We went to a nursing home today to practice our history and physical exam skills today, and then presented to our preceptor (again, another awesome name: Dr. Pompei). We then went back to several patients to listen and observe some interesting findings–a heart murmur, a gigantically swollen leg, and lastly, a very soft murmur in a patient recovering from a hip replacement.
Sharing the room with the hip replacement patient was an elderly gentleman, dying of cancer. He drew much more attention than the heart murmur. His muscles were wasting away, his face was thin, and only his eyes and head moved around the room, the rest of his body remaning still. I felt intensely uncomfortable, but still wanted to make some sort of effort to try to connect. I was extremely judgmental of everything I said:
* “How are you doing, sir?” (How do you think he’s doing, Graham? He’s dying, you idiot.)
* “Can I get you anything?” (What could you get him? Dr. Pompei just asked him the same thing 2 minutes ago.)
And then a couple minutes of awkward silence before I said goodbye.
I guess I just wanted to fill some sort of loneliness void for him, even if it was just for a couple minutes. But I think that it was a silly assumption a) that I could even accomplish that b) that he even wanted that or c) that a 2 minute conversation could even do that.
My experience is colored by my grandmother’s death in a nursing home when I was thirteen. She died of ALS/Lou Gherig’s Disease, and I can’t help but think how very selfish I was at that age–wanting to play computer games or watch television than be stuck visiting her for an hour. My visit was also colored by the fact that a woman was playing piano by ear at the nursing home, just as my own grandmother used to do.
If a large proportion of medical care is so routine: sore throats, ear infections, colds and flus–maybe we should make room for physicians to take on a higher calling: helping people maximize their number of years of high-quality life, and then helping them to die with dignity, respect, comfort, and peace.