Dear Palliative Care,
I must admit that I used to associate you with Charon, the ancient Greek ferryman who helped people cross the river Styx and enter the afterlife. This was before I met you.
It was not that I did not appreciate your work. It was that I found it difficult to navigate my feelings because I associated the referral to you with the loss of them.
When I first started scribing, you were not even on my radar. I had been so worried about working in oncology, thinking death would be skulking around every corner. I was afraid that I would come to work on Monday, and the bad news from the weekend would pounce. It was not like that, and I felt relieved. But I still dreaded the day when I would need to turn to you.
And then we had an appointment with RM. He was suffering from so much pain. His cancer had metastasized to his bones, and he used the word “pain” 24 times during our 15-min appointment. At the end, the doctor turned to me and told me to place my first referral to palliative care, to you.
A few weeks later, I learned that RM had died. He was my first patient to pass. The grief that I expected to feel arrived, forcing its way into my heart without knocking. For nights I tossed and turned, arms flailing as I tried to stay afloat. One thought, one dove flew above the water. RM died, but he died without pain.
After RM, my fears around you dissolved like salt in water. Like the Dead Sea. There was still brine — I wished none of my patients would need you — but I could not ignore your importance. Saltwater burns wounds, but can also help people float.
WT came into the liver clinic. He had no chance of getting a transplant. He was afraid, not about the destination but about getting there. He did not want to suffer. You granted his wish. I hope you know that when you did, you granted his family's and mine as well.
It also helped me to see another side of you. We placed JL's referral for comfort care and, for the first time, a referral to you was not a goodbye. She came back, and she came back happier, healthier, and more determined than ever. She sat up straighter, as if a weight had been lifted off her shoulders. She smiled and laughed in an appointment for the first time, and so did we. What a gift you gave us.
Toward the end of my year as a scribe, I was in the room with ML. Her glioblastoma was not responding to treatment anymore, and she understood what that meant. The doctor had stepped out of the room to take an urgent call. Just before this interruption, she had brought up the possibility of referring her to you. ML looked at me and asked, “Is this giving up? Is this the end of my story?” ML was an author, and her preferred metaphors involved writing. I thought about RM,WT, and JL, and the dozens more of my patients who you had helped. I shook my head and said, “No, this isn't giving up. This is taking control. This is choosing to pick up your pen and write the final lines of your story yourself.”
I have already admitted that I used to think of you as Charon. I actually still do, but you have redefined my image of Charon. Not skulking and skeletal, ready to pounce. Now, he is on the shorter side, with a warm smile and outstretched arms. He greets me when I see him and listens while I introduce my patients. I still do not want to see them cross the Styx, but I look at Charon and know the journey will be smoother — with less pain and suffering. I can only imagine how difficult your job must be, but that is why it is so important.
Now, I look at Charon and place my patients’ hands gently in his. He helps them into the boat, and together they glide along the surface. I watch the ripples from the boat and my tears until they disappear. My heart is full of gratitude, knowing my patients are in good hands.
Thank you.
Acknowledgment
I would like to thank my classmate Melanie Ambler for reading an early draft of this letter and providing insightful feedback.
