Cuidados Paliativos

From suffering to transcendence

Narratives in palliative care

Maria Auxiliadora Craice De Benedetto, MD
Coordinator of the Brazilian Society of Family Medicine’s (SOBRAMFA’s) Department of Humanities in São Paulo, Brazil Ariane Gianfelice de Castro, MD
SOBRAMFA’s third-year family medicine resident

Elsi de Carvalho, MD
SOBRAMFA’s second-year family medicine resident

Rokia Sanogo, MD
SOBRAMFA’s first-year family medicine resident

Pablo González Blasco, MD PhD
SOBRAMFA’s Scientific Director

Correspondence to: Dr De Benedetto, SOBRAMFA, rua Das Camélias, 637, São Paulo, 04048-061, Brazil; telephone 55 11 5583 3539; fax 55 11 5589 7678; e-mail<!– var u = “macbet8”, d = “”; document.getElementById(“em0”).innerHTML = ‘‘ + u + ‘@’ + d + ”//–>

Working as family physicians in an academic palliative care ambulatory clinic in Brazil has taught us many lessons. We have learned, for example, that even if a story’s only possible ending is death, it can be written in many ways. The various people involved in a story—patients, patients’ families, family doctors, and family medicine residents beginning their trainee-ship—experience it according to their own perspectives and interpretations. Any situation can have unexpected meanings for each of us. The most important lesson we have learned is that, even if the end of the palliative care story is inevitable, its course can be changed. The direction of the changes often depends on the nature of the patient-doctor and the family-doctor relationships.

The first encounters with terminal disease are usually frightening for our junior doctors. The following comments illustrate their feelings and concerns at the start of the traineeship:

“I think I will be useless here, since there is nothing to do.”

“During training we are taught to deal with success and to apply scientific evidence and technological advances to solve medical problems. Such subjects as pain, suffering, and death are almost ignored, as if they don’t represent important elements of daily medical practice.”

“At medical school, I had few contacts with death, and when it occurred it was in artificial circumstances, where doctors I considered more capable commanded the scene. But everything was done with that same detachment they had always tried to transmit to us as being the only attitude suitable in such situations. Personal feelings were not allowed, and I felt that something was missing.”

“I panic just thinking that I will have to see terminal patients. I won’t know how to behave.”

“I don’t know what to do if the patient asks me ‘Am I going to die?’ or ‘Doctor, when am I going to pass away?’” Continue reading Cuidados Paliativos