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Palliative Reflection

1) The document describes a palliative care rotation with a 57-year-old woman in hospice care for advanced ovarian cancer that had spread throughout her body. 2) The patient's daughter and aunt were at her bedside, asking many questions about her care, while the patient herself was unconscious. 3) The author reflects on their own grandmother's end-of-life experience, where she rapidly declined over a few months and died within a couple days of entering hospice care. 4) They feel future goals of care conversations could help smooth the dying process and better utilize hospice resources to allow for more planning and discussions with loved ones.

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Michael Spike Levin
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30 views

Palliative Reflection

1) The document describes a palliative care rotation with a 57-year-old woman in hospice care for advanced ovarian cancer that had spread throughout her body. 2) The patient's daughter and aunt were at her bedside, asking many questions about her care, while the patient herself was unconscious. 3) The author reflects on their own grandmother's end-of-life experience, where she rapidly declined over a few months and died within a couple days of entering hospice care. 4) They feel future goals of care conversations could help smooth the dying process and better utilize hospice resources to allow for more planning and discussions with loved ones.

Uploaded by

Michael Spike Levin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Michael Levin

Dr. Otto
Geriatrics Rotation
3.21.2019
Palliative Reflection

R
My first reaction was one of shock. She was 57, and already in hospice. Why? Advanced
ovarian cancer. It had spread though her pelvis and abdomen and was obstructing her bladder
and colon. It was in her bones and extremely painful. And it was in her brain, and starting to
affect cognition. So terrible, so young.
One of the techs told the nurse I was shadowing that her daughter was there with her.
Apparently, her daughter had been there most of the time, right by her side. “Good,” I thought,
and then “Oh gosh, how old is this daughter?” Also, apparently, a sister from New York arrived
overnight and was suddenly asking a lot of questions about care. It seemed to be something the
staff rolled their eyes at- “Oh great another one of these.” I knew the frustrating experiences
that led the staff to their reactions, and I also ached for the family who was doing their best to
show their love and how they might have felt if they heard the conversation.
When we went into the room, the patient was unconscious in bed. She was in a tense
posture- if we did not know her pathological processes, I would have described it as
decerebrate. Her eyes were slightly opened and rolled backward in her head. Her daughter- I
thought looking like late high school age- sat by her side. She had lots of questions about
treatment, doses of pain medicines, etc. She was trying to intellectualize and micromanage,
albeit politely, to help cope. There was an older woman asleep on the couch in the room when
we entered. She woke and sat up, but did not say anything, just kind of looked at us with
disdain. Dad was apparently at work. Did he not know his wife had maybe days left to live? And
aunt was there leading the conversation. I felt sad, awkward, out of place. Towards the middle
of the interaction the nurse I was shadowing introduced me- the family was very excited to
hear I am a medical student, and they wanted to talk to me about that. Eager for any
distraction, I suppose.
E
I have no memories of my dad’s parents. My mom’s dad died when I was in 4 th grade. I
think at that time I did not really understand it, so it did not affect me much. My grandma
moved in with us after that and lived in our basement for two years or so. We grew closer
during that time, it was nice to see her every day. She fell down the stairs one day and broke
her hip, and eventually went to a LTC, where she lived for about another two years. I remember
my mom went to see her mom every single day. I’d go about once per week with her. Over the
course of about two months, she rapidly declined. She got a pneumonia in late June, and went
to the hospital. It was there that she started talking about her death. Once I was alone with her
in the hospital room- I’m not sure where everyone else was- and she looked at me and told me
she was ready to die. This seemed unprovoked to me. I was a rising high school freshman- why
was she telling me this? After a few trips back and forth to the hospital- for a lung issue that
never fully resolved- over a few weeks, my grandma decided she did not want to go to the
hospital any more. By this time, I was away at boarding school. She was moved to the hospice
section of the LTC, and died less than 2 days later. My parents called me at school. They would
cremate her and bury her and have a service, and we had another service over thanksgiving
break, when I was home.
A
Dying can be very messy. It certainly felt that it was for me. And now, it seems
unfortunate that my grandmother died so soon after going to hospice. Would she have
benefitted from a conversation about goals of care sooner? Did the patient that I saw discuss
her death with her daughter, sister, husband, before it was too late? What they should do,
what she wanted?
As a future physician I want to make a part of my practice making this process
smoother.
P
I think I’ll have a goals of care conversation with every new patient. I will encourage
them to discuss their goals with their loved ones, and I hope to find ways to help people get in
to hospice before they have only a few days left, to better utilize the resources there to have
conversations, make plans, etc.

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