose to spend a week on the palliative care unit to see what goes on, but also to sort out my own feelings about death. it's probably natural to be uncomfortable with death, even so, this discomfort undoubtedly stems from the mystery of death. we all fear what we cannot understand. for me, it's been therapeutic to participate in the dying process with these patients. they've taught me much in their few short last days.

in any case, waterproof mascara is recommended. and a box of tissues.