Working on the inpatient palliative care service, I heard people repeatedly reference “a shift” that had occurred — whether it was during a one-on-one conversation with a patient, a family meeting, or while discussing a patient’s care with her primary provider. I didn’t expect how powerful these shifts could be until I started witnessing them firsthand. I especially didn’t expect to see a shift within myself.
One patient was desperate to survive her illness. She was only in her fifties and was firmly not ready to die. The palliative team sat in that space with her and allowed her to express her feelings of frustration and abandonment from the healthcare system. Her family surrounded her and echoed those emotions. Then, after the team listened to these emotions, validated their anger and their fear, a shift happened. The patient and her family came to terms with the inevitability of death. Although unspoken, they also realized that they were not being abandoned.
Another patient was suffering from liver failure and severe malnutrition. She was curled up in the bed when we walked into the room, her spirit struggling to stay lit amidst the darkness of her pain. Her husband commanded the room. He paced back and forth and refused to take a seat when offered a chair. In a small yellow notebook, he had archived meticulous notes on her medical care. He knew every detail of every appointment and had documented intricate calculations on the energy content of each meal she ate, to ensure that she was getting the appropriate nutrition. He expressed his anger about the lack of progress his wife had made despite trying every medical intervention possible. We listened. We sat as witnesses to her suffering. He sat down. His wife spoke up. “No more.” A shift.
I think the most striking shift was the one that I witnessed within myself. The shift was slow yet remarkable. The shift happened as I heard the palliative care teams open conversations with “can you tell us what is important about you that we can’t read in your chart?” and watched people’s stories unfold. Why was this the first time I had heard this question? The shift happened as I heard people discuss their relationship with God, and instead of shying away, I felt inspired to lean in.
Undoubtedly, palliative care is what patients need when they are facing decisions surrounding chronic illnesses to help them shift their focus from the illness back to themselves. What I have been surprised by is how palliative care is often what we as providers need as well. Looking at our patients through the values-based lens helps us to also shift the focus back to ourselves and remind us why we pursued medicine in the first place.
Erin Drake was born and raised in the Denver area. She is completing her fourth year of medical school and will graduate this spring. She will be going into OB/GYN and would love to find a way to combine her interests in women’s health and palliative care.