How should The Good Doctor respond when medical care can offer no cure? How does The Good Doctor deal with death and dying? First-year students at the UCF College of Medicine came face to face with those questions as they worked recently with hospice care providers and terminally ill patients.
Their lessons included how teamwork among healthcare providers can ease the patient’s burden, dealing with family dynamics and how to understand the healer’s role in accepting that treatment must end.
“As a medical student, my training is all about: take control, find out what’s going on, fix the problem,” said Sean Chagani. “But hospice takes that control away from the doctor and gives it to the patient. Hospice empowers the patient to make choices about death. I didn’t realize that before.”
Students worked with nurses, social workers and chaplains from two local hospice organizations – Vitas and Cornerstone. They worked in two-person teams to see the psychosocial issues related end-of-life care. On March 6, Dr. Gary Miller from VITAS and Dr. Lucy Ertenberg from Cornerstone held a reflections dinner at the College of Medicine for students to share their feelings about the experience. Dr. Miller, who paid for the dinner, said he hoped visiting with hospice patients provided students with an understanding of how teamwork can bring comfort to terminal patients and their families.
Lisa Brubaker talked about the fact that the morning after each hospice home visit, the doctor, nurse and social worker all meet to discuss patient’s and family’s condition and to come up with a joint plan for moving forward. “Seeing how the team worked together made me reflect on how I hope I am part of a great team that will work for the good of the patient,” she said.
Student Sami Saikaly said he saw how faith helped several of the hospice patients he visited cope with the physical and emotional pain of dying. “I know God’s taking care of me and that makes the pain bearable,” one of Saikaly’s patients said. The medical student, who considers himself “pretty religious” said he hopes that as a physician he won’t forget about faith to “help people physically, emotionally and spiritually as well.”
Communication was another common theme of the student reflections. One patient reassured a student it was OK to talk about death, that he didn’t have to treat it as a taboo subject. Students were surprised to find patients upbeat – and even joking. Several students said their patients seemed happy and relieved to talk about subjects relating to “real life.”
Megan Mizera said her patient had not said a word until the social worker left her bedroom. Mizera noticed the patient was drinking coffee. “I asked her, ‘Do you like coffee?’ I love coffee, I’m addicted to it and we started talking about hazelnut and vanilla crème and we were laughing. I was talking to her about life. She didn’t want to talk about dying. I remembered what a mentor, a retired psychiatrist said to me, that to sit down and really talk to a patient is always meaningful. ”
Family dynamics were another key lesson for the students. One patient had four generations of family surrounding him in his final days. Other families couldn’t bear to see their loved one dying and stayed away. A patient worried about who would care for her disabled child when she were gone. A 60-year-old daughter, with serious health issues of her own, was caring for her elderly mother and worrying that she wasn’t able to do enough. A member of the hospice team told her, “I understand you want to control this, but this is out of your control. But you can be there, be her daughter. That is the comfort she needs.”
Medical student Austin Moats witnessed that talk and reflected on it at the hospice event. “It taught me that it only takes a second to ask family how they’re doing,” he said. “And a few words in this situation seemed to go a very long way.”