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Editor's Commentary on Just Like Me

 , June 07, 2020

In “Just Like Me,” Solmaz Ehteshami-Afshar writes poignantly of her experience caring for a patient who is alone at the end of his life. Like him, Ehteshami-Afshar is an immigrant whose family is far away, in another country. In the essay she reflects, “What will my future look like? Can my loved ones be at my deathbed? Where will my partner be? Can I be close to my parents if they need me? What if my nieces and nephew need me?”

While this piece is about Ehteshami-Afshar’s identification with her patient because of their shared experience of immigration, the questions she raises about end-of-life care – who we want to be there, and how our deaths might look if our loved ones cannot be there – feel even more relevant in the setting of the COVID pandemic. As countless stories emerge of patients who find themselves alone in their last moments, or perhaps with only a PPE-clad clinician lingering at a distance, many of us have considered similar questions in recent weeks.

Nonetheless, the experience Ehteshami-Afshar describes is specific. Not only did her patient find himself alone in his final moments, but also he died in his country of migration, not his country of birth. Is this what he would have wanted? And where might he want to be buried? These uncertainties trouble the writer and her narrative. They force those of us who care for immigrant patients to consider another dimension of our goals-of-care discussions. How do these conversations change when a person is far from home, or perhaps has more than one home? Do we even routinely ask our patients where “home” is for them?

While the death of Ehteshami-Afshar’s patient was unexpected (she writes that “[h]e was also one of those unlucky people who came to the hospital for a minor procedure and ended up with multiple organ failure”), her essay prompts us to reconsider the importance of understanding who our patients truly are – where they call home, whom they call family, and how they wish for us to handle a worst-case scenario. May we be inspired by Ehteshami-Afshar’s meditation to recommit to this kind of deep doctoring.

Irène Mathieu