Riana B. Jumamil, AB 2014

Medicine is challenging. There are many sacrifices that go into it, but there are also many meaningful moments. For instance, coordinating end-of-life conversations. No matter who you are - whatever status, color, orientation, culture - the one thing that is certain for all of us is death. It is incredibly important to help make that death as dignified as possible. We can do chest compressions, give pressors, do all the things in modern medicine that are good at keeping people alive… but at the end of the day, we should be honoring patients’ wishes. Some people  have to go down fighting, and others value being comfortable. I remember one young patient who was diagnosed with lung cancer when she was still in college. 

When she came to us, she was intubated in the ICU. Nevertheless, she made it known who she was - “Warrior” written on her arm and pen in her hand. While the family was looking to pursue another chemotherapy or treatment, this patient clearly wrote that she no longer wanted to be in pain. She wanted to feel as human, as much of herself as possible. She was at the end of her life and wanted to spend time with her family.

This was already hard because of COVID restrictions, but our team did our best for her. As doctors and healthcare providers, we take care of so many patients who come in and out of the hospital. It’s easy to, but we must not forget that they are people with their own stories, lives, and values.

Preparation for end-of-life conversations is incredibly important, especially now during COVID era when I feel like I am having an abundance of them. Writing down an outline of what to talk about has helped me guide these discussions. I make sure everyone is introduced in the room to each other, on both the health care provider and family side. Then, I ask what their understanding of the situation is and grasp where the conversation is shifting. From there, I try not to do most of the talking. I ask open-ended questions, have them talk to me. A lot of times, our patients are intubated and not able to share their thoughts. In those cases, I turn to the family and ask: ‘we’re just meeting this person at this vulnerable time of their life, and we are not lucky enough to have known them as you did, so what are they like?’ It’s always nice to hear about who they are as a person, to know who we are treating beyond the diagnosis and disease.

Something I have always struggled with is the very real notion of imposter syndrome--especially at Harvard and throughout my medicine career. Let’s be real. I want to name it and normalize it. There have been many times when I felt I wasn’t smart enough, my scores weren’t good enough, or that I was at Harvard or Einstein or UCSF by mistake. There’s always pressure to show that everything is perfect and successful and things are going amazingly well, but that may not be true. I want to remind people to be kind and true to themselves. Medicine is hard. We’re all trying and on our own journey of learning, and it’s okay. Just look at where you are and all the things you’ve accomplished. You only need to compare yourself to who you were yesterday.

Your patients don’t care about your Step One score, but they do care about how you treat them as a person in the hospital. They will remember you for the rest of their life. So what kind of person will you be?

Riana B. Jumamil MD

AB 2014 | Human Evolutionary Biology

Resident Physician at UCSF Internal Medicine Primary Care Program (UCPC) 

Interviewed and Compiled by Felicia Ho