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Gold Foundation Essay

2011 Humanism in Medicine Essay Contest: First Place: Palliation

Dahl, Nathan

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doi: 10.1097/ACM.0b013e318236dd69
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During the summer months following my first year of medical training, I found myself walking the halls of our city's regional medical center with its palliative care team. I had taken the rotation as part of an elective track, hoping to see firsthand what medical care looked like at the end of life. It was here that I met Lauren Johnson, the nurse practitioner who cochaired the team and served as my mentor during the experience. She was a small woman, unimposing, and yet her cordial affect was such that one could not help but feel a sense of camaraderie and ease after even the smallest of interactions.

Over the course of our weeks together, she introduced me to the life and obligations of a palliative care provider. We rounded on patients throughout the hospital, with ailments ranging from malignancies to heart failure to terminal degenerative diseases. We consulted on new admissions with particularly dire prognoses, and we followed up with previous patients after they had been discharged to home or hospice. She taught me the rationale behind using various opiates in pain management, highlighted the balancing act between pursuing treatment and ensuring quality of life, and discussed the ethical considerations in alleviating suffering. My mind struggled to keep up with a laundry list of painkillers, sedatives, antinausea drugs, and other medications used to bring relief to the terminally ill, but my repertoire as a practitioner grew daily as a result.

What Ms. Johnson impressed upon me, however, was not merely her expertise in juggling medications; it was her uncanny ability to perceive her patients as human beings. She read each chart not as the totality of a patient's existence but as a single chapter in a long and often unexplored tale. She would talk to patients about their homes, their families, what they still wanted to do with their lives and what they were most afraid to leave behind. We would spend 20 minutes with one man on the regrets he had toward his children, an hour with a 90-year-old lady as she told us about her art. She showed me how broad the scope of human suffering could be and how much of a person we could miss buried underneath the tests and lab values. Management of pain or nausea was important, but only inasmuch as it stemmed from addressing the needs of the person in front of you. She stressed that we were treating people, not diseases, and that people required more than medicine. It was a slow understanding for me to come to, a difficult concept to internalize after months where life could be described fully in terms of physiology and biochemistry.

Toward the end of my time with the palliative care team, we saw a gentleman who was admitted for a late-stage lung cancer. His prognosis was poor, and he was experiencing a great deal of pain and agitation. At several points he was delirious and panicked, a combination of the aggressive medications he was on and the metastases of his cancer to his brain. He would claw at his gown and oxygen mask, firing imaginary weapons at enemies long since gone. These episodes were physically and emotionally draining, not only for him but also for the extended family that never left his bedside, their vigilance matched only by their sorrow at seeing him in this state. During one particularly bad bout, our palliative team was paged and arrived to find his wife and daughter crying as his eyes once again darted fearfully around the room. Ms. Johnson went to fetch a sedative, and as I obediently turned to follow, she stopped me. With her voice hushed, she implored me to stay, saying that a mindful presence was what this family needed more than anything.

So I turned back toward the man, now thrashing sporadically against some foe unseen. My white coat belied my utter lack of experience in the hospital setting; my stomach turned to ice as a half-dozen tearful family members looked to me to do something, anything. Slowly recalling what I'd witnessed a dozen times over the past few weeks, I walked over and sat on the edge of his bed, placing my hand reassuringly on his shoulder. With a speed that caught me completely off guard, he grabbed both of my arms and locked his eyes on mine with a frantic gaze, breaking his stare only to blink. His eyes were still fearful, but as I watched, he drew peace from that touch, as though his grip on me served as an anchor through whatever chaos he was fighting. We exchanged words, but what we said I don't remember. The words didn't matter. I held him like that, his eyes latched on mine, until Ms. Johnson returned with the sedative. We laid him down to rest, and Ms. Johnson quietly assured the family that we would do everything in our power to see that he did not suffer further.

That man passed away the following day, and my time with Ms. Johnson, now Lauren to me, ended shortly thereafter. I still remember some of the dosing guidelines for morphine, but it is not what I took away from that rotation. She imparted the human aspect of medicine, the need to bear in mind that patients are more than the sum of their illnesses. I remember clearly that the difference I made for that man had nothing to do with medicine, nothing to do with my labs or data or science; it came from the ability to recognize a patient as a human being and to reach out accordingly. The profound realization that the person on the other side of the chart is just that, a person, is something that cannot be conveyed through a textbook, not really. It is a subtle revelation born only from experience, from humility, and, sometimes, from a walking example of what empathy in medicine can look like.

The Arnold P. Gold Foundation Humanism in Medicine Essay Contest

The Arnold P. Gold Foundation is a not-for-profit organization founded in 1988 to nurture and sustain the time-honored tradition of the compassionate physician. Today, students, residents, and faculty at over 93% of medical schools in the United States and at medical schools abroad participate in at least one Gold Foundation program. These programs and projects are derived from the beliefs that compassion and respect are essential to the practice of medicine and enhance the healing process; the habits of humanistic care can and should be taught; and role-model practitioners who embody humanistic values deserve support and recognition.

The Gold Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to reflect on their experiences in writing. Since the contest's beginning in 1999, the foundation has received close to 2,000 essays from students at more than 125 schools of allopathic and osteopathic medicine.

Contestants for the 2011 Humanism in Medicine Essay Contest were asked to ponder the following quote by author and social change activist Parker Palmer: “‘Good teaching cannot be reduced to technique; good teaching comes from the identity and integrity of the teacher.’ Write about your experience of how a role model taught or influenced the way you practice/intend to practice medicine (use personal experiences or observations where possible).” Winning essays and honorable mentions were selected by a distinguished panel of judges. For the tenth year in a row, Academic Medicine is pleased to publish the winning essays.

These essays can also be found on the Gold Foundation's Web site at www.humanism-in-medicine.org/essaywinners2011. For further information, please call the Arnold P. Gold Foundation at (201) 567-7999 or e-mail: [email protected].

© 2011 Association of American Medical Colleges