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First-year med student Emmanuel Aryee writes about his experience spending time with a patient in their final hours.

By: Emmanuel Aryee ‘18

Yesterday, I saw a person die for the first time. I’m sure you must be wondering how I got here. You see, I’ve been interested in oncology for a while now yet whenever I tell people that, I’m mostly met with looks of concern and the occasional comment on how it will be a tough specialty for me and how I’m likely to see most of my patients die. While I have no doubt that my medical training will be sufficient to help me face any challenge I might encounter, I felt the need to begin my preparation to treat terminally ill patients early. This is why I didn’t hesitate to sign up for an elective entitled “Community End of life and Hospice Care” with Bayada Hospice in Norwich, Vermont.

Over the next couple of months, I learned a lot from my elective. I could articulate the difference between assisted living and a nursing facility. I became acquainted with the requirements for a patient to qualify for hospice care. I visited a number of nursing facilities in the Upper Valley, most of which I previously did not know existed. I got the chance to meet and interact with patients under hospice care, their family and their care providers. It was a very enlightening experience for me but it wasn’t one without difficulty. During the course of the elective, I had two patients die albeit in my absence. That all changed yesterday.

Sometime yesterday afternoon, I got an email from Bayada asking for volunteers to be with Mary; an actively dying woman who did not have any family around. I replied saying I could stop by for an hour around 8 pm. As I drove to the care facility, I wondered exactly what I would do when I got there. From my previous experience seeing patients, I knew sometimes it was just enough to be there; this was however my first solo visit to an actively dying patient. There was the possibility that she could die before I got there or even after I left. I decided I’d just make good use of the one hour I had with her.

It was dark when I pulled up in the driveway of the facility and got out of my car. I made sure I had my Bayada ID around my neck to gain access to the building. I rang the bell at the door and was shown in by one of the CNAs who directed me to the nurse on call. She had been informed that a Dartmouth medical student would be coming in that evening so she walked me to Mary’s room. As we walked, she explained to me that Mary had stopped eating for the past four days. We walked into the room and I found a chair beside a wide awake Mary lying in bed. She shared the room with one other patient but tonight, the second bed was empty and she was alone in the room.

Valentine Godé-Darel on Her Sickbed by Ferdinand Hodler, 1914, oil on canvas (source Wikipedia)
Valentine Godé-Darel on Her Sickbed by Ferdinand Hodler, 1914, oil on canvas (source: Wikipedia)

Mary laid in bed wrapped in the bed sheets with a blank expression on her face staring at the wall in front of her. She had her nails painted pink and was wearing a fairly generic silver necklace. She was essentially nonverbal and except for the occasional incomprehensible outbursts, she mostly just moaned. It was very quiet in the room and all I could hear was the sound of Mary’s moans and the tick-tock of the hanging wall clock. I tried talking to Mary but she never replied. She just continued with her almost synchronous moans. Her mouth was slightly opened the entire time but her eyes were wide open; I don’t think she ever blinked.

Around 9:30 pm I knew the one hour I had promised to volunteer had passed but I didn’t feel like leaving. Mary was all alone and so far all I had done was watch her lie down; I didn’t feel very helpful. Not too long afterwards, her moans became louder. The sound was monotone and increasing in frequency. Honestly, I felt very useless looking at her. I tried to talk to her but that didn’t achieve much; I wasn’t even sure she could hear me. At this time, I noticed an old copy of the New Testament on a desk beside her bed. I didn’t know who it belonged to but it gave me the idea to sing hymns to her. I sang the first two lines of the first hymn that came to mind and I stopped. I don’t have a really good singing voice and as inconsequential as it might seem at this moment in time, I was worried I would be doing more harm than good. I decided to hum instead. I hummed the tunes of all the hymns I could think of. I eventually ran out of hymns. I did a Google search on my phone for more hymns and just went down the list humming all the hymns I was familiar with.

At this point, the sound of her moans became softer and less frequent. I cannot attribute this to me humming but I’d like to believe my presence provided her with some sort of comfort. She grew quieter till she stopped moaning altogether around 10:25 pm. I suspected she might be dead; both her eyes and mouth were open but she was very still. I looked at her chest for any signs of respiration but there were none. I continued to hum and watched her to see if I could find any signs of life. The next hymn on my list was “God be with you till we meet again.” I thought it was a fitting hymn. I hummed the tune, reciting the words in my head and walked out to get the nurse on call.

She came in, evaluated Mary and went out to get the RN. The RN also evaluated her and listened for heart sounds. She pronounced Mary dead at 10:45 pm. I closed my eyes and said a little prayer… till we meet again Mary.

After finishing her first year of medical school, Peace Eneh ('17) is embarking on an exciting but daunting global health project in Nigeria.

By Peace Eneh

I am excited but super-scared.

Peace Eneh
Peace Eneh

I am excited to go home to Nigeria—I am always excited to go home. But this time is different. I am going home as a budding medical student to do global health research. I have always dreamed of going home to help improve the health-care system. That is the whole point of coming to the United States to study medicine. I have always dreamed of returning to make a difference. But as Shonda Rhimes said at Dartmouth’s recent commencement ceremony, it is time to ditch the dream; it is time for me to not just be a dreamer but to actually start doing something, time for me to start making my mark.

The global health opportunities available at the Geisel School of Medicine at Dartmouth were very attractive to me and one of the main reasons I came. As soon as I started first year I met with Dr. Joe O’Donnell and spoke with him about my dream to practice medicine in Nigeria. He immediately saw that I had a passion for global health. He connected me with the mentors that will help me turn this dream into a reality.

I also became part of the Global Health Scholars (GHS), a group of Geisel medical students dedicated to the study of medicine across cultures and borders. We are supported by the Center for Health Equity and also by the Dickey Center for International Understanding. With all these connections and support from the medical school and Dartmouth College, it was apparent that, here at Dartmouth, I can actually start making a difference in global health.

I met with Dr. Lisa Adams, the associate dean for global health, and she provided guidance on how to set up my research project in Nigeria. This summer I will be working with Dr. Chukwumere Nwogu, who is leading a collaboration between the Roswell Park Cancer Institute in Buffalo, N.Y., and the Lagos State University Teaching Hospital (LASUTH) in Nigeria to establish a cancer clinic in Nigeria. This clinic will be one of its kind in my country.

Nigeria is experiencing an increase in cancer rates and the diagnosis of cancer tends to happen late. We are also grossly unprepared and unequipped to care for these patients. A way to address this medical challenge is to start at the level of the medical institution to educate physicians about cancer care so that they will be able to not only care for the population but also to educate patients about the disease. However, before instituting an adequate training program for the caregivers in Nigeria, it is important to do a needs assessment to understand the deficiencies that might be present in medical knowledge about cancer and cancer care. The medical institutions in Nigeria produce many physicians every year. We want to start at that level to train them about cancer care so that as they enter the workforce they will have the knowledge to provide adequate cancer care for their patients.

I am super-excited to be part of this project aiming to empower the Nigerian physicians. I strongly believe that one of the best ways to create change in global health is to invest in the caregivers at the local level. Building human capacity by investing in intellectual development of the caregivers at the local level will produce positive and sustainable results.

My project will be to survey some medical students and current physicians at LASUTH to evaluate their knowledge and attitudes about cancer screening, diagnosis, and treatment. We hope that this information will be used to determine how best to plan and implement a training program for the caregivers. It will also be great to gather information that might help to encourage the medical schools to incorporate cancer education into their curriculum.

So I am excited about this venture. I am also scared because it is easier to dream than to do. Things are about to get real. Now I am about to interact with the health-care system in Nigeria as a rising medical professional. I have heard stories about the challenges that exist, but I have also heard about the opportunities. It will be hard, but it will be rewarding. It will be crazy, but it will be one of the most courageous things I have ever done.

I am ready to be a doer. I am definitely not going in as an expert but as a student eager to learn. I am ready to learn from the best teacher: experience. I am ready to learn from my country about its health-care system. I am ready to learn from the many caregivers working tirelessly to serve Nigerians. I believe that to be an effective doer, I need to be a great student. So with my pencil in hand, I am ready to be schooled. Lesson number one coming right up.

Originally from Nigeria, Peace Eneh ('17) moved to the U.S. in 2007 to attend Concordia College in Minnesota. She spent two years working as a clinical research coordinator at Masschusetts General Hospital before arriving at Geisel in the fall of 2013.