By Christine Bridges, MD @Cbridges2016
We were locked in tight; cell door locked. 48 hours ago when I arrived in Orlando I did not think I would be behind bars, but there I was with a cell full of hospice and palliative medicine providers, plotting our escape. Escape rooms have now become a new and, in my opinion, best tradition at the Annual Assembly of Hospice and Palliative Care. The Pallimed-Geri Pal event is in demand and I was excited to be part of this group. We signed up from all over the country, with no idea who our collaborators would be. Now we were divided into two cells, and I was trying to pass Luscious Linda (so named at her Improv session the morning before) a key through a defunct toilet, shouting through the wall we shared.
Two years ago I made my first trip to Phoenix, AZ to attend the Annual Assembly of Hospice and Palliative Care, hosted by AAHPM and HPNA. At that time, it felt nearly as terrifying as attempting a prison break. In 2016, I began considering a career change from outpatient family medicine to palliative medicine. I turned to social media for career advice, and the response was unanimous: “Go to the Assembly.” It was last minute when I booked my flight, and the closest hotel was thirty minutes by Uber. Looking out across the first plenary session I saw 3000 strangers. I felt like an outsider, from mispronouncing ‘Palliative’ to feeling shock that people actually prescribed methadone for pain. I recognized the passion for deeper connection with our patients, and the hope to provide patient-centered care. Every session was eye opening, and every person was welcoming. I thought people would question why I had come. Instead I heard, “That’s great, I’m glad you’re here!” Prospective fellowship program faculty members agreed to meet with me while at the Assembly. I worried my plans for a fellowship were too ambitious when I learned the time line for applications was shorter than I had expected. I told one program, ‘I think I should wait a year.’ “Why?” the professor responded, “You know how to fill out an application. You know what you want. Just do it.” These were life-changing words.
I was working on my fellowship application when our family was rocked by the news that my mother had breast cancer. It was early stage, found on a routine mammogram, and a cure was possible. We drove back home to Oklahoma for oncology appointments and surgeries, went home to practice family medicine, and flew to interviews across the country. I wondered what life would look like a year from now, five years from now, while I ironed my suit in strange hotel rooms. I wished and hoped that I was asking the right questions in office visits and being my mother’s best advocate. I tried not to be the ‘daughter from California,’ disrupting care plans and rapport, when a clinical trial fell through. Suddenly, discussing goals of care and learning how to control symptoms became an immediate part of my life, rather than a distant professional goal. I emailed specialists about treatment options and tried to explain to my mom what our choices would look like in real life, not just in theory. I answered questions about how to move palliative care upstream while on interviews. I talked and listened and talked and listened, trying to be a good communicator.
‘Prison’, it turns out, is a great place to learn communication. On each side of our Escape Room cell in Orlando were the pieces we needed to break free. The wall between us prevented us from seeing all the available tools to make our getaway. A less physical barrier separates us from the knowledge, insights, and goals that our patients possess. We can feel locked away from best resources when we are trying to have goals of care conversations. Yelling louder didn’t help reach across the division between our cells, neither did focusing on iron bars. Listening to the discoveries and insights of everyone on both sides of the wall became the only way we could escape. I could break open the soap to reveal a hidden key, but it would do us no good if we didn’t know the locked box was located in the opposite cell. Very sneaky education, Christian Sinclair, very sneaky! We did not successfully escape from our prison cells, but as they say in VitalTalk: “Let’s talk about what you did well.”
The Journey from Phoenix 2017 to Orlando 2019 has been a remarkable one. This year I arrived onto humid streets with my team members, as a fellow – no longer an interloper. Walking across the hotel I saw familiar faces who had helped and inspired my new career. Practice-changing information filled each session. I even learned how to use Twitter. I called my mom on my last morning, “It has been so great, I just feel like I have so much to do.” “You’ll always feel that way, you’ve found your tribe,” she replied. Then she hung up to head out with her friends, cancer free for over a year.
From the beginning, my time in HPM has been full of surprising lessons. I have no doubt that my career ahead holds many more, though hopefully not from a prison cell. Whatever the future holds I know that the Assembly will stand as a place to refresh, renew, and connect to people who inspire, in a field that helped me as a person, family member, and provider from the first moments I joined its ranks. I hope someday I will be asked how to launch a career in HPM. I will happily pass on the same advice I was given – go to the Assembly, join the #HPM twitter feed, read the blogs, see what we’re talking about! There are scholarships, supportive colleagues, and new knowledge that will make this journey the best one of your life. Here’s to 2020, San Diego, and a lifetime of communicating past barriers!
Christine Bridges, MD is a hospice and palliative medicine fellow at the University of Louisville Health Science Center. She enjoys baking and watching zombie movies with her husband.