There's a quiet anxiety every time you have to bring up #PalliativeCare care w/ patients or families. You never know how they'll take it.

From a recent conversation:

"I'm glad you're the one taking care of my husband right now. Thank you for your honesty and kindness."

1/

It's the last stretch of my intern year. A lot has happened. I've learned so much from so many mistakes.

In residency, there is always someone to catch the medical mistakes before they happen.

But no one can catch the words from your mouth.
Sometimes, words can hurt more.

2/

A couple months ago, a patient's son came up to me in the hallway. He wanted to talk about his mother, who had metastatic breast cancer. We wanted to send her to hospice at home. It's what she wanted.

But he was angry and confused. He had not known about the metastases.

3/

"Everything is happening too fast."

I spent a long time with him and her other family members. We ultimately decided to send her to inpatient hospice, with the goal to get her home eventually.

He thanked me at the end, after his tears had dried.

4/

Later, the hospice agent, who had listened to the entire conversation, would compliment me. "You were really great," he said. "You gave them some peace. I'm impressed."

5/

Something he didn't know:

I was the intern who had taken care of the patient 4 months ago, when she first came to the hospital, and was first diagnosed with metastatic breast cancer.

I was the one who informed her of her diagnosis.

6/

I looked back to my notes from back then. Documented: "Discussed diagnosis w/ patient and son at bedside."

What did I say back then?
What did I mess up?

His confusion, his anger, his sadness - could I have prevented some of it?

7/

People go into medicine for a lot of reasons. But virtually everyone wants to "help people" in some capacity. When you hurt them instead, there's a guilt that builds up.

You carry it quietly, in the back of your heart, where even your nightmares don't go.

8/

These days, my voice has gotten softer. I speak slower. I use smaller words. I repeat myself.

I don't really know if it's working. You don't get to see the consequences of your words.

But at least this last time, I was better.

fin/