My third two-week block was a bit different, as I transitioned from inpatient OBGYN to Palliative Care (PC). I knew very little about PC before this elective; I knew that teams often consulted them to talk to patients with particularly difficult diagnoses, and that they were the people who managed getting some terminally ill patients into hospice. I learned that the role of PC in the hospital is three-fold: symptom management, goals of care discussions of various caliber, and hospice referral.
I worked at Vanderbilt Hospital (VUH) and at the TN Valley VA hospital down the street. At VUH, there is a PC consult service and an inpatient PC unit. I got to spend time on both services, shadowing the providers and learning so much from them in the process. They taught me about how to manage pain with various opioids, how to deliver bad news to patients and family, how to discuss goals of care and advance directives (not the same thing), and how to conduct family meetings. The family meetings were especially interesting–we were present for a particularly difficult one that included members of the primary team as well as the ethics board, whom I’d never been able to work with before. The VA’s PC service was a bit slower than VUH’s, but I still feel like I had a very robust experience and learned quite a bit about the important role of PC. In addition, I got to know the team quite well; I helped them celebrate one of the attendings’ birthdays and found out that the PC social worker there had gone to my grandfather’s church while he was still pastoring in New York!
The attendings I spent time with at both hospitals were phenomenal. Their bedside manner, their way of coping with difficult situations, even their sense of humor…all of it is something I want to emulate. One of the attendings sat down with me and gave me some great encouragement, reminding me that I am meant to be here even when I feel like the opposite is true. She also put me in touch with some child psychiatrists, so I can learn about what they do and why they do it in the near future.
On my last day of the elective, I shadowed a Child Life specialist. Child Life finds creative ways to make being in the hospital or having a family member in the hospital easier for kids. This can involve playing games with them, leaving them toys to entertain themselves, using puppets to teach them about aspects of their care…the possibilities are really endless. I helped build a Lego tower for a boy who had been badly burned, talked to an adult patient followed by PC about meaningful gifts he could send to his grandchildren (such as “fingerprint jewelry” which is a fantastic idea), and “shopped” Child Life’s personal “toy store” (they probably had a different name for it, but I don’t remember what it was). I didn’t know Child Life existed before spending time on PC, but if you ask me, these people work absolute magic.
PC has to be the most emotionally taxing service at the hospital. I asked about the coping strategies of many of the people I worked with and was encouraged by their willingness to advocate for self-care. I’m not absolutely certain about what I want to do with my life, but it has to be something that allows me to make myself more of a priority than it is right now.