I met with an elderly patient and his wife today in the nursing home. The man has agitation and experiences delusions, some of which are quite vivid and upsetting to the patient, his wife, and the nursing home staff. I was consulted in order to "stop the delusions".
During the course of our conversation, I asked this very confused patient how he feels things are going. He told me that he spends his days shearing sheep on a ranch in Australia. He went on to describe in great detail the shearing process and his daily chores. As he talked, his drawn and anxious face became relaxed and his eyes gleamed. However, with each word he spoke, his wife became visibly more distressed and tears welled in her eyes. She whispered, "It's not true. I never argue with him, but none of it is true. He's never even been to Australia. He has never sheared a sheep in his life".
I steered the conversation to his diagnosis and the toll it has taken on his wife and family. After a time, I asked the patient, "What brings you comfort? What keeps you going?"
His response:
"Some nights, I lie on the cold ground after a long day on the ranch, and I look up at the stars in the sky. I think that I would like to go to sleep and never wake up. But then...then I hold a little lamb - a baby sheep - in my arms and I feel its warmth and I know I have to keep going, just so I can take care of it."
After a few moments of silence, I said, "You keep going then...for your children. Those baby sheep are like your children". And this man who had forgotten every aspect of his former life except for his name looked me right in the eyes and nodded. And then he smiled.
His wife began crying in earnest then, and she told me that she has learned more about her husband's illness in our twenty minutes together than she had in the past two years of going from specialist to specialist.
Just so you know, I hated medical school. I wanted to quit every day. I used to think, "If this is what being a doctor is going to be like, I don't want any part of it". I have since learned that being a good physician has very little to do with USMLE scores, the ability to memorize lab values in order to impress attending physicians on morning rounds, or the unique honor of securing a coveted residency/fellowship/faculty position. Those things are nice, but, in my mind, being a good physician has everything to do with being willing and able to sit and be truly present with patients and families during pivotal life transitions. Sure, we try to put out fires. But, if we can't put out the fire, a good physician takes the patient's hand and walks with him through the flames.
So that's why I love being a hospice and palliative medicine physician. How about you? What is your story?
