I'm not really sure what to title this

Talking about hospice medicine is hard

I know I’m officially a neurotic pre-med because less than one year after deciding to commit to a back-of-the-mind pipe dream of being a doctor (catalyzed by the most traumatic shit of my life), I am now in every possible pre-med forum, private chat, club, and TikTok live. I am insufferable.

The other day while I was doing my usual sleuthing online—to get jealous at this cycle’s acceptances, find more programs to apply to, etc etc—I came across a post about hospice. Part of me jumped! Yay, hospice! Most pre-meds are looking at emergency medicine, dermatology, or other competitive specialties to get shadowing and volunteer experience in. This isn’t different at Columbia. In fact, it’s probably exacerbated by the hyper neurotic pre-meds in the post-bac program, who often come from banking or big law, and are looking for a ROI on the ungodly tuition fees.

“How do I feel fulfilled volunteering in hospice when my patients don’t show it?” (I changed the wording so you can’t look it up, nosy you.)

It’s a question I know all too well. With my grandmother, well, I have always described her as an angry patient because of our family history. I flew every weekend one summer to help sort out her care after adult services got involved when my Dad and her had a falling out. And I moved her to one of the best facilities for dementia in New Jersey so I wouldn’t have to drop out of college again to be her caregiver. I watched her nights before school, and evenings after class. My identity as a college student felt wept away as I exposed myself to the worst of caregiving. And all the while, her dementia worsened and the truth of my childhood—that she didn’t like me—came out all over again. It was thankless work with a lot of isolation and dark moments.

Spread thin and watching my life crumble, I joined a grief group at my school for a brief time, packed mostly with young women who had lost their fathers. Some were self-loathing perpetual criers, though there were others who were a bit more reflective. My favorite girl from the group was a young artist who lost her estranged dad while in college, and was iced out of her friend group because she took a gap year to grieve and didn’t show up to protests occurring on campus. Part of me envied that she even had friends to begin with, because my identity at my undergrad was tied to my role as a caregiver from the start. I doubt most of my classmates knew who I was; I usually had to speed out of class to catch the NJ Transit into Elizabeth. Anyways, the artist was always appealing to me because with words and art she captured the injustice of being punished for caring. She cared about someone who didn’t care for her, and in response she lost friends she hoped would care for her. Her dad wasn’t thankful for her, and frankly her friends didn't expend the level of care she expended on her dad. Whoever said you get what you put into the universe clearly forgot this poor woman.

The topic of appreciation for near death people is tricky. In my case, and the artists’, familial history can predictably make caring for someone till the end a thankless job. I knew I wasn’t going to be my grandmother’s favorite by caring for her, because the qualities that drive me to care for her were not the things she loved or didn’t love me for. But I have those qualities, and I needed to see her death through. It’s the same with the artist, and every hard ass nurse you’ll meet in hospice. Caring for someone until the end isn’t a kindness, but a morally good deed.

Still, with all of this written out, I had nothing I could say to the writer of that question. I wish I did. The draw to caring until the end is stupid, a net negative, and yet necessary and expected of every single person who doesn’t want to die sitting in their own piss (a reality my grandmother almost saw out). Death and feeling appreciated by those who are dying is a difficult topic. Sometimes on this blog, I abandon my ideas of moral good in medicine, or I avoid the feelings that bring me here in fear I’ll change my mind. I once sent out a newsletter on this blog which had been partially generated by AI because I couldn’t bring myself to write a conclusion that had any value. I’m sorry to whoever read that one and saw the ChatGPT message at the end. Some things are just hard. Writing is hard, caring is hard. I’m actually not sure which is harder. But we must do them anyways