I am the director of a Family Medicine residency, one who also does Palliative Medicine, as part of my faculty duties, who often has residents or medical students rotating with me.
Most of these residents and medical students are young, some very young, have little understanding of life, let alone the end of life; don’t know what I, at 62, experience daily as the macular degeneration of life itself, the tunnel vision of diminishing opportunities, the starburst of life lit beyond light, of life about to be obliterated; of what patients themselves, faced with life-threatening illnesses, experience as the stick in the spokes of the bicycle of life.
All the more reason for yet more education.
Many states, including Iowa, where I myself practice, now impose End-of-Life CME on physicians. And we here at the residency have been in the vanguard in this respect, in terms of providing that education.
Still, even as Baby Boomers continue to enter the age of such decisions, those Boomers get to meet my residents, some of whom, at 25, at 26, cannot imagine life at Boomer ages, let alone life for even older patients, many of them facing illnesses, chronic to some, imminently fatal to others.
“I am dying, I’m dying of cancer,” a patient tells me, and I, at 62, take that to heart, thinking that there but for grace, that there, in fact, both my parents went, went themselves all too young.
A resident these days is less likely tempered by life, let alone by death; more likely to be at some remove when illness, when death, imminent or not, interrupts life.
How to teach?
How to make the heart know what it so learns best by breaking?
I have no easy answer, even as I, as a residency Program Director, must find that answer, the better to meet new rules that will dictate that residents be able to independently address end-of-life issues.
I can only say so much when residents are with me, don’t always know what to say.
After all, we, in Hospice and Palliative Medicine, are, in effect, guides, each of us Charon, oar in hand, plying the Styx, always transporting souls, never the dead; souls loved, mostly; souls sometimes lost; souls often begging the tide of hope, the rare one kneeing redemption, all of them, their eyes, that catch in the voice, asking only for eyes to meet their eyes, a hand to touch theirs, arms to surround them, this touch, this, at the end, that abiding, that human touch.
In such moments, my mother, dying in her 40s of breast cancer, is the ghost in the room, and sometimes my father, diagnosed with pancreatic cancer, dead four months later. Their fate, my experience, my education.
But, again, how to teach that?
Can that, that urge, that compulsion to recognize the need for touch, even be taught? Can any number of standardized patients in medical school prepare any medical student to, in the end, care, take the place of the wounded heart?