by Colin F. Nolan, UNC School of Medicine Class of 2015
My hospice experience came as a timely reminder of why I even got into this business in the first place. I had a feeling that I would probably learn more about the differences between hospice and palliative care. I could have guessed that I would dabble in the tangled intersection of government-funded insurance and end-of-life hardships. I didn’t expect those two days to jog my memory and dust off an experience I had long before I had even signed up to take the MCAT.
My mom has been a hospice nurse for nearly fifteen years. My dad was laid off in the early 2000s and she went back to work to help put four kids through catholic high school while my dad searched for stable employment. At first she cleaned houses, babysat, and did odd jobs, all the while working to renew her nursing license. Upon passing the test, she landed a job on the palliative care unit at a local hospital. She later transitioned to work at a local hospice home. She routinely put in 12-hour shifts, five days a week, taking care of dying patients and their families. I often wondered how she got up in the morning to do that each day.
My latest experience in palliative medicine and hospice (at Hospice & Palliative Care Charlotte Region) called to mind a memory of when I shadowed a physician that worked at the hospice home my mom worked at. At the time I was contemplating whether or not to pursue medical school after graduating from college. Why I felt that shadowing a hospice doc was a good idea I don’t know, but I did it anyway. Admittedly, I probably didn’t know what I was getting myself into. (I knew what my mom’s days were like but she did an exceptional job dealing with the downsides of her line of work on her own. So I really didn’t know.) When I shadowed, I saw first-hand what a dying person looked like. I remember seeing the nurses care not just for the patient, but for the family members too. I will always remember the way the whole hospice team worked to let the patient find peace with dignity, while at the same time tending to inconsolable and sometimes volatile family dynamics, all in the confines of a space that aspired to offer the comfort and tranquility one might experience at home.
I know it takes a special type of person to work in palliative medicine or hospice because my mom is a special type of person.
I have a lot of respect for the work that these special types of people do day in and day out. I think back to the meeting I sat in on within minutes of arriving to Golden LivingCenter, on day one of my hospice experience. (As an aside, it never ceases to amaze me how my white coat, albeit above the knee, allows me — a stranger– unfettered access into the most private and vulnerable moments of people’s lives.) I sat and listened to the son of a very ill woman vent his frustrations with the system to a nurse practitioner. He had quit his job to take care of his mom and help with her transition from hospital to skilled nursing facility, and so forth. He was strapped for cash, and due to loopholes in paperwork, was now being charged for several days of care his mother received at Golden LivingCenter. He had no idea how he was going to afford it. His mother’s care had been left to him to supervise, as his other siblings were either unable or uninterested. The NP was able to reassure him that it would be alright and that the patient was so lucky to have a son like him looking after her. I swallowed hard as the grown man started tearing up, and the NP rubbed his shoulder as she reassured him. Again, I was struck by how caring for the patient is only the beginning of what these people have to handle as part of being a palliative or hospice care specialist.
A patient had expired minutes prior to my arrival to an inpatient hospice unit on day two of my hospice experience. A few hours later, my NP who I was shadowing, pulled me aside and told me what was about to take place. I huddled with her into the patient’s room, lights dimmed, with the rest of the hospice team. In all, there were about twelve or thirteen of us in the room, in addition to the patient’s three family members. The chaplain said a few words about the patient, who was positioned under the covers in her bed, with flowers and a prayer shawl placed neatly on her. The emphasis was on the peaceful passing that she experienced, with her loved ones at her bedside. We bowed our heads in prayer in the flicker of the electronic candles several nurses were holding. I stole a glance at the room. Here were all these people, surrounding three strangers and their dead loved one, only a short time after she had finally passed. It was humbling. It was humbling to be there in that sacred moment—to be considered part of a team, if only as a shadow, with the opportunity to affect the lives of people in that way.
In that moment I saw why all of those special people get up every morning to do what they do. We lifted our heads at the end of the prayer. The family exchanged hugs with the chaplain and the nurses that cared for them and their loved one. The son then cleared his throat and thanked the hospice team up and down for how they took care of his mom in her final days, and how they helped ease what was, of course, a painful process for him and his family.
During a time where the focus is so much on what I plan to do — what I will specialize in, where I will match, when I will get my application together, and who will write my letters of recommendation — it was refreshing to have a few days that so succinctly showed me why, I too, am getting up every morning to do what I do.
Thank you for that.