Friday, June 03, 2005

The Sweetest Patient

I had the sweetest palliative care patient yesterday. Well, I don't know that I can say that; almost all of my patients are incredibly sweet, particularly the palliative care ones. But this patient touched me very deeply.

We had to use a translator as she didn't speak English. Normally, one might expect a language barrier to create an emotional distance as well. But most definitely not with her.

Most of the day, the patient's daughter and I did fairly well communicating. And every time I went into the room, the patient always flashed me the warmest, most beautiful smile.

At the end of the day, I was preparing the patient for transfer to an in-patient hospice facility.

In case you don't understand the difference between palliative care and hospice, I will try to briefly explain.

Hospital-based palliative care units are generally for short-term care. This may be either in managing a pain crisis for a patient already enrolled in hospice but requiring an intravenous pain infusion. Or this may be for a patient who is transitioning from curative care to palliative care. We can provide both curative and palliative care simultaneously, which hospices don't do. Or patients may be hospitalized when they are imminently dying and then die in our comfort care suites. Some people prefer to die in a hospital or their families may prefer it.

In contrast, hospices do not provide any curative care. They are excellent with symptom management, although not all of them will perform more invasive symptom-management treatments such as continuous infusions or palliative radiation. There are also differences in insurance reimbursement, which I won't go into in detail, as that is not my area of expertise. I would welcome others, especially those who work in hospice to help clarify other differences that I may have missed, as this isn't exactly the focus of this post in terms of the story I am telling.

Anyway, this patient was not imminently dying, was not in pain, and had stopped all curative treatments. So we had no reason to keep her in the hospital any longer, so we discharged her into an in-patient hospice program.

With the help of a translator, I reviewed her paperwork with her and her daughter. Afterwards, I approached the patient to say my goodbyes.

She again flashed me the loveliest smile. But as she continued to smile at me, her eyes started to cast downward. Then her lip trembled and tears flooded her eyes.

She was sitting in a chair. There was nowhere nearby for me to sit, but I wanted to position myself on her level. I did my best by leaning in towards the chair she was sitting in. I put my arm around her, gently rubbing her back and expressing my sympathy with my eyes to the best of my ability.

The translator was still busy with the daughter across the room.

The patient then took my hand, held it in hers and pressed it against her face. I was deeply moved - by her sorrow, her sadness, her warmth and affection.

The translator, by then, had returned. "You touched her," she said with a melancholy smile.

Sometimes I have to remind myself: Death is inevitable. It's going to happen to us all. Medicine can't keep it at bay forever. All I can hope for is to make the journey a little easier, even if only for one day.

Some days, that doesn't feel like enough. I just want to fix it. Yesterday was one of those days.

But I will never forget this patient. What a beautiful woman. I hope the rest of her journey is lighter and brings her peace.

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