I I had never been on rounds before. I had never really known what they consisted of, other than what I had seen in the typical hospital TV drama. And I certainly had never seen what the palliative doctor actually does.
I should have been prepared, given my area of research. I knew that palliative care is a type of health care in which providers attend to the patients' needs beyond simply the physical. Palliative doctors work to provide emotional, psychological, and spiritual care, recognizing that the patient is more than the illness. As most people do not realize that palliation is an option until they are faced with a terminal illness and are not improving from standard medical intervention, palliative care is often inaccurately equated with hospice care. Although I knew the textbook explanation of palliation, I was not at all prepared for what the day had in store.
We had just met with three individuals who were discussing discharging their mother's best friend, to move her home and begin care in a hospice program. I listened quietly as the doctor asked what they would do when the patient's health declined and she was unable to care for herself. I was fascinated by the fact that the three family members and doctor calmly discussed the course of care, simultaneously negotiating the logistics, while also recognizing and paying homage to the patient as a person. The group made the whole conversation look skillfull. I guess you could say, the first experience of the day was somewhat what I had expected.
We left the family alone to talk and turned down a hallway to visit with another family member. We were heading toward a man who was sitting temporarily in a hospital wheelchair. He was shaking slightly and staring nervously at the open room across the hall. I followed his gaze, and to my right I saw 8 or 9 doctors, moving quickly in yellow, sanitary gowns, gathering around a hospital bed. I couldn't see a face, but I noticed a bare, swollen leg on top of the bedsheets. I looked back to the man in the wheelchair. He continued to shake, and I glanced to Dr. Broderick and the orthopedic surgeon, as they began talking about the woman in the other room.
"He's really anxious," the ortho explained, referring to the shaking man in the wheelchair, who I later learned was Ron. Dr. Broderick motioned for Kavin and I to pull up a chair. I set a chair next to Ron and tried to listen to the doctors' conversation. I soon learned that it was Ron's wife's swollen leg, I saw peering out from under the bedsheets. Dr. Broderick busied herself in the room with all the other doctors, as Kavin and I tried to distract Ron. Ron told us he and LuAnn were married in 1950. He smiled as he reminisced, but each time he referred to his wife or their family, he stared nervously at the group of doctors blocking his view and began shaking more uncontrollably. We continued to talk in soft voices, asking him to tell us about his granddaughter. Ron had just shown us pictures as Dr. Broderick came back and pulled up a chair next to us. She didn't have to begin with "It's not good," because we already knew. Dr. Broderick began explaining to Ron that his wife's lungs were surrounded by fluid and that anything they did to try to drain the fluid would be invasive and likely unsuccessful.
Ron's eyes started to well with tears as Dr. Broderick spoke. I was fighting back my own tears as I reached out and put a hand on Ron's shoulder. Dr. Broderick asked Ron if she could call her daughter. The phone rang a few times, and Dr. Broderick, Ron, Kavin, and I all waited in silence for the daughter to answer the other line.
Dr. Broderick finally spoke, "It's not daddy, it's Dr. Broderick" she began. I barely listened to the details, instead I was looking at Ron, watching him transition from uncontrollable shaking to staring at the room, glancing at Dr. Broderick, and looking at the clock. He was agitated and rightfully so given we had just overheard Dr. Broderick tell Ron's daughter that Ron's wife of almost 60 years had only days if not hours of life left. Ron's eyes welled up again. Dr. Broderick said, "Yes, he's aware. He's hearing everything I'm saying." Ron chimed in, "Tell her not to worry about me, I've taken my medication."
Dr. Broderick relayed the information, and we all listened quietly as she finished the phone call. She handed the phone to Ron. He tried to make lunch plans with his daughter, who was on her way from another city, trying to make it in time to see her mother alive. Ron mentioned some pizza that he had in the refrigerator at home. I rubbed his shoulder. Ron got off the phone, and the doctors in the other room were lowering LuAnn's bed. They left the room and discarded their gowns. I couldn't help but think that this small act symbolized the giving up and the beginning of LuAnn's dying process. Dr. Broderick told Ron he could go in and sit with his wife. Ron made his way to her room, and I carried a chair in to place by the bed. Ron sat down, seemingly unsure of where to look, and finally his eyes rested back on Kavin and myself.
We put on gowns, entered the room, and knelt by Ron's chair. It was eerily quiet, the room was dimly lit, and it was only then that I saw LuAnn's face. Her eyes were closed, as she struggled to breathe, with her husband and two strangers taking watch by her bed.
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