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The Beige Room

Rahman, Arifeen S.

doi: 10.1097/ACM.0000000000002515
Teaching and Learning Moments

A.S. Rahman is a second-year medical student, Stanford University School of Medicine, Stanford, California; e-mail: arifeenr@stanford.edu.

An Academic Medicine Podcast episode featuring this article is available through iTunes, the Apple Podcast app, and SoundCloud.

The tension was so palpable in the room that the air felt denser. Maybe it was just the 12 humans who were crowded into the 10 × 10 dimly lit room. The couches were plush and beige, the unremarkable kind you would find at an upscale orthodontist’s office. They were clustered around a table with a plastic seascape fixture. Only the oddly placed sink suggested that this family meeting room had once been a patient room. It was a good reminder—as physically disorienting as the dim beigeness of the room was, we were nestled in the heart of the hospital wards.

I surveyed the participants of the family meeting that had been called in the Beige Room. Four daughters and sons sat perched on the couches, lines of exhaustion and frustration marking their expressions. Representatives from palliative care, social work, oncology, nursing, and ethics were assembled before them.

Minutes ago, we had been down the hall, crowded around the patient’s bed. I can only imagine how overwhelming it must have been to slip into lucidity and find so many figures, draped in white coats, towering over you. Worn lines and brown ridges on the patient’s too-thin body disappeared under the blankets. That must be what end-stage leukemia looks like, I thought.

“What do you want us to do?” one daughter whispered.

“I want to go home,” the patient responded with a rasp. Tears seeped out of his daughter’s eyes. Minutes later, we were sitting in the Beige Room; a family meeting had been convened.

“You’re not doing anything. You think he’s dying so it doesn’t matter. But he wants this. He wants to keep fighting,” the daughter began. “Also stop telling us that. He knows he’s dying. We know he’s dying. Please stop telling us every time you enter the room.” Thinking the family was in denial, the residents had mentioned this truth repeatedly in the last 48 hours.

“But he said he wants to go home,” the ethics consultant noted.

“Yes, but only because he feels like you have given up on him. He is not getting treated here. So, what’s the point?” another daughter interjected.

“We are physicians,” the eldest daughter stated. “We’ve treated patients like him.” What must it be like to do that as your job, I wondered, then to suddenly become the grieving family of a dying patient?

I watched the oncology fellow as she sat patiently. She must have been an hour late for clinic at that point. Yet, she listened to what everyone was saying.

When she spoke, she voiced words no one else had. “I’m sorry you have felt like that. We all want to do what is best for him. From your perspective, you think the transfusions are helping, but we see no benefit to them and they risk overloading his lungs. We want to make sure his values are respected.”

And suddenly like a squeezed balloon, the anger drained out of the patient’s children. They agreed to consider hospice. Yet, questions lingered, as did disappointment and dissatisfaction, emanating from all parties.

Try as I might, I couldn’t tear my gaze from the seascape fixture on the table, translucent plastic depicting calming waves. I wondered if looking at it gave the family any solace. A better investment would have been earlier, clear communication about the patient’s goals and those of the care team. Yet, it felt to me like no amount of training would fully take away the difficulty of this conversation, the hollow feeling of negotiating the course of the final days of a human life. Maybe that’s why we avoid it. These conversations are messy, imperfect, incomplete. As a future provider, I hope to have the courage to face these inevitable conflicts in values head-on, using the right dose of empathy to understand the perspective of the family when a loved one is dying.

For now, I watched the meeting end. I glanced at the emptied room, before turning off the lights and closing the door.

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Acknowledgment:

The author would like to thank Laurel Braitman for her incredible mentorship, unwavering support, and constant encouragement.

© 2019 by the Association of American Medical Colleges