Hello, I'm a third-year student about to begin a palliative elective. Any advice?
M3 elective
- Thread starter okokok
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M4 here, did a month long palliative elective early in my m4 year, all inpatient consultations for adults. Mostly goals of care discussions and what followed from that. A few extubations a week. Lots of opiate rx and end of life symptom management. The team I joined (two MDs, one NP, one MSW, one chaplain for a ~400 bed hospital) was incredibly compassionate towards everyone they worked with. First time in medical school where I wasn't actively shunned from family discussions and by the end of my four weeks my team had encouraged and supported me enough that I even ran a few of them myself (with them in the room, of course). You'll come face to face with a lot of uncomfortable circumstances (spouses/siblings who havent seen each other in decades and now they need to make a decision about someone's care who abused them 20 years ago, M.D. family members keep their stroked out grandpa alive for months "waiting for a miracle," tons and tons of cheating, ALL this dirty laundry comes out when people are dying and you'll be right in the center of it!) and you'll find many many feelings you unwittingly compartmentalized earlier on in clerkships (!) will rear their head. Tons of self reflection.
Moving forward from that experience i've come to appreciate more the importance of communication between you, the patient, the nurse, the family, EVERYONE. My first week I wanted to drop the rotation and seek refuge in therapy -- when it ended I wondered what the hell I had experienced -- six months from then I have learned when palliation is done well and when it's done poorly -- and insert myself as a medical student and advocate for patients when necessary. I greatly appreciate the tools the experience has given me and am actually thinking of doing a palliative care fellowship in the future.
My advice is to find someone you can speak openly to during the first week or two. My SO at the time actually refused to hear any more of what i had to say past the third day -- she said it was too depressing. And don't do what I did and read "When Breath Becomes Air" midway through your first week.
Moving forward from that experience i've come to appreciate more the importance of communication between you, the patient, the nurse, the family, EVERYONE. My first week I wanted to drop the rotation and seek refuge in therapy -- when it ended I wondered what the hell I had experienced -- six months from then I have learned when palliation is done well and when it's done poorly -- and insert myself as a medical student and advocate for patients when necessary. I greatly appreciate the tools the experience has given me and am actually thinking of doing a palliative care fellowship in the future.
My advice is to find someone you can speak openly to during the first week or two. My SO at the time actually refused to hear any more of what i had to say past the third day -- she said it was too depressing. And don't do what I did and read "When Breath Becomes Air" midway through your first week.
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Thank you, @m0biusace! I appreciate the advice and the examples of the kinds of things I should try to mentally prepare myself for. It sounds like you had a really enriching experience, I hope I learn as much as you did.
