In 2011, Smith enrolled in a one-year palliative care fellowship at Providence. She had a lot to learn. She found out she was a bad listener. And she was abrupt. As an ER doctor, sometimes she was so busy she didn't even sit down to deliver devastating news.
"I can remember saying to families things like, 'I'm sorry, there's nothing more I can do.' And I realize now that sounds like abandonment to many people when you say you can't do anything more. And the reality is I may not be able to do anything more to the patient that will make them survive, but there's a lot more that I can do. I always can do more."
A lot of what Smith does is talk to people. She doesn't advocate for or against treatment, but she wants patients and their families to understand their decisions.
If a doctor puts in a breathing tube, for example, that may extend a patient's life, but they won't be able to eat or talk. If they die with a tube in, the family will miss hearing their last words. So now Smith sits down for hard conversations and looks patients and their family members right in the eye. Earlier this year, she was called in to consult with the wife of a patient who was dying.
"When I entered the room," Smith says, "The wife said to me, 'I know who you are.' And I said, 'Oh. OK.' And she said, 'I don't want to talk with you and I don't want to like you because you're here to talk about death and dying, aren't you?'"
Smith had a short conversation with the woman, and left her a book on difficult end of life choices. She went back to visit her the next day.
"And she said, 'You know, I so tried not to like you. And what you had to say. And I really realize that we need to have this discussion now, don't we?'
"And I said, 'When you're ready, we're ready to have that discussion.' And she said, 'I'm ready now,'" Smith recalls.
Wed, Jul 03 2013