LAST WORD

Why I go to patients' funerals

By Gregory A. Hood, MD

My grandmother was an important and influential lady in my life. When she died last January after battling a long illness, I was confronted with the deeper meanings of life and death. Certainly I had been exposed to death many times as a medical student, a resident, and later in practice, but it had been more than a decade since anyone close to me had died. And for the first time, I was fully confronted by all that goes on after the moment of death is pronounced.

At her funeral, I thought about a family practitioner I'd worked with in California, who would regularly attend memorials, wakes, and burials of his longtime patients. I admired his sentiment and dedication, but I never made the same effort. I assumed that the family wouldn't want me to come. I was reluctant to impose by asking, uncertain about the response. And I was too busy.

Perhaps, too, I feared that confronting a patient's death would cause me to re-evaluate the care I had given: Could I have done more? Had I been able to communicate to the family what I had tried? How did the relatives view those encounters, given that their loved one was now dead?

My grandmother's death eliminated my misgivings. I resolved to go to visitations, if only briefly.

Not long afterward, one of my partner's patients died of metastatic lung cancer. I'd spent a lot of time with him and his wife while covering on weekends. This seemed like a good opportunity to keep my new resolution. So on that mild winter's evening, I made my way to the funeral home. I waited in the receiving line, spoke with the patient's widow, and met his son.

A few weeks later, I chanced into his widow in the office. She thanked me again for coming to the funeral, and her gratitude reinforced my gut feeling that physicians should attend such services. As busy as I had been in California, I realized, my packed schedule wasn't an excuse. Then what had held me back?

I think my fears and concerns stemmed from our American approach to life, health, and death. As physicians, we're expected to maintain life at all costs. We think of death as somehow the result of inaction or error. Intuitively, we know this isn't true, but the subliminal cultural elements that underlie these tenets are deeply rooted in our society. For instance, how many families have at least contemplated a lawsuit after a death or bad outcome? How many doctors, because they're afraid of a suit or of stirring a family's ire, have shied away from attending services or establishing a dialogue with the family?

How many lawsuits are brought out of pain? Not the physical pain the patient suffered before death, but the spiritual pain that is the natural result of the death of a loved one. It is a pain that is profound, at times excruciating, and typically difficult to treat. We minister to our patients when they are alive and, as we can, help them in preparations for death. Our proper role in their lives—and in the lives of their loved ones at their deaths—remains unique and special. When we vacate this role, pain and suffering can be needlessly prolonged.

The art of medicine is the art of healing. My presence at funerals is a natural extension of the healing art, and it serves to comfort and assist the survivors in their own healing. It's an honor and a responsibility. I've found, too, that the family typically makes an extraordinary effort to comfort me as well. After all, I'm also grieving the loss of a patient who had been a friend.

That's why I make visits—and visitations.

The author is an internist in Lexington, KY, and a member of the Medical Economics Editorial Board.

 

Gregory Hood. Last Word: Why I go to patients' funerals. Medical Economics Jun. 20, 2003;80:88.