Memorial

There was a memorial service on Friday at work, to remember patients for whom we have cared and who have died. It was a nice time to reflect on the work we do. I mentioned to one of the doctors I was going and he told me not to. “Never go to a patient’s funeral. It’s too hard to stay objective”. I told him it was good for closure. Often we see patients every day or week for months and months, and one weekend they are admitted to hospital and then they succumb, and we never see them again. Often the first we hear of it is when we happen to see their name in the obituaries.

I had another doc tell me recently that she doesn’t read the obits anymore because it’s too sad. There is no doubt that it is sad. I told her, though, that we need to take comfort in the fact that we help these people through their final days. We make them more comfortable, we help control pain and shortness of breath and bleeding. We preserve function and help patients to keep their dignity and stay in their homes as long as possible, if that’s what they and their families want. The knowledge that what we can and do accomplish all that should, in turn, give us comfort. Often when we see patients, it is known up front that we will not be able to cure them. But incurable does not mean untreatable, and there are things we can do to the last days to help.

The remembrance service talked about public grief and private grief. There are certainly patients that I miss, and am sad about when I hear that they have died. Once I hear that the death was peaceful and comfortable, though, it’s the family that I grieve for, not the patient. The patient is cured, then. It’s the task of those left behind to carry on with life in the absence of that person. For most of us, in North American society, once the funeral is over, the public display of grief is no longer socially acceptable. But anyone who’s ever lost someone knows it takes a lot longer than a few days for the acute sense of absence to subside.

In the depths of it, the finality of death is so unutterably sad that we wonder whether the whole effort of life is worth it. We feel like there is no point in being happy, in being human, if it risks this despair. It’s a physical sensation in the gut, or the heart, or the head. That is the private grief that can go on and on and on. Days or weeks later, after the funeral, there will be a moment when we want to make the bed, and call to the person to grab the blanket on the other side, and they aren’t there. Months or years later, we’ll suddenly hear a joke that we think they would like, and think, “I’ll have to call her…” It starts all over again, like scab ripped off and the bleeding starts again. That is the private grief they talked about at our remembrance service.

As health care professionals, we need to keep in mind that we are entitled to grief, both public and private. To be open about it is frowned upon. Doctor Number One, above, eliminates the risk of grief by not attending funerals. Doc Number Two chooses not to read obituaries. Sadness and the acknowledging of tragedy (because it is tragic, no matter how old or how sick the patient was, to those left to feel his or her absence) is dangerous for us, because there is a risk of reduced objectivity, and the treatment we provide may not be optimal if we can’t be objective. But it is impossible to treat, to interact with people without giving up some of that objectivity. It's the only way we can make decisions about treatment. Although our capacity for that giving is bottomless, I believe, we need to recharge our stores every once in a while, by acknowledging the losses and the grief. That’s why the memorial was so valuable. It gave us a safe and acceptable place to demonstrate our public grief, and the message we received was that it’s ok, necessary, in fact, to be sad, to allow ourselves the private grief.

Personally, not professionally, the service had me thinking about recent and imminent losses. My grandmother in November, my great aunt, last week, half a world away in South Africa, my (dad’s) dog who is kind of fading away before our eyes. It’s not so much the person lost, as the understanding of the effect of the loss on people left that make me sad. We cope, we carry on, but we can’t deny the exchange that has occurred with every contact. We gave, they gave. They received and we received. It is inevitable and unavoidable, the contact, the exchange, the loss. The comfort comes in the fact that the person carries on, in fond memories and funny stories. That may, eventually, help to mitigate the physical sensation of loss when they are gone, or to provide an outlet when all you want in the world is to talk to them. But we can’t minimize or ignore that we miss them. It’s what makes us human.

So beans to the doc who won’t read the obits. I admit there is less at stake for me, since I am not prescribing treatment. I am giving less and so I have less to lose if it should fail, but I want the closure. I want to know if it was peaceful and if we were able to help them. Knowing those things helps to reinforce the faith that what I do is important and not futile. It gives me the strength to come back tomorrow and do it again. It helps me to know that when the time comes and I have to face a more personal loss, it will be easier let myself grieve.