The Luxury of Time and Accepting Our Mortality. Learning to Treat and Comfort Others Approaching Their End of Life.

Jennifer Chen is a second-year medical student at the UVM Larner College of Medicine.

In the following blog post, Chen writes about her experiences volunteering at a local hospice.

Jennifer Chen

“I think of how fortunate I was to be able to spend time with the (hospice) residents and what I learned from them. To be reminded of all the quirks of the residents that I have met, even if I played just a small inconsequential role in the magnitude of their lives, and how much these experiences meant to me.”

It’s a quiet Friday night; the sun is setting and casting a soft glow down the hall. I knock on the door and peer into the room, where I see the elderly resident propped up in bed, surrounded by cards and flowers of well wishes. His wife sits by the bedside and they both look at me expectantly as I enter their room. Today, I am not here as a medical student, I am a volunteer meal assistant at the McClure Miller Respite House, an inpatient hospice residence.

Being a Volunteer

As a volunteer, I take meal orders for residents, help prepare the meals with the chef and bring it to residents in their room. In the kitchen, there is a board featuring all the current residents and their meal specifications, such as whether or not they are eating and if they have preferences so that volunteers can prepare accordingly. Some residents stay for weeks, others for a few days. We do our best to give comfort and support to residents and their families, provide hot meals and do what we can to help the transition for someone in their last days of life. Naturally, many of the residents stop eating, or eat very little, and the tray often comes back still full. Inevitably, a resident will pass away, and their name is quietly erased from the board.

The Power of Words, Choices, and Small Gestures

Over the last year, I learned the power of words, choices, and small gestures. We call those who are staying at the Respite House “residents”, not “patients”. We don’t ask, “how are you?” because sometimes the residents don’t feel very well. Instead, I learned it’s best to say “It’s good to see you.” We avoid giving big portion sizes because the residents usually do not finish it and might feel guilty or cause their families distress. 

I always ask for all the details for their order – would they like ice for their drinks, what type of sauce, what time would they like their meal served? Anything I can do to help the residents feel a sense of autonomy in an uncertain time. I learned to rely on the nurses as well; they know the residents the best and what they like. In my capacity as a volunteer, the best thing I can do is to keep a positive energy with the residents and help the residents feel more comfortable.  

In the spring, I remember one resident, Sarah*, who was close to my age. She sat in the bed, entangled in tubes and beeping machines, surrounded by her family in the dark room. Her father saw my UVM medical student badge, under my volunteer badge, and told me that Sarah was also a UVM alumni. Although she wasn’t hungry for a full meal, I suggested she have an ice cream shake instead. We spent a few minutes talking about favorite ice cream flavors and which to get, laughing about having too many flavors to try. Her family seemed very grateful to see another UVM face and was surprised that a medical student had time to spare to volunteer. They thanked me for my service, and as I left her room, I noticed the flowers were starting to bloom outside. 

Dealing with Death

I remember the first time I experienced a death on my shift. I went into a resident’s room to take their order and the family informed me it was not needed, as the resident had passed just minutes before. As a medical student, I was fumbling; I did not know what to do. I offered my condolences to the family and the nurse. I left the room, closed the door quietly on my way out and crossed the residents name off on my clipboard. 

I am lucky. I haven’t had much experience with death directly, even in my short medical career so far. I have never grieved. But I know in the future, I will have to deal with patients (actively) dying. Despite all the medicine and physiology that we learn in medical school, we have not yet had a class explicitly on death. How do we discuss dying and what does it look like? What does it mean to die with dignity, to alleviate suffering in those final moments? How do we as physicians support a family through the process? How do we facilitate these important discussions that we will have someday with our patients? Our job, as physicians and those in training, is to prevent and fight death. We bombard patients with antibiotics and surgeries, chemotherapy and radiation. We do all that we can to prolong and preserve life, sometimes at the expense of quality of life, sometimes prolonging the suffering instead. But what is equally important is accepting our own mortality and helping our patients with that transition as they approach the end of their life. I think about the classes I had earlier that week: the patient vignettes and discussion of what medication and treatment plan we offer our hypothetical patients. In our class, it seems like we almost always assume the patient gets better. 

What I’ve Learned

Over the last few months of being a volunteer in hospice, I have reflected on my future responsibility as a physician. My roles as a medical student and as a volunteer are drastically different. As a medical student, I have been taught to value efficiency. In our practice interviews with standardized patients, we are given just 15 minutes for the interview and physical exam. While we include empathy in our approach, we are primarily trained to see our patients and their illnesses as something that needs to be fixed. To be healed. As a volunteer, I have the luxury of time. I can sit with residents, chat about their day and learn about the story of their life. I don’t have a specific agenda in mind, except to help the time pass more comfortably.  

As I leave my shift, I think of all those who have come and gone at the Respite House that I had the honor of serving. I remember how one resident always liked to have a glass of wine with his meals. I remember how one resident had brought their cat to the Respite House and always insisted that I pet the cat for them. I remember how on Halloween, one resident had her room decked to the nines with Halloween decorations, including a fake skeleton on her couch. 

I think of how fortunate I was to be able to spend time with the residents and what I learned from them. To be reminded of all the quirks of the residents that I have met, even if I played just a small inconsequential role in the magnitude of their lives, and how much these experiences meant to me. 

*names have been changed for privacy reasons