Recently, I’ve been inspired by Caitlin Doughty over at The Order of the Good Death. Now, there’s a woman who’s not only really cool, but entirely unashamed of her interest in death and dying. So far as I can tell, she’s always been a bit morbid–er, a lot morbid–and that’s why she’s a successful and involved mortician.
In watching her videos, I’ve also realized something else that’s pretty cool. I’m kind of morbid too, and I’m also going to make a career out of it. The difference is that my patients are alive, where her clients are dead. The similarity is that the family is always around, and reacting to what’s going on.
With living people, there’s a whole universe of morbidity: grief, dying, pain, rot of various kinds. These are things which, I suspect, lots of people avoid like, well, the plague. I remember this idea, from back in my philosophy of religion course, that physicians are taking on the role of the high priest of death. This could be because death is being institutionalized into the hospital, and away from where people live and breathe. Some of my colleagues may be daunted by this additional responsibility, or think it an inappropriate addition to the job. Personally, I think it’s pretty cool, and I am not just pleased to have this privilege, I’m excited.
As I type, I have coming up on Monday my BBN OSCE, or as it is fully expressed: the breaking bad news objective structured clinical exam. I’m glad the faculty is making us do this particular OSCE, as I think we should all get some real experience in this before hitting the wards. Playacted experience still counts as real experience–getting medical students closer to prepared takes baby steps. Even though I’m very interested in this area, there’s still a large part of me screaming “eeeeek!”
Fortunately, I, and a couple other students in my class, have a little extra training for this, and that’s the spirituality elective I mentioned in my previous post.
This elective was my first and only shadowing elective, and it threw me straight at patients’ and families’ loss. I had the fortune to see people sitting next to patient beds and holding hands, to sit in with a family for an hour while we went through the experience of their story, and where they were now. I saw people who I suspect are now dead, and was with them and their supports as they grappled with the view on the horizon. I also saw clashes between health system and family, but that is, I think, a comment for another time.
While following chaplains around, I was amazed at their skill in wading through this realm that intersects and is adjacent to the social and psychological. They could come up with phrases that exploded into my mind with truth, and my heart with sincerity. The chaplains’ main skill, among many, was the ability to focus people onto their strengths, onto what would help them get through and experience this moment, their grief, their fear. They could do this with religion or without; it actually did not matter what the patient identified with, the chaplain could find something to speak to.
I’ve heard lots about stages of grief, and I’ve seen a bit in my time. Though I have many years of hard experience ahead of me, I think I can confidently conclude that it doesn’t really matter where on a schematic someone seems to be, that person has his or her own special, unique, and I think Caitlin might say beautiful, grief for this situation.
I just hope I can remember that. Not just for this OSCE, but for forever.