I applied to the palliative care ICM group as a first-year medical student with a personal motive. My grandfather had been paralyzed by a stroke and bedridden for a few years, and I wanted to learn how to speak with people like him, as they were approaching their deaths. I suppose I was also curious to find out how I would handle and understand another person’s death. So, at the beginning of the year, I was introduced to Marie, a patient on hospice care with a complicated medical history that included epilepsy, mental retardation, HIV and renal failure.** Marie had no friends or family to aid in her care. And while I tried, as an eager First Year, to wrap my mind around understanding and solving – or at least improving – her medical and social problems, I soon realized that my role in our relationship was to take a different path.
I met her for the first time about a week into the semester, when we went to her hospice facility. We sat down at the dining room table to talk. She stuttered badly and it was extremely difficult for me to understand what she was saying at first. I found myself waiting, often for awkwardly long periods, while she would pause. When I gave her the chance, she always started talking again
As I continued to visit her every 2-3 weeks, our communication had a lot of ups and downs, cycling with the complications of her disease and the side effects of her many medications. Sometimes she said more, sometimes she said less. Sometimes we didn’t speak for an entire visit. Initially, I’d arrive with an agenda of what I wanted to ask her, but eventually I learned to wait for her to speak and guide the conversation.
Although I don’t think Marie ever learned my name, she would light up when I visited and stop whatever she was doing in order to talk to me. She would describe her seizures to me in her own words. She told me about her parents and her childhood. She shared her understanding of death: when people die, she explained, they get to see their parents again. I could tell it eased her mind to share her thoughts with me.
She died at the end of the year. Just days before, we located some estranged relatives who came to her memorial service. I wish I could have expressed to them what an influence their family member had had on me.
Marie taught me a lot about my role in healthcare. Medical school is daunting, and I’d worked up personal expectations of becoming some sort of hero and miracle worker. But my work with Marie taught me that sometimes “making a difference” in a person’s care has nothing to do with working wonders. It can have everything to do with braving awkward silences, and listening to a person no one else will listen to. And I’m ever grateful for this lesson.
* Contributed by Val Simianu, a fourth-year medical student at IUSM
** The patient’s name has been changed to respect her privacy.