Light on the Wards

She's the reason I went into medicine. This young, wise palliative care physician, with enlightenment shining from her eyes, who is compassionate and humble and excellent at her job. She is the reason -so that I could be her. Or at least this side of her that I met today in the Montreal General Hospital Palliative Care Unit.

This was probably my best clinical encounter. Because it is calm and peaceful, and there is a seemingness of 'all the time in the world' for the patients, for the doctors to be with their patients, for them to share in a common human experience, to grieve and be existentially reborn, to walk together into very dark places, and if they're lucky, to enjoy just a moment of blinding clarity. But only a moment, most of the time. She said it well, that doctor: "Because how long can you stare at the sun".

And the patient. What a special woman. She also had that light in her eyes -the light of someone who has suffered, who is still struggling, someone with an abundance of joy and fear and love and frustration and hope and despair, all at the same time. She described the cancer that has made itself comfortable in her physical body like a monster lurking inside that she hoped would stay sleeping, so that she can live just a bit longer, so that she can be there for her teenage daughter, who is everything to her and the only thing to her, even amongst supportive friends. And she had been afraid to enter Palliative Care (who wouldn't right?) -but when she did go, she found she was looked after "like a Princess", her pain was addressed as the primary medical concern, and proper pain management is really complex medicine -doctors do not abandon their patients in end-of-life care. In fact, this patient said this doctor was the best doctor she had ever had -a doctor who she felt she could trust, who understood her, who had time for her, who what would she have done without her. They had a bond, that doctor and that patient -a real deep, existential connection that I have never seen before.

The doctor told us that there is a surprising similarity in experiencing the world of Obstetrics and Gynecology and Palliative Care -they were the only times that physicians were granted the privilege of being a part of the very personal, intimate human existential moments that were birth and death, for the sake of birth and death. I get that. I don't know it at all of course, I'm just a first-year medical student. But there's a beautiful synchrony there that I can understand, esoterically, anyway.

And it is beautiful indeed. Not easy though. Not at all. I didn't cry there -I went with the patient on her emotional 'roller-coaster' (excuse the cliche) as she told the story from her diagnosis, to her prognosis, to her multiple events of suffering, surgery, pain, infection -all of which had been debilitating in some way, whether physically, emotionally, psychologically, etc... I heard her talk about how she turned to God to get through those times in her life, one moment I watched her comment hopefully about getting on with life and going home soon, and the next, I felt the lump in my throat and forced back the wet, quivering scene in front of me, as tears flowed from her light grey-green eyes, down her cheeks and neck. No, it does not look at all easy. And yet.

It seems that in a big hospital frenzy of waits and lines, and crazies (the health care workers, not the patients), the impatience, the egos, rushing, rushing, rushing (time pressure indeed!), the place where patients, before they enter, perceive fearfully as death row, is actually where there is calm, there is time, there is cooperation between professionals which is inter- and intra-disciplinary, where the well-being of patients and medical staff are both taken into consideration (which means better doctoring!), where there is space to embark at last on your spiritual, existential journey -where you can, if you choose to, 'conference with the birds' -through valleys and mountains, hells and heavens until you transcend yourself and return home (as in your physical home, to be with your family and friends in your last days), or return directly Home. It doesn't happen that way for everyone, all the time -this is clear. What is also clear though is that people are not just going to Palliative Care to die. The doctors and patients in Palliative Care seem to me really to be living in the truest sense of being alive -intensely with heart, mind, and body. The end-of-life world seems to be a microcosm of life itself, really -it roughs you up pretty bad and you only get the spiritual reward of healing some of the time. But what an honour for a physician to be a part of all of that. Don't you think?