Posts Tagged ‘grief’

“I learned that whatever we say means nothing, what anyone will remember is that we came” (Julia Kasdorf)

The “rituals and practices around death”, poet and Undertaker Thomas Lynch writes in his book ’The Good Funeral’, “are a window into the soul of a culture. A society that is unsure about how to care for the dead and is confused what to do with grief and loss is a society that is also uncertain about life”.

The Irish tend to acknowledge the importance of, and participate in these rituals ; the wake, the paying of respects to the deceased in the family home or funeral parlour, and the funeral itself. In a situation where words are inadequate, these rituals afford us an opportunity to bear witness to the grief of others and acknowledge our shared humanity. The “dead don’t care” Lynch says, – “but they do matter”.

However clear our roles and responsibilities surrounding the death of a friend or relative, things aren’t always so clear when it comes to the death of one of our patients.

Very few of my medical colleagues (rural GP’s excepted) regularly attend the funerals of their patients. Reasons often centre around the logistics of cancelling clinics and operating lists at short notice. Our primary responsibilities, we feel, are to those still above ground and that our care of our patients ends when they do. For some funerals may be too painful a reminder of our fallibility as doctors  – and we may even be concerned that we will be blamed for the death at the graveside by angry, grieving relatives.

Dr. Danielle Ofri, writing in the New York Times, suggests that there may be deeper, unacknowledged reasons for not attending; “Now that the medical care chapter has closed we’re not quite sure how we fit into the patient’s life. We were so recently actively directing the medical care — doing something — and now we are the awkward bystanders”.

It also hurts; “It hurts to keep seeing the bodies of your patients — bodies with whom you have been intimately familiar — laid out in stone-cold carriage. It hurts to see the face of someone with whom you’ve had deeply personal conversation, now rigid with that oddly blank expression. It just hurts.”

There are so many practical and psychological hurdles to attending, its not surprising we don’t usually turn up.

And yet medical relationships are not purely professional. Because of the intimate and deeply human nature of our interactions it is not unusual for us to build up strong relationships with our patients over time, to develop mutual affection and even friendship with them and their families. To deny this part of the relationship by not acknowledging its end, is a denial of an important part of ourselves and our patients.
So what should we do? How do we reconcile our human responsibilities and our need to grieve with those of being a doctor?

“Lead with your humanity” says Thomas Lynch (speaking at the recent dotMED conference). “I encourage you to be among the people of the dead when the time comes – as it always does. You will be improved by it.” He urges us to attend, or reach out in some way; “You can do some really good medicine by just being part of that – when you can – to the extent that time allows – a phone call, a bereavement letter, five minutes at the wake, a cameo appearance at the funeral, a handful of dirt over the grave”.

The funeral, he explains is a means of “getting the dead where they need to go and getting the living where they need to be”.  As humans, being present at a funeral forces us to look into the abyss it presses us against the ontological and the existential, and makes us ask the important human questions.  “Is that all there is? Can this happen to me? Am I all alone? What comes next?”.

He also suggests that for doctors, facing the human realities of a death in one our patients reminds us that not only are we fallible but also that death is an inevitable. “You spend your lives trying to stop the sky falling. But the sky is falling”.

Whereas the attendance of a doctor at a removal, funeral or at the home of one of their patients after they die is not usually expected, sometimes the smallest spark of kindness at the darkest time are the ones that illuminate the most. These kindnesses are the “stuff of good medicine – these ordinary miracles we do for one another”.

It’s comforting to know, that some of our best medicine can come about by just showing up.

 

Thomas Lynch spoke at the dotMED Conference in December 2014. Next meeting will be in February 12th 2016.

 

Levels of Life by Julian Barnes. Published by Jonathan Cape (Hardback) 2013 

This is a wonderful short book about ballooning, photography, love and more specifically, an attempt by its author, Julian Barnes, to come to terms with the death of his wife. 

Levels of Life will be a gift to those trying to make sense of their own grief or indeed anyone who has ever loved  – ‘Because every love story is a potential grief story’. In articulating his own grief, he helps us understand how love and loss behave like two sides of a balanced, inevitable equation; ‘The thing is – nature is so exact, it hurts exactly as much as it is worth, so in a way one relishes the pain, I think. If it didn’t’ matter, it wouldn’t matter.’ 

Although grieving is not an illness, reading this book brought me back to importance of stories and patient narratives in medicine; stories help their tellers make sense of their own world when it all goes wrong.

One of our jobs as health care professionals, according to writer and doctor Jay Baruch*, is to be ‘professional story listeners’. Bearing witness to, and acknowledging these stories forms an important part of the healing process. These stories also connect us on a very human level to our patients, and in listening we may unexpectedly receive comfort in return.

I’m happy to recommend it to anyone, particularly those trying to make sense of loss or those trying to help them. 

* Dr. Jay Baruch presented  ‘Story-Centric: curiosity, a glass of water and other creative tools for future doctors’ as part of Millenial Medicine 2013.