JOURNAL OF PALLIATIVE MEDICINE Volume 17, Number 5, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2013.0424
Through Those Precious Angelic Eyes Noel S.C. Javier, MD
I
t has been two years since I took care of an angelic fiveyear-old girl in an inpatient hospice facility. The experience continues to remind me of how precious life as well as death is. An oxymoron if you will, it has taught me and moved me beyond words. I am pleased of how we have come of age in the provision of high-quality hospice and palliative care. As an internist at heart with specialist training in palliative medicine, I have always been drawn to the care of seriously ill children. During my fellowship year it was not enough that I had four weeks of pediatric palliative care. I ventured out to one of the best children’s hospitals in the country to do additional training in this field. It was fascinating how the tide of my life led me to this path. I knew for certain that I will always have a soft spot for taking care of children. I was called! It was a cold January afternoon when I received a phone call from a palliative care doctor. She told me of an unfortunate little girl who had been anoxic and encephalopathic from a cardiac event. The parents decided against feeding tube placement and wanted to allow the natural process of dying. It was difficult for the family to take her home, as they had two other children. Without much ado, I advocated for her at my institution. The hospice inpatient facility at that time had not taken care of children. After fulfilling the necessary steps and training, we embarked on her care. I advocated! As I examined her, I was reminded of my five-year-old nephew. I would come out of the room emotionally drained. I would spend hours trying to make sense of why this happened while also struggling with my own fears and insecurities. During the day I personified this brave and strong presence. At night I would cry for hours. I am only human!
The little angel taught us about her symptoms, her spirit, and the dying process itself. It was not until three weeks later that she entered the active phase of dying. When she was taking her last few breaths, the mother exclaimed, ‘‘I am here.’’ In an instant, this angel held on to dear life for a few more days. Both were not ready to let go. I was humbled! On the morning of her eventual passing, the mother went home to take a break. Agonizing cries from the father could be heard as the nurse gently encouraged him to hold his daughter one last time. She took her final breath and died peacefully and comfortably in his loving arms. I was moved! SILENCE followed. Each member of the team took it all in.. Our lives were never the same again. She left a legacy of inspiration, openness, and resilience with a renewed look at life and death through her eyes. Good life after all is just as important as good death. I grieved! As I look back on this experience, I am reminded of my own transformation as a doctor but ultimately as a human being. She allowed me to care for her in a way that I could not have imagined more perfectly. By allowing myself to grow, I am also able to give more of myself for the advocacy and care of seriously ill children in need of the basic tenets of any form of medical attention—simply put: tender and loving care. I rest my case! Address correspondence to: Noel S.C. Javier, MD Geriatric and Palliative Medicine Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place Box 1070 New York, NY 10029 E-mail: [email protected]
Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
617
Through Those Precious Angelic Eyes Noel S.C. Javier, MD
I
t has been two years since I took care of an angelic fiveyear-old girl in an inpatient hospice facility. The experience continues to remind me of how precious life as well as death is. An oxymoron if you will, it has taught me and moved me beyond words. I am pleased of how we have come of age in the provision of high-quality hospice and palliative care. As an internist at heart with specialist training in palliative medicine, I have always been drawn to the care of seriously ill children. During my fellowship year it was not enough that I had four weeks of pediatric palliative care. I ventured out to one of the best children’s hospitals in the country to do additional training in this field. It was fascinating how the tide of my life led me to this path. I knew for certain that I will always have a soft spot for taking care of children. I was called! It was a cold January afternoon when I received a phone call from a palliative care doctor. She told me of an unfortunate little girl who had been anoxic and encephalopathic from a cardiac event. The parents decided against feeding tube placement and wanted to allow the natural process of dying. It was difficult for the family to take her home, as they had two other children. Without much ado, I advocated for her at my institution. The hospice inpatient facility at that time had not taken care of children. After fulfilling the necessary steps and training, we embarked on her care. I advocated! As I examined her, I was reminded of my five-year-old nephew. I would come out of the room emotionally drained. I would spend hours trying to make sense of why this happened while also struggling with my own fears and insecurities. During the day I personified this brave and strong presence. At night I would cry for hours. I am only human!
The little angel taught us about her symptoms, her spirit, and the dying process itself. It was not until three weeks later that she entered the active phase of dying. When she was taking her last few breaths, the mother exclaimed, ‘‘I am here.’’ In an instant, this angel held on to dear life for a few more days. Both were not ready to let go. I was humbled! On the morning of her eventual passing, the mother went home to take a break. Agonizing cries from the father could be heard as the nurse gently encouraged him to hold his daughter one last time. She took her final breath and died peacefully and comfortably in his loving arms. I was moved! SILENCE followed. Each member of the team took it all in.. Our lives were never the same again. She left a legacy of inspiration, openness, and resilience with a renewed look at life and death through her eyes. Good life after all is just as important as good death. I grieved! As I look back on this experience, I am reminded of my own transformation as a doctor but ultimately as a human being. She allowed me to care for her in a way that I could not have imagined more perfectly. By allowing myself to grow, I am also able to give more of myself for the advocacy and care of seriously ill children in need of the basic tenets of any form of medical attention—simply put: tender and loving care. I rest my case! Address correspondence to: Noel S.C. Javier, MD Geriatric and Palliative Medicine Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place Box 1070 New York, NY 10029 E-mail: [email protected]
Geriatric and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
617
