Friday, 2 December 2016

Hospice Visit

noun a home providing care for the sick or terminally ill. (1)

hospice care
Care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. (2)

We were seated in a circle and told to stay in the room while waiting for a hospice patient who had kindly agreed to see us. The room was buzzing with everyone's chatters. Someone was definitely asking his/her friend if he/she could quickly run to the pantry to get a cuppa. Gotta love the Brits, it's always tea o'clock for them.

I've never been to hospices before, let alone talk to a hospice patient. So when the consultant told us in the morning briefing earlier that we'll have a half hour 'Goldfish Experience' (basically a session where we get to speak with a hospice patient, which the consultant likened to watching a goldfish in a bowl, from outside the bowl.... I know right.... I didn't get it either), I wasn't quite sure what it entails.

The multiple speech bubbles in the room popped one by one as a lady in a wheelchair was slowly manoeuvred into the room. All eyes on her.

The patient introduced herself - her name, her age, her diagnoses; indirectly telling us that her days are numbered and she was now on a countdown, with the most stoic expression hanging on her face. 

At that moment I felt a pang, like a tightening across of my chest, and a lump in my throat. I quickly averted my head, my pair of eyes on the floor now instead of her blasé pair, as I tried regaining my composure. I held my head up again. Questions fired off, from the consultant and the other students.

"Can you tell us how did you first find out about your condition?".

"How do you feel now, though, talking about this? Are you still upset about it or do you sort of, like, don't really mind the topic now?".

"Do you have any other medical conditions?".

I wanted to cover my ears and tell them to stop. The questions were very loud, too loud, like a staccato of high-pitched noise banging on my eardrums and I couldn't take it. The questions felt like a dozen of darts aimed at the patient, bombarding her, taking her down, but I saw her answering each and one of them instead of flinching and ducking away and taking cover. She was short of breath, but she kept going. She told us that she cried her eyes out when she was first told about her condition and how it was irreversible. She told us that she's alright now whenever this topic is brought up, she's no longer upset about it, but she said this with a monotone that suggested something else. Is it because she's been asked How Are You Feeling for so many times that she's gotten fed up, that she subconsciously felt the need to give an answer that's pleasing to the healthcare professionals? Or maybe the alternative answer was too long, too difficult to word that she feared no one would have the time & genuine concern to listen? Or the fact that the topic of impending death, just like everything else, loses its novelty when recounted over and over again? She listed her other health problems, which sounded like reading the Table Of Contents of a medical textbook.

"Do you think much of the future?" someone asked.

"I don't, no," she said. She took a lungful of air. "I can't,". Another bout of inhalation.

I wanted to run and flee the room, or stand up in elegance and politely excuse myself to the loo, idk, anything to get a change in vantage point of this patient telling us about her final days. My vision of her soon turned glossy and once again, my head dropped. I looked at the carpeted floor. I bit my lower lip in an attempt to suppress the forthcoming tears. 

What do you say to someone who can't afford to think about the future, someone who lives her life by taking it one day at a time? You can't tell them to get better soon, when all they do is they get by.

"Is there anything that you used to do before that you're unable to do now? Something you wish you still can do?".

"Playing with my grandkids and taking them out for football. It's just... Sad that I won't get to see them growing up,".

I felt like my heart was physically crushing. 

A quick survey around the room revealed to me that I was the only one on the verge of an emotional breakdown. Everyone else seemed okay, indifferent. They're either desensitised to the idea of speaking with a dying patient, or they were doing a hell of a good job feigning apathy. 

Or maybe I'm just an overweight luggage of emotions.

In other words, maybe I'm not cut out for this profession.

I know there's a fine line between being too emotionally involved in a patient that it impedes the due medical care and being emotionally detached that you become desensitised to, thus overlook patient's spiritual, emotional, spiritual & psychological needs. I know some days it's harder to strike the balance than other days. Oh, the number of times that I feel incompetent to be in this field... Prolific. One of the reasons I wrote this post is not to dwell on my shortcomings, but to reflect and produce a reasonable framework about why I felt what I felt and how to go about it if the situation presents again in the future, which I'm sure it will. 

Most of the time, writing helps, hence this post. But some situations call for an external intervention, a shoulder to cry on, or a pair of hands to reply my Whatsapp message when I was tearing up during the bus ride home.

I'm glad for Ulfah's existence for a plethora of reasons, one of them is her ability to discern when to laugh at my being a crybaby and when to respond with appropriate sympathy

I hope everyone has an Ulfah in their lives or something/someone they can fall back on when they trip over in life every now and then, a means of escapism. Whatever your coping mechanism, I hope it heals your battle-scarred spirit and restores your faith in yourself.

The second reason I wrote this post is to tell you guys that Medicine has taught me a lot - like how to treat a patient who's come in through emergency with projectile & bloody vomiting, and how to slickly escape ward rounds with impunity -  but that day's lesson was that none of us was promised a Tomorrow; life is temporary and fleeting, death is a sure thing. I may have made a remark of this in a playful manner previously, but that doesn't make it any less true. Man. Death laughs at my folly of forgetting its imminent arrival. Time laughs at my folly of thinking I have 'later' to repent. Reminds me of this scene from Shrek The Third :

And when I say Medicine has taught me, it's easy to picture the teaching as a cocktail of doctors and textbooks and the bank of past exam questions (courtesy of seniors, you guys are the, but really, for me personally, a significant portion of my learning comes from patients. To work up the courage to open up about something so confidential - oftentimes intimate & embarrassing - just for my own learning purposes, must have left them feeling at least a teeny bit vulnerable. They don't owe me anything. They could easily say No and shut me out whenever this annoying medical student comes approaching their hospital beds and asks about why they've come to the hospital, yet they answer my questions anyway. Most of the patients that I spoke to before have actually been eager, like it gives them a sense of altruism to know that they're contributing something into the education of future doctors. And for that, I can't be more grateful.

Giorgio Baglivi said it best when he said, "Let the young know they will never find a more interesting, more instructive book than the patient himself."

Ugh I'm so sorry that this post is all over the place and not well structured. I just.... I needed to let it out and now it's out, but in the form of jumbled up mess, a close representation of how it is in my head. But anyway. Yeah. Happy December everyone! 'tis that time of the year again.

Also, where the heck did the year go?!


  1. Hi Sheerot, I teared up while reading this, don't worry, you are not the only emotional train wreck around, friend!

    When I was thinking about what I wanted to do with my life with a newfound love for science and patient care I really wanted to do medicine after I'd be done with my degree now. But knowing my ridiculously high level of empathy and ridiculously low ability of controlling my emotions I knew I wouldn't be able to do it. So I've decided to apply to several rehabilitation programs like physio and OT, because that way I still get to be a clinician, but with patients who'd already be on the road to recovery inshallah.

    Hahahah sorry for the randomness, but just felt like sharing that with you; I would've totally reacted the same way had I been in your position. You're doing so well, hope everything is good for you and I'm sure that one day inshallah you will find that perfect balance between being able to control your emotions yet not be so insensitive <3

    1. Thanks for sharing this Amal! Good to know my gut reaction to the patient was nothing too out of ordinary and my worry was not unfounded. And wow I think working at rehab programmes is SUCH a fantastic & rewarding vocation. You go Amal!! Wish there's more exposure on this field of work in Malaysia, especially for youngsters like SPM leavers etc.

      And THANK YOU for your kind, kind words! Needed that dose of reassurance :) May Allah bless you with lots of bunnies, Amal!