Fourth Year Reflections – When Medicine and Life Collide

Kelly Gardner '14
uvmmedicine blogger Kelly Gardner ’14

With graduation quickly approaching, I can’t believe my four years here at the College of Medicine have gone by so quickly. There have been many wonderful and many challenging experiences. As I reflect back on my most meaningful memories, I realize it was preparing me for when my own personal life and medical life would collide. Being a medical student made me better prepared for what I faced as a daughter. And what I endured as a daughter will make me a better physician.

During third year we have the opportunity to spend our clerkship rotations at hospitals outside of Vermont. My very first clerkship was Inpatient Internal Medicine in Bangor, Maine. Two weeks of the clerkship were spent on the palliative care team. I had never been exposed to this kind of medicine before and I was drawn to it. Not only is it end of life care, but these clinicians also help patients control their pain and other symptoms to have a better quality of life. The doctors and nurses on the team weren’t just caring for the patient; they cared for the whole family. I saw doctors cry with their patients and nurses give special momentos to family members once their loved one died. One moment in particular sticks in my head when the director of palliative care was preparing me for extubating a patient (taking out their breathing tube). Before we walked in the patient’s room, which was also full of family members, he stopped and said, “Who are we taking care of in that patient’s room?” I wasn’t exactly sure what he was asking, and he responded, “Every person in that room. That’s who we’re taking care of today.” Just a few short years later I would come to find out in my own life how important those words were.

As a fourth year medical student I completed an Acting Internship on the adult medicine service. I made a last minute change to do my month with the oncology team. The medicine was interesting but I was drawn to the family interactions in oncology. As a team we had to have many difficult conversations with patients about their goals, and with families about when they wanted to take their loved ones home and care for them with hospice. During this month my own father became very sick. The skills I learned throughout third and fourth year, which I thought were preparing me for when I was a doctor, were also preparing me to take care of my own dad and help my family navigate tough medical decisions.

One of the requirements of the AI was to be part of a “code status” conversation. This is when you discuss with the patient and/or their family whether or not they want CPR or a breathing tube if their condition deteriorates. This is an incredibly difficult but important conversation to have, especially with oncology patients and critically ill patients whose condition can change rapidly. Establishing goals of care early on gives everyone – the team, the patient, and their family – a better idea of what to expect and allows the patient to express what they would like the end of their life to look like. When my own father’s condition started to rapidly decline, I had to have this conversation with my mother. From my experiences in the hospital I knew how important it was to make this decision as early as possible, and from my experiences with my dad I knew how important it was for his own wishes to be carried out. We decided as a family to let him pass peacefully if and when the time came.

On the oncology service I saw many patients go home with hospice care. I knew what the medical details were but never fully understood what this meant until I experienced it myself with my family. As medical students we learn tirelessly how to prolong people’s lives, but until I experienced my own father’s hospice care and death, I never knew how equally gratifying it could be to care for someone in their final days, making them comfortable and making their death as peaceful as possible. Medicine could not save my father’s life, but it could give him the death that he wanted which I now understand is equally, if not more so, important.

As I look forward to graduation and the exciting next steps of residency, I’m so proud of all that I’ve accomplished but I wish my dad was still here. But I also now understand how enduring my own father’s sickness and caring for him as he passed away will make me a better doctor. He gave me something extra, a level of empathy I will have for my patients and their families. That unspoken understanding of, ‘I know what you’re going through and I’m going to help you through it.’ When I’m able to have those experiences with my patients in the future, I will always think to myself – Thanks Dad!

What are your thoughts about this topic?