Last week I spoke at a medical school. I do a lot of talking about end-of-life care these days, but I saw this invitation as a special opportunity. After all, only six medical schools in the U.S. require training in end-of-life care. Only two percent of their textbook pages even refer to the fact that patients die. The same is true of nursing books. I typically hammer medical education as inadequate when it comes to giving patients a dignified final chapter. This seemed like an excellent occasion to engage students in the potential that exists now that most people’s lives end slowly.
The lecture hall was brand new, handsome, with audio/video equipment as up to date as any I’d ever seen. Students filed in, a few professors, end-of-life care advocates, several people in long white coats (docs on lunch break, I assume). The dean himself introduced me, an act of either courage or class but welcome either way.
Still, I didn’t hold back. I spent the better part of an hour trying to explain the difference between a patient and a person, how a dying human being is so much more than a set of medical problems that refuse to be solved, how making a person pain-free enables all sorts of potential for mending relationships and spiritual calm. I showed data about how expensive the current approach of high-tech, futile interventions had become. I told stories of people dying well, surrounded by forgiveness and love. I exhorted the students to seek end-of-life care in their training, regardless of what specialty they might pursue, because it would give them a deeper sense of their patients’ humanity.
Truth be told, I laid it on pretty thick. There were comic moments too, though. When I mentioned that President Reagan had signed the hospice benefit into law in 1981, I asked the students how many of them had not been born yet. Quite a few hands went up. I can’t say it made me feel especially young.
I closed the remarks with a study done at the Thomas Jefferson School of Medicine, in which students spent two days with a hospice nurse. Afterward their comments were profound – humble, wiser, appreciative of the predicament dying people and their families find themselves in.
Then I asked if there were any questions. You all know this moment, the few seconds of awkward silence before the real dialogue begins. To me that is often the most rewarding part of the talk.
But this time there were no questions. Maybe the students were afraid to speak in front of their profs. Maybe the docs had to appear cool in front of the students. The silence stretched out. But I did not rush to fill it. I knew people had things to say. It was just taking time to begin.
Then a man at the back raised his hand. He looked to be about 65, had a grey goatee and glasses, and he was sitting on the aisle in the very last row. “I’m just a civilian,” he said, not a medical person, and he made some crack about feeling like a chicken among foxes. Everyone laughed. The dean made a joke in response. Then the man’s face grew serious. “I have something to say to the students.” He held up a copy of Last Rights. “I have read this book twice, and I just have to tell you …”
And then his voice broke, and he began to weep. The room went completely silent. I told him to take his time, to take a breath. He tried to collect himself, but his throat was closed and he only cried harder.
I looked around that handsome lecture hall, and I wondered if tears had ever been shed in there before. Then I realized something: This man’s grief was making my point in ten seconds better than I had in 45 minutes. It didn’t matter why he was crying. It mattered that these students, amid all of their lectures and labs, textbooks and tests, were receiving an undeniable reminder of the humanity that comes to them in times of deep vulnerability.
Medical students, are you listening? Do you hear the lesson in that man’s tears? And practicing physicians and nurses, does he touch your hearts too? Do you remember why you chose this profession all those years ago?