A call from the "cancer floor" sets a second-year psychiatric resident on a 42-year journey in treating patients with terminal illness. Far from being an unremittingly sad experience, working with patients who are approaching death helped refine a sense of focus on the importance of the day-to-day experience.
KEY WORDS: death; dying; mourning; power of listening; power of being; staff support; palliative care
The call came from the "cancer floor" at Yale-New Haven Hospital. I had just started my second year of residency training in psychiatry, rotating on the consultation liaison service. The caller from nursing station asked me to set up a time to see a patient who was dying of widely spread thyroid cancer that had not responded to treatment. At the appointed time, I went to the nursing station and was stunned to see the entire young house staff and nurses packed into the nursing station just waiting to see me. They explained, with a tremendous amount of concerned intensity, that they wanted me to see a patient, Robert (I use his real first name as my way of memorializing him, to thank him for what he taught me). They told me that he was a young man who had been treated by every conceivable, available method - sadly to no avail. The anguish on their faces was astonishing, and they certainly created the impression in my mind of presenting a most depressed and frightened patient. I quickly reviewed the chart and then walked down the corridor towards his room. I knocked on the door and heard a rather surprisingly cheerful invitation to "come in." I walked in and was almost wondering if I was in the right room. There was Robert, sitting in the hospital bed, with a hospital table hovering over the bed. It was crammed with books, newspapers, magazines, and audio tapes - one of which was obviously in a tape recorder - blasting a Bach piece. Robert turned the volume down a bit and cheerfully asked who I was. I gave my name and he asked me what department I represented.
I said, "Psychiatry," to which Robert replied smilingly, "Oh, do they think I need your services now?" He asked me to come in, pull up a chair, sit down, and then he proceeded to ask me a few things about myself: Why I was there? It was clear that it was Robert - not I, who was in complete control of the interview. I was totally flabbergasted, obviously expecting a depressed patient instead of this rather upbeat, fully in control young man. As I began questioning him to find out whether I was meeting a person in total denial of his illness or someone who had slipped into fantasy, it became abundantly clear that Robert had full knowledge of the short time he had left in life and was completely competent and realistic. As Robert explained to me, he was sad that he was not going to continue his life, but ... as he went on ... in his few short years, he had crammed more meaningful experiences into his life than had most people do during a long lifetime. Robert was a graduate of the New England Conservatory of Music, which explained the choice of music I was hearing. He had completed two years in the Peace Corp building a school in a mountaintop village in Peru, and he had engaged in many other profoundly satisfying activities during his short lifetime.
We talked some more and finally I asked Robert, if, were he to find it comfortable during the time he was going to be at the hospital, might I accompany him during this phase of his journey? He very quickly agreed and invited me to spend time with him. I took out a piece of paper and scheduled myself to see Robert in two days at a particular time, and I told him we would do this regularly. He thanked me and I took my leave, going back to the nursing station. Again, waiting was the entire house staff and all the nurses. They were waiting for me to tell them what I was going to do for Robert. As I looked at their faces I learned my first lesson in this area of medicine, namely, that often it's the staff members - even more than the patient - who need attention. …