When D., a woman in her mid-30s, learned that she was dying from complications of AIDS, she fully expected that her life would end in much the same way it had been lived: homeless, alone and among strangers.
If it hadn't been for Dr. Jason K. Alexander, a medical student at the time, she might have been right.
Two years earlier Dr. Alexander, along with four other classmates, had created a project that paired medical students with patients who were dying alone. "We wanted to reach out to patients who had been shunned, the people others didn't want to deal with," Dr. Alexander recently recalled.
The program, which also helps family members who are struggling with terminally ill loved ones, was part of an innovative new center for humanism at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in Newark. The center offers four-year scholarships for students with outstanding academic and community service records.
D. was one of the program's first patients, a woman who years earlier had been rejected by her own family. "She was angry at first," Dr. Alexander said, recounting his initial visit with her. "She was dying, but she took the opportunity to attack me, a medical student who had walked into her room and said that he was just there for her to talk."
Dr. Alexander was about to leave when he remembered the advice of his faculty adviser: let the patient guide the conversation. "I surrendered to her anger and told her that we didn't have to talk, that I would just sit in the room with her." After several minutes of trying "to embrace the deafening silence," Dr. Alexander heard a noise coming from where D. was sitting. "I saw tears rolling down her eyes," he said remembering the moment. "She began sobbing that she was scared and had no one."
That visit would be the first of nearly daily conversations between Dr. Alexander and D., meetings that would continue several months until her death.
The school's initiative, started with a $3.2 million grant from the Healthcare Foundation of New Jersey, is part of what many believe is an expanding movement in medical education: a growing emphasis on the human side of medical care. Leaders of this "humanism movement" have come from both the general public and within the ranks of medical education. And although they have focused on issues like patient-centered care, physician professionalism, clinics for the uninsured and disaster relief, nearly all have agreed on one thing: the importance of supporting what they believe are the natural, but often suppressed, ideals and inclinations of those who chose to pursue a career in medicine.
"I believe there is a yearning among physicians to practice this way," said Sandra O. Gold, president and chief executive of the Arnold P. Gold Foundation. The nonprofit organization has financed the bulk of the movement's initiatives in the last two decades, with more than $15 million in grants for research, lectures and conferences. "But everything that is happening to doctors dissuades them from these humanistic ideals," she said.