A Patient’s Gift

“Thank you for these past couple of days.”

A simple sentence, yet one that forever changed my perspective on end-of-life care.

A faint beeping noise echoed in my room as my eyes slowly opened; it was 5:00 AM. I glanced out my window. The sun had yet to rise, but the darkness and silence were comforting in their own way. After breakfast, I got ready and headed out to the hospital where I was doing my residency training in family medicine.

The crisp morning air woke me up, and the drive to the hospital was no different from usual. Little did I know that the rest of the day would show me what it truly means to be a physician.

I logged on to my computer, checked my patients’ vitals, reviewed the specialists’ recommendations and set out to see how everyone was doing.

The patient I was most eager to see was Mr. Hill, an eighty-seven-year-old man with greyish white hair combed neatly to the side, a matching goatee and circular glasses that sat perfectly on his nose. He’d been admitted a couple of days back for constipation, fatigue and recent weight loss, and we were awaiting test results to determine the best course of treatment.

Up till now, Mr. Hill had been cheerful, greeting me with a warm smile and asking how I’d been doing. He always seemed more interested in learning about my life than in discussing his own.

Our best conversations were about traveling and the places I’d been and or wanted to go. He always would say, “Oh, that place is beautiful” or “The food there is to die for,” but never elaborated, even if he’d been there himself. No matter what we talked about, he’d always thank me for spending time with him, opening up about my own life and talking about my dreams and ambitions.

Today, though, he seemed lost in thought.

“Good morning, Mr. Hill,” I said. He snapped out of his trance: We exchanged pleasantries, and he answered my questions as usual, until I asked what seemed to be on his mind.

“When I woke up this morning, I had a feeling that the test results will be bad,” he said. “I can’t seem to escape it.”

“Well, it’s important to try to stay positive,” I said. “I’ll discuss everything in depth with you once we have the results.”

He seemed reassured.

“Sounds good, Doc,” he said, smiling. “Keep me posted!”

As the day progressed, I kept checking on Mr. Hill’s test results, hoping for positive news. When the results finally arrived, however, they were the worst possible: He was dying.

Over the next hour, I consulted with colleagues to ensure that I thoroughly understood the results, and how I should convey them to Mr. Hill. Feelings of sadness, anger, anxiety, inadequacy and guilt overwhelmed me.

My job as a physician is to help people—to treat them and to instill hope during their toughest times, I thought. How can I do this for Mr. Hill?

Despite my reluctance, I knew I had to tell him his results. Although I knew the “right” way to deliver bad news, when I entered his room and saw his smiling face, my textbook knowledge vanished. Everything became real. I was about to tell this cheerful, optimistic man that he might be dying, and that I could do nothing to help him.

From medical school, I knew that the way to start was to get a sense of the patient’s understanding of the situation. For example, I could ask Mr. Hill what he knew about his disease and prognosis, or what he’d been told. I could follow up by asking him how much he wanted to know.

The next steps would be to review his test results with him, then give him time to process everything and ask questions. After this, we would discuss possible treatment options and how these might affect his life expectancy.

This is a simple summary of a very complex process. Still, I had the game plan, and I’d practiced it many times with my peers in medical school. All I had to do was stick to the plan, and nothing could go wrong…right?

It was time. I took one last deep breath.

“Hey, Mr. Hill,” I said, trying to sound confident, “we finally got those test results back, and I just wanted to talk to you about them.”

He gazed at me for a moment.

“I’m not doing well, am I, Doc?”

Just like that, the strategy I’d been taught and the plan in my head became useless. Looking Mr. Hill in the eye, I felt a heaviness in my chest, a flush of warmth, and a stuffiness in my nose.

“I’m sorry,” I said. “But based on the tests, Mr. Hill, it looks like you aren’t.”

He looked out the window again. I stood there in silence, waiting for him to process what I’d said.

When he finally spoke, he didn’t talk about the test results, the prognosis or the possible treatments. He talked about his life.

Mr. Hill told me everything about himself—from good to bad, from happy to sad, from the things he’d never forget to the things he wished he could. The topics ranged from his time in service, to meeting the love of his life and the places they’d traveled together, to descriptions of his children and grandchildren. This was the first time since we’d met that he wanted to talk about himself—and no matter what he was saying, he never stopped smiling.

I simply stood there, making sure I took in every word. I could tell this was what Mr. Hill needed—and I felt so honored to be in that room, listening.

After he’d finished, he looked at me again and said, “I’ve lived a good life, Doc; it’s nothing to be sad about. Anyway, let’s talk more about those results.”

In the course of covering his illness and his prognosis, we created a plan on how to proceed in the time ahead.

As I started to leave, Mr. Hill said, “Hey, Doc! Thanks for listening to me—and thank you for these past couple of days. I’ll see you tomorrow, bright and early.”

“Bright and early as always, Mr. Hill,” I replied. “See you tomorrow.”

My memories of Mr. Hill will stick with me for the rest of my life. In such a short time, he taught me so many lessons. He taught me that experience is invaluable, and that no amount of education or planning can prepare you for everything. He taught me to be confident in myself and helped me push away some of my inner self-doubts. He taught me that sometimes the best thing you can do for someone is just to listen and try to truly hear what they’re saying and where they’re coming from. One of the last things Mr. Hill taught me was to live my life to the fullest, with no regrets, and not to be afraid to share my life story with others.

He changed my perspective, not only on how I want to be as a physician but also on who I want to be as a human being—and I couldn’t be more grateful.