The Healer's Art: Honoring Life and Death in Medicine

As a new first-year medical student, I was still learning to take medical histories in the hospital when I had my first conversation with a patient about death.

Mrs. L. was a woman in her 80s who had been on dialysis for seven years due to kidney failure.   Mrs. L. was lying in bed, her arm hooked up to a dialysis machine.  Over the noise from machines in the room, I had to shout to be heard.

"How are you feeling today, Mrs. L.?”

“I am going to go home soon so I can die,” she replied frankly.

Panic set in; I wasn’t sure how to proceed.  No one in my first few months had told me what to do if a patient said they were ready to die. 

I awkwardly continued, “Oh, you are getting to go home soon … so you must be feeling better.”   I continued my interview, asking why she had come to the hospital and how her stay had been. Every few minutes, Mrs. L. would bring up how tired she was, or mention how she was looking forward to passing away.  I would nod and move forward with my interview.

Confused thoughts ran through my head: Is my patient suicidal? We hadn’t had our psychology block yet, so I was unsure. I had heard that many elderly patients were depressed. Should I tell my preceptor?  What should I say, what should I do?  I felt really sad and scared every time Mrs. L. brought up the subject of death.

As we moved away from medical topics to her job and her retirement, the conversation flowed more easily.  Mrs. L. told me about her career and her amazing life, in which she broke gender barriers and worked a man’s job both in World War II and in her career as an academic.  She told me about what she was doing now in the community and all about her friends.  It was clear to me that Mrs. L. had lived a full life, and I was touched to have heard her story. 

Toward the end of our long conversation, she brought up once again that she was ready to die.  I worked up the courage to ask why she felt that way.  She responded that dialysis was expensive; she was contributing to the Medicare debt; she felt tired and was simply just ready to move on.  We ended our interview, and I thanked her for her time and for letting me talk with her.

After the interview, I spoke with my preceptor about Mrs. L.’s decision to die and what I could have said in response, but there was little time for deeper discussion, so I left, craving more guidance. Some of my first-year colleagues I talked to did not know what to do or say either.  We were here to help people to live.  Where were the classes on how to talk with people who wanted to die?

I found my answer shortly after winter break, when I started seeing posters for an elective entitled The Healer’s Art. This provided a forum and a structure to explore who I am as a healer, what I can bring of myself to the healing relationship and how I can best be of service to others.  The small group format provided a safe space where I could share my own experiences and learn from what my colleagues had to tell me.  I was able to learn more about my innate healing abilities and how listening generously to others is one of the most important aspects of healing. I also learned that dealing with my own grief and loss is the first step to accepting the suffering of others.

The course came at a time when I was feeling the most burned out from my first year, ready to throw in the towel.  All I wanted from medical school was to learn how to become a healer.  Medical school was not at all what I thought being a doctor would be like; it seemed to me to be full of objective science, without an equal focus on compassion and healing.  But in The Healer’s Art, I was able to connect with my classmates in a new way and saw that they too were struggling with the issues they were encountering.

The Healer’s Art has been taught every year at UCSF since 1991. At noon on January 7, Dr. Rachel Remen, the director of the course, will give the annual introductory noon lecture entitled The Art of Medicine: Remembering That Who You Are Is As Important as What You Know. This talk, to be held in N 225, is open to everyone on campus and is an opportunity to learn more about The Healer's Art. The elective is for medical students only, and will take place on five Wednesday evenings during winter quarter.

Each session begins with a discussion and reflection on the evening’s topic, followed by a small group discussion. The small groups stay together throughout the course and include faculty who are there to learn alongside students. This year the course* and each session’s topics are on the following dates:

• Session 1: 6:30-9:30 p.m., Wednesday, January 9: Discovering and Nurturing Your Wholeness
• Session 2: 6:30-9:30 p.m., Wednesday, January 23: Sharing Grief and Honoring Loss
• Session 3: 6:30-9:30 p.m., Wednesday, January 30: Small Group Discussion on Grief and Loss
• Session 4: 6:30-9:30 p.m., Wednesday, February 13: Beyond Analysis, Allowing the Awe in Medicine
• Session 5: 6:30-9:30 p.m., Wednesday, February 27: The Care of the Soul, Service as a Way of Life

(*Each session begins in the Lange Room on the fifth floor of the Library, except Session 3, which occurs entirely within the small groups.)

Contacts:

• Amelia Castro, M3 - Amelia.Castro@ucsf.edu
• Chloe Le Marchand, M2 - chloe.lemarchand@ucsf.edu
• Elaine Lee, M1 - ELee@ucsf.edu
• Alice Mao, M1 - Alice.Mao@ucsf.edu
• Erin McCreary, M1 - Erin.McCreary@ucsf.edu
• Brandon Perkovich, M1 - Brandon.Perkovich@ucsf.edu
• Shannon Satterwhite, M1 - Shannon.Satterwhite@ucsf.edu
• Elise Taylor, M3 - elise.m.taylor@gmail.com