Cristina Cazorla, a medical student at Universitat de Lleida, Spain, explains what she gained from a clinical placement with a palliative care team.
A close family member recently confessed that he didn’t understand how anyone could devote their professional life to caring for the terminally ill and their families… in effect, palliative medicine. Frankly, I wasn’t surprised by the comment because death is still a social taboo: an awkward, scary and inevitable moment that confronts us all.
I’m a sixth-year medical student and during my month’s clinical placement with a palliative care team I have learnt that this little-known specialty is born from a real need of patients, their families and society in general. The need for someone to be alongside and provide support to improve the last moments of life and to consider the patient as a whole person and not just a disease.
A typical working day in palliative care begins around a table with review and discussion. When you see the team in action the importance of teamwork becomes clear, all of them share their knowledge and experience. Everyone has a specific function, both professionally and personally: Conchita’s insight, the decisiveness of Maite, Montse’s tact, Maria’s dedication, the sense of humour of Jaume, Pilar’s sensitivity, and the spontaneity of Rosa. Treatments and diagnostic tests gain or lose importance only if they provide a clear benefit to the patient’s situation.
I learnt never to forget that patients at the end of life are still able to make decisions and cope with their situation provided they are given enough information. I remember one patient who felt his oncologist had not told him the truth about his condition. I agree, I too would want to be told the truth. And yet, there are professionals who simply aren’t interested in learning how to deliver bad news, to communicate or guide a patient and family at this sensitive time. In my opinion, this is an enormous failure in health care. All doctors, even palliative care doctors, feel queasy when they must inform the family or the patient that nothing more can be done. We should not be afraid of showing our feelings with patients, of letting their experiences hurt us even if they do make us think about our own vulnerability. Being sensitive doesn’t mean being weak, but rather being closer to the patient.
The art of medicine is not just about treatment options, tests and screening – things that are learnt with practice. What is really difficult about being a doctor is how to connect with patients, how to communicate with them taking into account their circumstances and creating confidence based on information. Building a relationship with a patient is a really complicated issue – in the context of palliative care it is essential. Watching the palliative care team was a treat for they are expert communicators. What impressed me most was the team’s ability to listen, to words as well as silences and gestures; to interpret what a patient wants to say (even if he doesn’t say it!); to understand concerns and fears; to help patients to face death without drama; to look at patients without judging; to understand the family’s role and identify resource needs; and to help patients to manage hope and expectations, based on alleviating symptoms on the worst days and enjoying the best days.
And there was also careful attention to detail: spaces in which to inform the family, language that was easy to understand, empathy, respect of a patient’s will, and therefore his freedom; and above all being alongside and letting patients know that they are not alone.
My thanks to all the palliative care team from the Arnau de Vilanova Hospital (Lleida) for giving me the opportunity to learn how you work and for all you have taught me. I felt like a member of your team…see you soon!
More personal stories on the EAPC Blog…
If you have enjoyed this post from Cristina, you may find our ‘Palliative Stories’ series of interest that includes posts from the perspective of patients and family carers.