Saturday, May 25, 2013

Codeword: Grace

I spent the last three weeks on a palliative care rotation working at an inpatient hospice facility. It's been an eye-opening experience. I've learned a lot about drugs that provide comfort at the end of life. Patients end up in hospice care when they've decided to pursue comfort measures only. Interventions done in hospice, whether pharmacologic or otherwise, are meant neither to artificially prolong life nor hasten death but only to provide comfort. I was very thankful to be working in a facility run by Roman Catholics where something like assisted suicide is completely off the table, especially in a state where it is unfortunately legal. More important than learning about pharmacology, I've seen the interactions between the providers, who are experts in this area of palliative care, and patients who have a terminal diagnosis and often have days to weeks to live.

At times I've questioned whether going into medicine was the correct choice. I've thought back longingly at times to the days of doing construction before I went to seminary back in the early 2000s. But the privilege of being with my patients and their families at their most difficult moments is something I'm very thankful for. The only other profession which probably has that same privilege is being a pastor or a priest.

Out of all of the patients I cared for in the past three weeks, one especially stands out to me. He was an elderly gentleman, close to the age of 90. Before he arrived I read through the hospital paperwork that had been faxed to our facility. I saw that while he had significant Alzheimer's dementia, he had still been walking up and down stairs and sitting at the dinner table and eating with his family until a week ago. A week ago he had fallen and after the fall his mental status never returned to its prior baseline. He was taken to the hospital where multiple problems were discovered including a broken pelvis, a heart attack and a blocked bile duct resulting in a severe and deadly infection called ascending cholangitis. The gastroenterologists, experts in the GI tract, were consulted but because of all of his severe medical problems were unwilling to risk an invasive procedure to try to unblock the bile duct. As the patient's clinical picture continued to worsen in spite of powerful antibiotics, IV fluids and other interventions, palliative care was consulted and the decision was made by the patient's wife and children to transition to comfort measures.

As I read through all the paperwork we had received I was interested to read that this man had been a Baptist pastor. I made a mental note of this, thinking that this might be a good opportunity to pray with the family, something I'm always on the look-out for. The patient arrived and was started on a morphine drip for his severe pain from his pelvic fracture and biliary obstruction. In my (very inexperienced) medical opinion the patient looked to be actively dying. I thought he probably had hours to live. After getting him situated I went to meet with his family along with one of the staff doctors at the hospice facility. We had a long discussion regarding the patient's prognosis, what to expect very near the end and the details of comfort care. One of the patient's seven children warned us that they were a "singing family" and that there would probably be some loud hymn-singing emanating from the patient's room. Now they really had my attention as I'm one of those strange folk whose favorite music genre are hymns, especially those written more than a century or two ago.  The meeting ended and I went back to my duties, caring for other patients.

The next morning I was surprised to see that my patient had made it through the night. When I entered the room it was crowded with his many children and a gaggle of grand-children. I examined the patient and answered many questions regarding his care. As I was about to leave I mentioned that I would have liked to have heard a hymn at some point. I didn't assume that this grieving family would invite a doctor, a stranger to them, into this fellowship and worship of the Lord. I was surprised when a hymn, "How Great Thou Art," was rapidly begun. So I belted out this hymn with the rest of the family, around their dying father's and grandfather's bed.

I should have known that my experience with this patient and his family would be a blessed one from the beginning though. During our first meeting, after his arrival, the family was asked to come up with a codeword so that if one of them called our facility asking for information the information could be supplied without breaking privacy rules - if the codeword were supplied. After a brief moment of silence one of the patient's sons said the word "grace." The patient's elderly wife who was hard of hearing and had said very little during the meeting asked for the codeword to be repeated. "Grace!" said her son. She smiled. "That's a good one! I'm saved by grace!" she replied.

I was greatly blessed by this patient and his family. They preached the gospel to me. It's good to be a doctor.

And when I think, that God, His Son not sparing;
Sent Him to die, I scarce can take it in;
That on the Cross, my burden gladly bearing,
He bled and died to take away my sin.