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David Solomon is dying. He has advanced lymphoma and will live for only a few more weeks. Exhausted and wracked with pain, he lies on a hospital bed, a yarmulke on his head. His bony fingers are wrapped around a styrofoam cup filled with ice chips, which he sucks continually. His voice a raspy whisper, the 70-year-old man is talking to a young physician sitting at his bedside. The two are discussing Solomon’s worries, family situation, even his spiritual beliefs.
“When God decides it’s time, it’s time,” the dying man says. “I’ve had a good life … a good life.”
After a long pause, the physician places her hand on Solomon’s arm. “I think it’s wonderful that you have such a strong religious faith,” she says.
THIS MIGHT SEEM like an unusually tender and personal doctor-patient relationship, but the USC School of Medicine aims to make it commonplace, at least among physicians trained here.
Solomon, you see, isn’t what he seems. He’s actually Larry Lederman, a professional actor playing a dying patient. And his compassionate companion isn’t really a licensed M.D. She’s Kate Kaufman, a first-year medical student.
Kaufman was among the first to take a workshop called “The Dying Patient,” developed by Pamela Schaff, director of the school’s innovative Introduction to Clinical Medicine program. The workshop is now mandatory for all first-year medical students.
“Most physicians are still really bad at talking with patients about how they want to die,” says Schaff. “It’s just not something people feel comfortable with. We want to make sure the students have a forum where they can explore their own feelings and hear from patients.”
Schaff’s staff carefully trains actors like Lederman to play near-death lymphoma patients so convincingly that the first-year students easily fall into the fiction. The mock-docs then interview the pretend patients, asking about their concerns and emotions, how they want to die and who they want to make decisions for them should they become incapacitated. The students even take the patients’ “spiritual histories,” asking about religious convictions and other beliefs.
After the interviews, Schaff critiques the students. Then the patient rises from his sick-bed and also comments on the experience.
“The Dying Patient” workshop is just one example of the ICM program’s emphasis on patient-centered learning. To gain an understanding of the complex issues facing gravely and terminally ill people, USC medical students are also required to take an ethics course; tour an oncology or AIDS ward; visit a hospice, retirement home or grief counseling center; and observe a medical team specializing in symptom management.
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