There have been a handful of times now where, standing before a patient with poor prognosis, I found myself at a loss for words. Whether they were rapidly deteriorating or on the cusp of rapidly deteriorating, every single one of them faced the unknown, yet, I had a sneaking suspicion that they all knew about the unknown.
The unstable patients sought answers just as much as the rest of us. What’s happening, what’s going to happen, am I going to die? Some of us choose to tell the patient that they are not doing well or explain the basic pathophysiology, followed by what’s going to happen. Another cohort avoids answering these questions altogether and opt to reassure the patient that they will be cared for, no matter what the answer to these questions are. Others choose to tell the patient that they will be okay.
In the face of excruciating uncertainty and especially in the setting of patient care, it is not unreasonable to question: should we give hope to those who exist in a reality where the statistics are against them?
Some envision hope to be a torturous process of ambiguity, a supplantation of some tendril of optimism to hang their hat on altogether. Others use hope as motivation to propel them, or to at least push them through.
And if we agree to provide hope, should we provide it by any means necessary? This is not to say that we would be promising a statistically terminal patient that a magical treatment would cure them, however. When facing a patient who is presently deteriorating and asking the question, “am I going to die?”, do we tell them that they will be okay?
Can we tell them that they will be okay, in spite of the uncertainty we face on the other side of the bed not knowing if they will be alright? What chances can we take by assuring them of this, and can we take the responsibility that comes with assuring someone of okayness?
There is something that prompts these patients to ask that very question, and it’s often not just the blaring alarms that clue them in. With one of my previous patients, there were no alarms, and the only true indicator was my patient themselves, suddenly overcome with a sense of doom in the early hours of the morning. A feeling, they said, that they were going to die.
Unfortunately, they were correct.
These questions, ultimately, urge us to know the patient. Answers cannot be found nor given in the form of essays or standard operating procedures, however much I would like to provide them. These answers come from the patient as a person, begging us to ask, “what matters to you?” And it may not be that we can explicitly solicit what exact words they would like to hear in their final moments, but rather, what values we can extract from their lives to provide comfort as they face the unknown.
Cindy Reynolds is a member of The University of Arizona College of Medicine - Phoenix Class of 2026. She graduated from Arizona State University with her BS in Biochemistry with a minor in English Literature in 2021 and her MS in the Science of Health Care Delivery in 2022. She has special interests in health policy, running, ice cream, and fuzzy socks.