WHEN MY MOTHER-IN-LAW Seda made the painful and difficult decision to discontinue treatment for ovarian cancer and start hospice care at home, my partner and I, her caretakers, were anxious about leaving behind her superb healthcare team at Massachusetts General Hospital. All through the two-year process of her illness, we had relied on her doctor and nurses to answer questions at any time of day or night. How would we manage without them?
And then her oncologist told us he was coming to visit. Despite predictions of a blizzard, Richard T. Penson, MD, drove an hour to an unfamiliar town, bringing a visiting resident from England with him. Introducing Seda, who was also a physician, he told the resident that she was a woman with much wisdom.
After doing a short physical exam, they sat by her bedside. Dr. Penson held her hand and talked with her openly about the dying process. All along he had asked her what her goals were: to attend her granddaughter's high school graduation, to hold her newborn great-granddaughter. She had met those goals. Now, he asked her if there was any more work she needed to do, any other things she needed to resolve. She responded that she was planning her memorial service.
He said it was important to tell the people around her, “I love you. I forgive you. Will you forgive me?” “I've been saying ‘I love you’ a lot'” she answered. Dr. Penson, pointing out that he was wearing the tie she had given him, said that it had been an honor to treat her and that he loved her.
The young woman resident talked with Seda for a few minutes on her own after Dr. Penson left the room. She observed the family photos and asked me questions about Seda. It was clear to me that she was extremely moved by the experience. What better way to teach respect for a dying patient's dignity and humanity than with a visit to her home? By visiting, Dr. Penson communicated to Seda that she was still important to him. By bringing a resident, he communicated that she still had value, that people could learn from her.
I wondered if he had come because she was a doctor. But when we thanked him, he said that he tried to visit patients at home when they started hospice care, explaining that he did it not only for the patient but for himself, to help him with closure.
As the CME industry redefines the credit system and develops new education models such as point-of-care activities (see news story, page 11), I hope we also explore new ways of teaching health professionals how to provide emotional care. There's been much discussion about the need to teach doctors better communication and interpersonal skills. I'm not sure empathy can be taught, but certainly Dr. Penson's example and experiences could help other doctors.
I'll always remember his visit, how he held her hand, how touched she was. He became an integral part of the dying process, helping her to die at home with dignity, in the care of those who loved her — to die as she wished.