The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.
As a student doctor, I usually have more time to spend with the patients so I often would receive either the new patients (a veritable pandora's box of possible health problems) or the hospital follow ups. This one was a hospital follow up. As I quickly scanned through her chart, I wondered, "what in the hell is she doing HERE?" She had terminal cancer and judging by the ER doc's notes, she was not long meant for this world. What was she doing at family practice?
Tattoos, a gruff voice, and a face carved with lines of a hard life, she was an independent woman who was not too keen on doctors. She would be more at home on a Harley than in a doctor's clinic. This was the last place she wanted to be. The interview quickly became disjointed and scattered. Twenty different bottles of pills, a patient who is confused, and an accompanying friend who was clearly concerned. After getting the gist of the history which ranged from her coughing and vomitting up blood to "I think my blood pressures have been running too high doc", I decided her history of hypertension was really quite irrelevant. I sensed that she wanted someone to be blunt and give it to her straight so I asked her, "What is your understanding of hospice?" She had no idea what it meant. Wow. The previous doc had recommended hospice and hadn't even really bothered to outline what that meant to the patient. We then began one of the most honest and open conversations I've ever had with a patient in my short career. It started with me saying, "You are facing the hardest thing anyone has to face and that is your death," and ended with me telling her about my own personal experience with hospice. Somewhere in the middle I told her, "ask yourself, how would you like to die?" I finished up and then went to tell the attending.
The attending came in and did his thing. As we walked out of the door, I felt a tug on my sleeve. The friend whispered, "She wants to ask you something without the doctor here."
The patient sat looking at me for a moment and asked, "How long did your brother live?"
"From diagnosis to death? Fifteen months. And he died at home with his family all around him." She looked me squarely in the eye and held my returned gaze for a span of time which was unmeasurable. There were no more words left to say. She continued to look me right in the eye, shook my hand firmly, and said with a voice beginning to crack with emotion, "thanks, doc...thanks." That was the most heartfelt gratitude I've ever heard from a patient.