Sarah Hanafi is a medical student in the Class of 2018 at the University of Alberta
In healthcare, we sometimes hear the saying, “I went home thinking about that patient.” I thought I knew what this meant until I met Winnie.
It was a foggy Tuesday and the humidity hung thick in the air. On my first day as an elective student in Palliative Care, I was apprehensive as I exited the elevator onto the hospital unit where I would be spending the next two weeks. Soon after my orientation, I was asked to go meet my first patient. Winnie came to us with pain and shortness of breath due to an advanced lung cancer. We worried that Winnie’s hospital bed would become her death bed.
During my first encounter with Winnie, it became obvious that her tumour and—even more so—her mortality were weighing heavily on her chest. She suffered most at night, when she would wake from nightmares struggling to catch her breath. When she found no one at her bedside, panic would engulf her as she feared she may have taken her last worldly gulp of air.
In that first meeting, her husband stepped out to grab a coffee. She joked that she does not let him leave her because she hates being alone. As I summarized our plan and said I would return in the afternoon, she reached for my hand and implored me to stay.
Winnie questioned her place with God. When she sought counsel with her mother-in-law, a medicine woman, she was told a woman of faith should have nothing to fear in meeting her Lord. And so she agonized over her status in His eyes, unable to reconcile her fear and her faith.
We rallied strong pain medications, sedatives, and supplemental oxygen to quell her shortness of breath and anxiety—but still the suffering overcame her nightly in waves, like a dingy in the throes of a violent sea storm.
She vacillated between the pleasant, charming Winnie and the brittle, irritable Winnie. She was as emotionally fragile and delicate as her physiological status, which continued to teeter in the proverbial balance.
Each day I returned home consumed by the image of her frail, emaciated body: a chest wall so thin that I watched it bounce up and down as the heart beat against its cage, offset by legs so edematous they served more as tethering weights. But even more so, I kept seeing her anguished face and hearing the distress of her voice.
A few days into our therapeutic relationship, I thought maybe we had forged some progress in the battle for comfort. Winnie was “feeling stronger,” she proclaimed. Unfortunately, this meant she was finding contradictions to her mortality; without the progressive physical pain and difficulty breathing, she could reason away the tumour that was ravaging her vessel from within. Having previously sought a referral for medical assistance in dying, she now wished to revisit the idea of a medical ‘cure’. I could not fault her. After all, I was also an eternal optimist. As we reiterated her prognosis and sought to definitively determine her goals of care, she froze, unable to continue the conversation. Her pain and shortness of breath returned in full force.
We had no pill to treat existential distress.
When I went to check in on her the following morning, she was visibly anguished. Before I could finish inquiring—rhetorically—about how she was doing, she asked, “Why do they hate me? Is it because I’m a dirty Native?”
My heart sank. Perplexed, I asked what had happened and she described waking panicked in the night and then trying to make her way to the washroom. Her swollen legs did little for her mobility, and she fell. The nursing staff attending to her followed protocol; they assessed the nature of the fall prior to helping her up in case she had a fracture that, if manipulated through repositioning, could cause further harm. But explanations of protocol are meaningless in the face of generations of institutionalized racism. I felt defeated, knowing I could do little to make the hospital feel like a safe place once again for Winnie in her dying days.
Her pain and shortness of breath became unmanageable. “It hurts!” she cried. This time, her chest heaved in a manner that communicated searing emotional pain – I did not need my clinical skills session to teach me that.
We had no pill to treat intergenerational trauma.
For ten days, I made my journey home by foot with my head down and my posture slumped in failure and eventually shame. I was failing Winnie. On the tenth day, my preceptor noticed my silence and the turmoil on my face after we had met with Winnie, and he asked what was on my mind. I stumbled over my words, not knowing how to put the whirling, emotionally-steeped thoughts into a cohesive phrase. I did not want to make it about me. Eventually, it came out: “I don’t know what to do—I feel like I’m failing her.”
He gave me a knowing look filled with empathy. I will forever remember his next words: “Sarah, sometimes being present in their suffering is all we can do. And that is still healing.”
It has been several months since I said goodbye to Winnie, but I still think about her every week. I remember her charming manner of speech; her seven daily cups of Tim Horton’s coffee; and her full-toothed, whole-hearted grin. Although I am still learning to be at peace with my inability to cure my patients’ suffering, I will forever be grateful to Winnie for being my first teacher.
Note: This is a true story, though the patient’s name has been changed. Consent has been given for this story to be told.