Accepting the hopes and dreams of our patients is a way to show compassionate presence.
Lifelong Learning in Clinical Excellence | August 30, 2022 | 2 min read
By Joshua Briscoe, MD, Durham VA Health Care System
“She doesn’t get it.” The resident sighed. “He’s dying and she just doesn’t get it. We were hoping you’d come talk to her. Maybe clarify the goals of care?”
Looking at our patient’s chart, I somewhat agreed: he was really sick. Maybe he was dying. If only we agreed on what dying was. “I can meet with her. But I’m not in the business of twisting arms.”
In Netflix’s adaptation of Neil Gaiman’s “The Sandman,” the main character has lost the ruby he uses to control dreams. The mournful thief who now has it, John, wants to employ it for a noble purpose: to rid the world of lies. “The ruby wasn’t made for that,” the Lord of Dreams warns. “It’s harming you and your world.”
John doesn’t see the damage he’s caused. “It’s revealing the truth.” He gestures to the carnage around them, wrought by his ruby-powered revelations, “This is the truth of mankind.”
“No. You’re wrong,” the Sandman shifts the scene to one in which the people are making small talk about their mundane lives. “This is the truth of mankind.”
“They’re lying to themselves,” John huffs. “All lies.”
“Not lies, John. Dreams . . . Their dreams inspired them. Their dreams kept them alive. But if you rob them of their dreams, if you take away their hope, then–yes. This is the truth of mankind.” The scene collapses back into shadow and death.
As I stand outside our patient’s room, I see a woman praying over the frail body of an older man. Her hand embraces his as tubes and wires embrace his face and chest. They seem to be struggling against one another for his body. Is she lying to herself? Her tears fell onto the sheets.
We clinicians are so often like John, enamored with the power of our tools to reveal truth. Our tools outmatch our wisdom. When that happens, tools blind can blind us and harm those who might otherwise benefit from their use. Here, our tools can’t tell us when our patient is dying. They weren’t made for that. We need to walk slowly and by different lights if we’re going to accompany people through the darkest times of their lives. Our eyes might need to adjust.
So, I don’t think this woman is lying to herself. Her tears speak the truth that she can’t yet say. Even still, she has a dream. My job today isn’t to break that dream. If her husband is dying, grief will soon envelope that dream and we’ll be in a different place. My job, instead, is to sit with her in her dream, if she’ll have me. In this dream, is there a hope here that won’t crack like ice under the weight of suffering? Could there be a hope that, like water, fills our thirsty hearts?
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.