My medical school’s secondary application, like that of many other medical schools, asked me to describe a personal or professional challenge or conflict and to explain how I worked to resolve it. However, unlike other medical schools, my school specified that they did not want to hear about the MCAT or another academic challenge.
For this question, I wrote about a challenge that I have been facing for most of my life. Although I was 23 years old at the time of writing my response, I was still learning how to discuss with others my father’s death from cancer, which occurred when I was six years old. As a child, I was taught the concept of death, but I did not ever take the necessary time to express my deeply held emotions of confusion, pain, and grief. Death seemed to be a topic overlooked in my family. Consequently, I did not gain practice engaging in conversations about my father’s death very often.
I described in my application essay that it occurred to me that I would soon enough need to be able to discuss death for the sake of my future patients, their families, and my colleagues. For the first time, I explored connections between my own loss and my observations regarding the role of death in medicine. I read books, watched docuseries, and listened to podcasts pertaining to death in medicine. Also, I engaged in conversations with physicians at the hospital, where I worked regarding their thoughts on how physicians deal with death in their practice. It became clear to me that even with their many years of training, physicians are often ill-equipped to discuss death. These conversations and my ongoing reflections prompted me to realize that despite death’s inevitability in medicine, and how death is a part of our shared humanity, many physicians view death as a feared, taboo subject. I concluded in my application essay that I would embrace, rather than stray away from, the difficulties of discussing death as a medical student and physician, and that I also wanted to help the medical community to do the same.
Fast forward to my life as a medical student. For the class in which my peers and I learn interviewing skills, among other patient-centered themes, we met weekly in small group sessions with our two physician facilitators. In the session focused on the psychosocial history, we took turns interviewing a standardized patient who had a different case for each student. These interviews occurred in front of my entire small group class.
My interview started off smoothly. Then, when I asked my patient if she had experienced any major changes or stressors in her life recently, she told me that her mother died just last week. I was shook. None of my peers’ encounters related at all to death. I felt that my medical school purposely gave me this case to put what I wrote in my application essay to the test. I knew exactly how I was supposed to act in the encounter, that is, with the utmost empathy, concern for the patient as a person, and effective validity techniques. I was recently taught these things, which I had carefully reviewed to prepare and feel confident for taking my patient’s psychosocial history. But at this moment, I felt anything but prepared and confident.
I struggled to find and articulate the words to make the patient feel that I truly cared for her and that my heart went out to her, let alone that I could empathize with her. My nerves and tension were obvious to me, while I so strongly wanted to be warm and comforting. I continued to ask her the checklist of questions as I was instructed, but not in the manner that I wanted to, or how I conveyed in my application essay that I would one day.
As disappointed and frustrated as I felt after my standardized patient encounter, I viewed it as an important learning experience. I realized that I first needed to be patient with myself. Whether it is due to the inherent sensitivity of the subject or that it can be triggering, death is, in fact, difficult to discuss. I recognized that just like the many other skills and knowledge bases that I must develop in medical school, practice is crucial. I have since tried to fully lean into experiences that will seem to allow me to practice discussing death.
My medical school is one of over 70 medical schools to offer the humanistic elective course called The Healer’s Art. Two of the five sessions were devoted to loss and grief. In the days leading up to the first one, I nervously pondered how I would best explain my experience with loss to my three peers and physician facilitator. While actually sharing my own experience with death, I felt heard and appreciated. As our conversations about my story unfolded, I began to feel less uneasy and afraid of talking about death. It was ultimately such a special feeling knowing that my peers and I had crafted new connections—they knew about my experience with grief and loss—and I learned about theirs too.
As I pursue my medical education, I will continue to identify and welcome experiences that can shed light onto the art of discussing death. As my standardized patient encounter illustrated to me, they may even appear unexpectedly. I encourage you to also challenge yourself to improve in your ability to talk about death with others, and in a way that is compassionate, sensitive, and genuine. I believe that COVID-19 further illustrates the importance of physicians being able to confront mortality in their practice, including in the contexts of engaging in end-of-life care conversations with patients and informing families of their loved ones’ deaths. Now more than ever, we will be better served as both physicians and people at large if we embrace the challenge of discussing death – a thread in our shared tapestry of life.
Emily S. Hagen is a medical student.
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