Despite making arrangements (in my head and otherwise) and laying out my plans on the OPD table and in rigorous discussions at the bedside, calls and messages have been pouring in from patients, expressing surprise at my decision to desert them, for a new position. Of course, this might all serve as a timely reminder of the kind of interdependence that one develops on their palliative patients. While, I have continued to provide them guidance and persevered to respond to their messages, these events underline their lack of trust in the system.

The guy from states, expressing a tame preference for my candidature, enquired about the outcome of my interview with a national level organization. 
The frantic sister called for support in the dying hours of her brother’s life, pleading for him to be institutionalised for provision of comfort care (was faced with abject rejection across multiple settings). The system which was supposed to support her during her hour of need had recklessly deserted her.
And the Muslim wife who expressed horror at my departure, attempted to go back on her desperate pleas while trying to construct a picture of reconciliation with the system (to which she does not have an alternative).

The question is how does one move ahead from here and go about building a certain level of trust. The answer might lie in making treatment-related decisions more transparent and giving patients the right to discuss and empower themselves (even in a resource-constrained framework). One needs to move away from the traditional idea of a patient-doctor relationship and envisage a new shared reality, where the patient and their caregivers are your equals.

Allegiance need not be divided between the administrator who hired you and the patient, and that they may be treated as one single entity. That patient participation ought to serve as a reliable system-related metric, and that their feedback is duly considered in the multi-source feedback (as a legitimate vindication of the quality of your efforts) needs to become a reality.
The stereotypes may then be blurred, (despite their idiosyncrasies and their differening manner of dealing with systemic malaise) and merge into one reality, that of intense and acute need.

Their shared suffering also represents an urgent need to transcend distinctions based upon religious and regional identities, in order to work together, for that common denominator – the patient’s family, which requires support much beyond the patient’s demise. 

Disclaimer – Every attempt has been made to safeguard the identity of patients referred to in the vignettes and any circumstances arising out of this moral treatise are completely unintended on the part of the author. The author does not intend to cause any harm to another individual’s or organization’s reputation and has tried his level best to ensure that identities are fiercely protected.