Abstract
My grandfather's death made a profound impact on my life personally and professionally. Our family was able to share in his last joyous days thanks to a caring physician who first suggested palliative care. During these final days in which friends and family said their goodbyes, I realized as a medical student the immense impact we as healthcare workers truly make in our patients' lives. Reflections on palliative care, faith, medicine, and death following this experience influenced my formation as a Catholic, grandson, and as a physician in training.
Lay summary: This article describes the personal experience of a medical student who witnesses the final days of his grandfather's life. Life, death, faith, palliative care, and the impact of physicians on families during these times is the subject of his reflection following his grandfather's death.
Keywords: Palliative care, Faith, Death, Medical student
Introduction
“It's time to say goodbye to your grandpa.” Normally these mundane words signaled the end of our trip to our grandparents’ house, but on this day, my mother's words were anything but routine. On this day, it was not just another goodbye, for this was my final goodbye. As I approached Grandpa on his deathbed, I pondered the past week's events that ultimately led to this moment.
One week earlier my eighty-three-year-old grandfather had suffered an acute perforated bowel—a deadly diagnosis if not treated quickly—after throwing a surprise birthday party for my grandmother's eightieth birthday. He was urgently rushed to the hospital and thankfully stabilized after an emergency surgery. While he was in recovery post-operatively, the family debated the next course of medical action in his long road to recovery. Grandpa was sharp as a tack mentally, but his medical history was so extensive it could be mistaken as a small medical textbook. Recovering from such a life-threatening condition is never easy in someone who is young and healthy, much less in someone elderly and carrying as many other diagnoses as Grandpa. It was at that time that a nephrologist, who knew my mother since she worked as a pharmacist at the same hospital, pulled her aside when he saw her in the hallway. Once my mom explained Grandpa's recent situation, he gently and compassionately recommended considering a palliative course for my grandfather, the first time she had heard such advice. With Grandpa's history, it was undoubtedly the most rational decision, yet one we struggled to arrive at ourselves due to our emotional involvement. After a family discussion that included Grandpa front and center, we decided that palliative care was indeed the best course of action.
Grandpa was discharged from the hospital in stable condition to spend his final days where he desired, in his home surrounded by his large family. Over the next week, family and friends traveled from near and far to say their final goodbyes to Grandpa. These days were not a mourning of his approaching death, but rather a celebration of his incredible life. He was placed in his favorite rocking chair in the middle of the kitchen, and we all gathered around to share stories, tears, and most of all, laughter. Friends brought food and gifts for Grandma, spent hours reminiscing with Grandpa, and offered words of gratitude for all his love and generosity. It was a beautiful celebration of a life well lived. Few times, if ever, will I again experience such abundant love as I did during those days.
During this time in a seemingly different universe known as my professional life, I was in the midst of my busy first semester of medical school, hours away from my family. Mom provided daily updates, but thankfully, I was able to see Grandpa a few times during his final days. It was during one of these visits that I managed to tell Grandpa goodbye for the final time. Through tears, I told him how much I admired him, how much I would miss him, and of course, how much I loved him. With matching tears, Grandpa told me how proud he was of me and how much that he loved me. It was a powerful, emotional moment between grandfather and grandson, one that time will never steal from my memory.
Time unrelenting, the patriarch of our family slowly grew quieter and more distant with each day. After eighty-three years of constant running, his body began slowing down. His grandchildren cared for Grandpa during those last days, helping him move from the bed to the bathroom, aiding him in the restroom, and seeing to anything he needed. Grandpa himself was prepared to go, fatigued from years of struggling health and ready for the eternal tranquility and peace that Heaven would soon provide. Seven days later in his bedroom, surrounded by his five adult children and holding the hand of his wife of fifty-nine years, Grandpa took his last breath.
Reflection
Only after months of reflection was I able to truly appreciate how influential this beautiful experience was for me, both as a grandson and also as a medical student. From a personal standpoint, what more could one desire for a dying loved one? He experienced the comfort of his home and the joy of his friends’ company. He was surrounded by more love in those final days than words can describe. Each family member, friend, and neighbor was given an immeasurable gift: the chance to speak one final time to Grandpa about his life, impact, and legacy. He too was able to reciprocate his love and respect, etching a distinct memory of that final conversation into each of our minds. Too often loved ones meet their end without having this intimate end-of-life conversation. Too often these words of affection and admiration remain unspoken. Our attitude towards this deathbed conversation is paradoxical. It is an interaction we strive to avoid until the last minute, denying to ourselves the reality that our loved one's breaths are numbered. Yet it is still a bittersweet exchange we deeply long for all the same, a conversation that has played itself out in our heads since our cherished friend's health started declining. How fortunate we were to have been given this opportunity to say goodbye!
From a perspective of a future physician, this experience helped me realize several important points. Let us never underestimate the extent of our impact on patients’ lives. I wonder how different the final chapter of Grandpa's life might have looked had the nephrologist never suggested palliation to my mom. Certainly it would have been easier for him to walk by or to simply offer condolences. Death is not an easy topic to discuss with families, regardless of the circumstance. However, he knew the long and tedious climb my grandfather would have to endure with additional procedures and treatments. He was able to communicate in a sensitive way to our family his knowledge of the vast medical care for only minimal benefits in such patients, allowing us to choose a path that provided Grandpa with the highest quality of life during his final days.
I still wonder today if that physician knows the extent of his simple hallway advice. Following the conversation, he likely returned to his clinical responsibilities, checking on labs and following up on other diagnostic testing. He made a decision in the hospital that translated into the most beautiful celebration of life and death that I will likely ever experience. Each family member will remember and treasure those final days with Grandpa, none of which may have been possible were it not for that physician.
As physicians then, let us not forget that the decisions made within these hospital walls stretch far beyond them. We must not let the multitude of medical advice we offer daily to patients dilute the significance of every recommendation that we provide. Take my grandfather's case for example. It was one of only dozens of recommendations that the nephrologist likely made that day. While it is unlikely each decision will address life or death situations, each still holds significant potential—for better or for worse—in the lives of our patients and their families. Additionally, we as physicians likely will not witness all the fruits that are born from the seeds of advice we provide in the hospital.
Reflecting on my grandfather's beautiful death also revealed to me that sometimes no treatment is the best treatment. This point highlights that the quality of a patient's life, with or without a certain medication, must always be considered. Too often physicians default toward prescribing a medication or treatment program without explaining all the options—including choosing to defer treatment—leaving patients feeling like they have no choice but to start that new drug. In circumstances where no treatment is a viable option, patients may still falsely believe they must begin some new therapy. Due to our training, doctors are too quick to seek an answer without considering whether an answer needs to be found at all. Regardless of what specialty within medicine, choosing to forgo treatment should always be considered and discussed with patients since many times patients are unaware that this alternative is an option at all.
Perhaps the greatest significance from this experience was the profound impact it had on my faith. Here lay a generous man who lived a holy life, on the verge of closing his eyes for the last time. He prayed every morning and night, sang in the choir every Sunday, and served as a church councilman for decades. Grandpa was a model Catholic in his home community. Grandpa had lived his life for God. Grandpa's life was by no means perfect, and it often deviated from its intended script, but he always trusted in God and life always worked out. Now, here he was: death was calling, and Grandpa was not afraid. After eighty-three years, he certainly had faith, faith that whatever happened after he took his last breath, he would be in God's hands. Even on his deathbed, Grandpa continued to display his unwavering trust in God: Grandma and their five adult children surrounded Grandpa's bed and were in the midst of a rosary when he passed away.
Conclusion
My grandfather's death served as a powerful reminder of why I chose medicine. This family—my family—will be forever grateful for the recommendation of the nephrologist who had the courage to propose palliative care. It opened the door to a wonderful end to a wonderful life. He helped our family and grandfather immensely in a time of need. What more as physicians can we desire professionally? The positive impact of this doctor's advice concerning my grandfather's future extended well beyond his disease or his hospital room.
Medicine is a unique field for a variety of reasons. No other field offers such potential to help in times of such vulnerability. When people are sick, their pathology is not simply confined to their physical wellness. It affects all aspects of our patients’ lives and families as well. Thus, when we are able to heal their diseases, we are fixing more than simply their health. The wonderful gift of caring for another's health should never be underestimated. In the vast number of patients we treat throughout the years, let us not overlook the significance of treating each and every patient. The decisions we make in the hospital have the potential to change patients’ lives and families for years to come.
While we greatly miss Grandpa, my family still reminisces about how wonderful his final days were. Personally, professionally, and spiritually, my grandfather's death left a profound impression on my life. At that time, I do remember thinking how all the life and love that transpired over that week at my grandparents’ house may not have occurred without a caring physician's advice. It made me wonder then as I do now, what fruits—or weeds—are growing from the seeds of advice I have offered to patients in the hospital?