I am an optimist. I want my patients to have hope, I want to help them keep hope. And when I see a patient who has the potential to stabilize, to even somewhat turn things around for a period of time or longer, I want that for them. Being palliative for me does not me turning everything off. Rather, it means doing everything possible to make decline as bearable as possible, to give as much quality to living for as long as possible. If we are able to get more living out of this process, then that is wonderful. And with the nature of mortality changing rapidly in these medically dynamic times - where a quiet but burgeoning revolution in the utilization of our own immunities to treat what befalls us is occurring - it is key to remain flexible in our notions of terminality.
This is why it hurts me to see a patient give up. It's not always clear why this is occurring. We don't live in our patients' bodies, we haven't walked in their shoes. We will never quite be able to comprehend how hard it is to suffer endlessly over years. But, when they have been suffering without cease, and come into my world, and I see that there are novel things which can be done to modify the trajectory, to ease the burden, to shift the course, I admit it is painful for me to have to acquiesce to their decision of doing no more, of letting go. I can't help but feel a sad defeat, wanting to give them my mindset of hope and optimism, wanting to be able to trigger a new internal blossoming of faith.
Sometimes, in spite of what we know we can do, in spite of where we know we can go, we simply have to accept the fact that people are tired and worn out from their illness. Patients, over years of dealing with practically insurmountable difficulties, can become so demoralized and robbed of hope, they simply know they want it all to end. This cumulative yet rational end-point of giving up, while very difficult to accept, is sometimes where the patient realistically is, and I respect that, too. While I want to give my all to my patients, I know that I must meet them where they are. When they have fought the fight they've wanted to fight, I will honor their desire to let go, and make sure that they have the comfort that they were always seeking. No matter how much it grieves me.
