Reflections on my Hospice rotation

Excerpt from the paper I submitted for my rotation at the Supportive, Hospice, and Palliative Medicine of the Department of Family and Community Medicine, University of the Philippines - Philippine General Hospital.



I READ Elizabeth Kubler-Ross' book, On Death and Dying, two summers ago. The stages of grief that Dr. Kubler-Ross proposed took on a new light as I read about patients in denial, anger, bargaining, depression, and acceptance. The images on my head of people suffering and dying and of the doctors telling them they don't have too long to live were distant, impersonal vignettes. At the time my hospital exposure was limited to short interview sessions with patients assigned to me, so I didn't know what the situation really was at the Philippine General Hospital. I was both inspired and challenged, of course. Taking care of the dying seemed like the sort of thing great doctors did well. I wanted to be a compassionate doctor, and, idealistic as this may sound, to be the best doctor that I could be.

Now that clerkship is about to end—how fast time flies!—the experiences that Dr. Kubler-Ross described in her book have taken on a new meaning. In a sense, I'm a different man from who I was last year. Seeing so much grief, pain, and poverty does something to people, I guess.

These past months I've seen patients die, some of them my very own. My first death wasn't easy for me. It happened at the Neurology Ward: a patient who had a bad case of pneumonia on top of a stroke. He was quite a fighter. I thought he could be weaned off the ventilator, but he eventually succumbed to infection. In the succeeding days, three of my patients eventually died too. In all cases I went home downcast, wondering why people suffered at all, asking God why He allows suffering in this world.

At the Medical Intensive Care Unit, I remember one patient with a severe case of leptospirosis. He wanted nobody else to do his blood work but me. Before he died of pulmonary complications he wrote me a note, “Paano na lang kung wala ka, Dok?” I had grown rather fond of him. I went home grieving, overcome by sadness.

I thought I'd get used to the idea of death, in the same way one eventually gets used to a new pair of shoes. There are days when I treat death casually. Calling and initiating a code becomes routine. Telling patients that they don't have too long to live becomes a scripted exercise, like praying from a booklet of formulas. But I'm relieved I haven't gone past caring—at least, not yet. There is always that danger, of course. The transformation from a compassionate physician to a mechanical, almost robotic health worker can happen anytime. In a way the system is to be blamed. Being on 24-hour duty shifts makes one grouchy, unable to perform optimally, let alone treat others like human beings. There is also the frustration of talking to patients who can't even afford to pay for the most basic of labs. It's a clash between what's real and what's ideal.

So I'm glad that I had my rotation at the Supportive, Hospice, and Palliative Medicine. At first I thought it was going to be depressing. My patients wouldn't live long. Not much could be done about them. That may be right—it was a stressful, depressing environment—but I was reminded to be compassionate, especially to the sick and dying.