Sing to Me: My Palliative Block
I recently admitted a patient dying of cancer and after running through our impression and plan with him (treat the anemia with a transfusion, stop the GI bleed with a scope and pantoloc infusion, alleviate his bone pain with radiation and opioids), I asked if there was anything else we could do at this time. "Sing to me," he said. Not because he knew I had any vocal training or skill, but in hope of some positive distraction. After all, he isn't the first patient who has asked me to sing. I've had several who have requested musical support toward the end of their life over pain killers or IV fluids.
There's substantial evidence that music helps with isolation, depression, fear, and physical pain in palliative care patients. It doesn't take a rocket scientist to reason out why music can help patients relax and find relief. It's soothing, pleasant, and can allow us to escape. I sat with this patient and sang a Brandi Carlile song. He'd never heard it before. "That was nice," he said. "She's right. To walk the best that you can, on the road you've left behind." I smiled and squeezed his hand. "She's a genius." I said and he laughed.
When I got up to leave, he added: "Dr. Ram. We are so much more than our circumstances, you know. I am not just a dying dad and you are not just a doctor helping a dying dad. And for a moment, we got to simply be instead of driven by do. Thank you." I thought about these words over the weekend and how often, especially during busy consult and ward days, it's too easy to forget that each patient is a person first. It certainly isn't purposeful, but when you have 20 patients to round on and several consults coming your way, you start to focus on just getting stuff done.
In fact, even as a Mom I fall victim to "dos" regularly: laundry, dishes, cleaning up toys, answering emails, etc. Then you're exhausted and it becomes difficult to enjoy the joy of being through play and quality time with those that matter most. As cliché as this is, every dying person I've had the privilege to connect with always says: in the end, your greatest investment in life will always be in people. We gain more by collecting experiences and moments with others than we do from collecting things. This doesn't mean we cannot accomplish the necessary tasks of day-to-day life; however, we need to ensure we don't allow them to overshadow what really counts.
This patient's first question to me this morning wasn't what we could do to alleviate more of his pains and symptoms; rather, he was worried about me only getting 2 days home with my family. His unselfishness moved me. I couldn't help but wonder: if I found out I had a terminal cancer tomorrow, would I regret having been away from my family to complete my studies? Probably a little bit. Yet as I finished my rounds late tonight, I was reminded that I have the gift of a career that thrives on an investment in people. In building relationships, sharing stories and validating memories.
I've enjoyed more laughter and deeper connections with my dying patients during this block than on most of my other rotations. Why? Because once patients enter a palliative unit, we're less concerned with machines and chasing test results, which gives us the space to be instead of do. To tell stories, share jokes, read poems, or quite simply, to sing together.