Death. No one likes to talk about it.Some are downright terrified of it. But it happens every day and no one is immune. Thankfully there are people like Bethany Calkins (MD ’07, BS ’03), a physician with the hospice and palliative care center at the Buffalo VA Medical Center, to help us through it.
Calkins, 36 and keenly enthusiastic about her work, can’t help but make an observer wonder: How does a young medical student end up choosing this path? For Calkins, it started at her grandfather’s bedside. When she was a senior at UB, her grandfather became ill and she sat with him at the hospital between classes. It ended up being the last three months of his life.
“I spent 20 years kissing my grandfather on the cheek and making small talk with him,” she says. “But this time that I spent with him was incredible. I learned about his military history, my grandmother [whom Calkins never met], his time raising my dad and aunts and uncle. It was like unlocking a time capsule into my own family.”
The experience had a profound effect on Calkins, who held vigil until the end. “His last 72 hours were the most intense time in terms of his symptoms, and solidified my understanding of how people die,” she says. “He was unresponsive, not eating, not drinking, losing weight rapidly. That’s when I knew he wasn’t going to get better.”
She now uses that “moment of discovery”—of recognizing death—to guide patients and family members through the journey, letting them know in advance what to expect throughout the process.
There were other revelatory moments along the way that helped lead Calkins to a career in hospice. As an up-and-coming doctor, she witnessed patients being treated in two very different ways: either as numbers, which she abhorred, or as human beings. Then she began a medical school elective performing home-based hospice care at Hospice Buffalo, and everything just clicked. The rotation normally lasted two weeks. Calkins continued for four weeks, and often asked to go in early and stay late.
“I enjoyed the work so much,” she says. “If there was more to be done in this field that I loved, I wanted to be there. I didn’t want to miss a thing.” After completing her fellowship in Rochester, she became a physician at Hospice Buffalo and remained there until May of this year, when she moved to the VA.
To succeed in this emotionally challenging field, Calkins explains, you have to be persistent, confident and passionate. “You’re talking to people about how they want to spend the rest of their lives and how they’re going to die. It’s not always pretty, and not every conversation goes the way you want it to. Then you have to come back the next day and do it all again.”
But while the work presents challenges, it also brings rewards. “To get a family of eight siblings who are unable to agree on their father’s care on the same page, to a place where they can sit and enjoy each other’s company even though something life-changing is happening in that room ... That’s a very satisfying feeling,” she says.
The best part of her job, she adds, is giving patients the power to make their own decisions. One of her questions to them is: “What’s important to you?” In a world where physicians typically spend ten minutes with patients, the question is disarming—and usually deeply appreciated. “Perhaps they want to go 24 hours without vomiting, or go home to die, or simply wear their pajamas in the hospital instead of a gown,” she says. “Their goals become my goals. We can’t solve everything, but at least they know someone is trying on their behalf.”
Calkins received a different kind of reward in 2015, when she was named one of the American Academy of Hospice and Palliative Medicine’s Inspiring Leaders Under 40. The selection criteria included, among other things, dedication to educating students and the community about hospice and palliative care, charity work, and notable professional accomplishments—which in Calkins’ case included her role in a Consumer Reports documentary titled “A Beautiful Death: Paul’s Choice.”
In the 18-minute video, Calkins helps lead Paul—an 86-year-old patient with cancer—and his family through the ups and downs of dying. Yes, ups. With Calkins’ care and support, they gain a greater understanding of each other and, together, are able to make a difficult time in their lives a little easier to bear.
“There’s no gene that allows you to sit down and talk with people about dying,” says Calkins when asked how she’s able to do this work day after day. “But I have an interest in the process and the experience of it. I enjoy the human side of medicine. The lab values, the images, the pathology—they’re OK. But the face-to-face time is what matters most to me.”