Our Greatest Teachers

When our patients transition into the final stages of their lives, when illnesses progress beyond our abilities to cure or stall them, when our treatments are more likely to cause suffering than benefit, and when our patients and their families are ailing—in that time and space, being able to deliver humanistic care is one of the core aspects of physicianship, and arguably, the highest calling of our profession.

Each day, during our routine patient care duties, we deepen our understanding of and respect for the community we are privileged to serve. Recently, I cared for a patient who was receiving hospice care for diffusely metastatic and incurable colon cancer with biliary obstruction. Even when faced with his relatively new diagnosis, limited prognosis, and daily, unpredictable abdominal pain, he told me he was trying to focus on the positive things in his life. I often found him on his laptop planning his family’s finances to make sure they would be ok after he was gone. His stoicism and selflessness were heroic.

In another encounter, the housestaff cared for a young patient with complications of sickle cell disease, who was worsening each day and developing kidney failure despite our best efforts. Her pain was becoming difficult to manage, and we didn’t know how she was going to do. One morning, she saw me wearing gauze on my hand and insisted that I tell her what happened and if I was in pain. Even though she was hospitalized and suffering—that morning, in that moment, she just wanted to make sure I was ok. Even through her pain, she saw and recognized our common humanity.

Another patient was receiving hospice care for malignant bowel obstruction. He admitted to our whole team that, while his family and friends were visiting, he carefully concealed his constant nausea and fatigue, so he didn’t make them worry and so that he could leave them with a peaceful and cheerful memory.

These moments of courage and warmth among our patients at the end of life—they shine through even the most impossible situations, and they surround us in our daily work. William Osler once said:

“Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life—the poetry of the commonplace.”

These moments of fortitude and bravery, these moments of human kindness that we witness among our patients—they happen every day, in every hallway of every hospital, hidden from the passing glance or casual conversation but detectable to all of us if we are sufficiently attentive and present to witness them. They remind us to bring our best selves to work. They remind us to be mentally present and emotionally available at the bedside, to maintain our patients’ wishes and best interests at the very center of our decision-making, and to care deeply about the work that we do.

Today I encourage each caregiver, at some point in the course of your day, to reflect quietly on a patient you cared for at the end-of-life . . . to remember that person for who they were . . . to remember their loving family members . . . and to offer them our gratitude for being our greatest teachers.