A Patient's Perspective
A Devoted Couple
Am Fam Physician. 2019 Dec 1;100(11):709.
On April 15, 2007, American Family Physician published the inaugural Close-ups department, featuring a story about my mother, who had experienced a stroke, and my father, who cared for her at home for seven years.1 Officially, their relationship lasted 56 years, but emotionally it never ended. Although my father remarried happily at 88, he always remained true to the memory of my mother. Even his own illnesses seemed expressions of his connection with her. Could his hospitalization on the anniversary of my mother's birthday have been a coincidence? Maybe, but it also could have been brought on by a temporal resurgence of grief, accompanied by a loss of appetite before that commemorative occasion. That could easily account for his dehydration, the proximal cause of his abdominal symptoms.
More mystery surrounded his stroke, which mimicked my mother's—it occurred in the same location on the same side, deep in the brain. He was taken to the same hospital, evaluated in the same stroke unit where my mother had been cared for. And like her, he aspirated secretions that led to his rapid decline, just as my mother's aspiration likely contributed to the lasting severity of her symptoms. He followed her faithfully to the grave.—C.W.
Is illness on a birthday or anniversary a coincidence? Anecdotal reports of increased distress on special occasions associated with the deceased have been corroborated by some studies, including one involving older persons.2 Other studies have looked at the relationship between important family events or holidays and mortality. Among patients with cancer, there is no evidence to suggest that they delay their deaths in anticipation of an important holiday.3 One study found an increase in deaths before Christmas.4
Although spouses may die of the same illnesses, the explanation is likely epidemiologic: stroke, for example, was the fifth leading cause of death in individuals older than 65 years in 2016.5 One finding that does suggest a mind-body mortality link between spouses is a spike in death rates among bereaved partners, especially in the first three months after the other one dies.6 How a lifelong devotion between spouses expresses itself in illness and death is not easily explained.
Referencesshow all references
1. Wellbery C. Close-ups: a patient's perspective. A fall in the dark. Am Fam Physician. 2007;75(8):1177....
2. Carr D, Sonnega J, Nesse RM, et al. Do special occasions trigger psychological distress among older bereaved spouses? An empirical assessment of clinical wisdom. J Gerontol B Psychol Sci Soc Sci. 2014;69(1):113–122.
3. Young DC, Hade EM. Holidays, birthdays, and postponement of cancer death. JAMA. 2004;292(24):3012–3016.
4. Medenwald D, Kuss O. Deaths and major biographical events: a study of all cancer deaths in Germany from 1995 to 2009. BMJ Open. 2014;4(4):e004423.
5. U.S. Department of Health and Human Services. Health, United States, 2015 with special feature on racial and ethnic health disparities. May 2016. Accessed June 10, 2019. https://www.cdc.gov/nchs/data/hus/hus15.pdf#020
6. Moon JR, Glymour MM, Vable AM, et al. Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses. J Public Health (Oxf). 2014;36(3):382–389.
This series is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD; Jo Marie Reilly, MD; and Sanaz Majd, MD.
A collection of Close-ups published in AFP is available at https://www.aafp.org/afp/closeups.
The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.
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