Patricia "PK" Kennedy has taught writing to first-year students at Princeton University since 2003. She earned a JD and an MA from the Washington College of Law at The American University in Washington, DC, after earning her BA at the University of Pennsylvania. Her essay “Some Body” appears in the Fall 2021 Intima.
In a profound reflection “Does the Patient Know the Prognosis is Terminal?” hospitalist and palliative care physician Julie Freedman engages with how her patients know they are living into illness that is terminal.
Freedman simultaneously explores, and explodes, our preconceived ideas of what it is to “know” one is ill, while sharing her own realization that the question she usually is asked to answer about her patients, i.e., “Does he know?” is actually not the right one:
“[M]ore and more, I think ‘Does he know?’ is…not the right question. It treats the transition from not-knowing to knowing as a single exchange of information. Yet, however skillful that conversation, it is mostly not the way my patients know.”
If you have the opportunity to read her reflection, you should. She guides us to the realization that in health and illness, “information is just one thin dimension of knowing.” And in that realization, she opens up a window into the patient as the “knower” of truths a doctor can only wonder about. It is in Freedman’s expression of a patient’s “knowing” and a doctor’s “not knowing” that helped me reconsider the dimensions of what doctors and patients can know together.
Freedman develops this idea further in her beautiful essay “The Vigil” (Spring 2021), where she speaks from the perspective of a palliative care physician who sees both humanity and clinical lack of clarity (or “not knowing”) in every decision she must make for her patients.
Freedman introduces us to the emotional complexity of Eleanor and Bill, a couple desperately fighting to maintain independence in the face of Eleanor’s diagnosis of Arterial Lateral Sclerosis (ALS), and the decisions she must make to care for Eleanor on their journey to the inevitable.
Her essay is remarkable not only because of the clarity with which she explains the flow chart of complex decisions she faces on the chance that any one of multiple complications may develop, but also because of the humanity she recognizes could be sacrificed in each scenario.
For example, in explaining the dire calculations required when deciding whether to intubate Eleanor, whose lungs are failing, she explains the “transformation” affected by the choice, turning Eleanor into a “chimera, part woman, part machine.” Amidst the striking image of a patient divided in two, Freedman shows vulnerability: “I [am] not impartial here. I want to get Eleanor back to her tulips and their brief season, but I really do not want to intubate her.” Freedman’s candor helps us see her as fully human, just as Freedman fully sees Eleanor.
There is no absolute certainty in anything Freedman decides, yet her ability to not know, to wonder with us, opens up a space where Eleanor and Bill (and their family) are together with Freedman, and we are there, too. Amidst a very sad diagnosis, “The Vigil” remains a hopeful approach to the narrative space doctor and patient can inhabit together as people: wholly human, reflecting, listening, and learning each other’s ways of knowing and not knowing.
Patricia "PK" Kennedy has taught writing to first-year students at Princeton University since 2003. She earned a JD and an MA from the Washington College of Law at The American University in Washington, DC, after earning her BA at the University of Pennsylvania where she played two sports. Her research interests are international humanitarian law, human rights law, creative non-fiction, and more recently, narrative medicine. Her favorite hobbies include sports, reading and music, and she's coached women’s lacrosse at Penn and Princeton and sings at local venues. Despite having had 15 years to live into her MS diagnosis, she would describe her relationship with it as shaky at best and writes often to find her way. Read more from PK Kennedy at medium.com/@pkennedy777. Her essay “Some Body” appears in the Fall 2021 issue of the Intima.