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Wednesday Sep 14, 2016

Death in the Family: It's OK to Let Go

When my aunt passed away from breast cancer this spring, she was at home in the comfort of her own bedroom and surrounded by her family. I am grateful she had the type of death that we advocate for our patients and ourselves. It didn't involve traumatic and invasive medical treatments in the harsh and impersonal environment of a hospital.

I was fortunate to spend time with her during her final weeks while she was still conscious. I will always remember her smiling at my daughter and how aware I felt during those moments of the continuity of life and death.

My aunt Colleen (left) and I smile during a family vacation. Less than two months later, she learned her cancer had returned.

My aunt's initial diagnosis in 2013 was surreal. The part of me that is a physician could not reconcile the blunt information given with the part of me that was her niece.

The possibility that my aunt might not be with us in the near future was jarring, but her surgeries and treatments went well. In a relatively short period of time, she was back to her usual active and energetic self. She made breast cancer a part of her past and moved on with life, making it easy for her loved ones to do the same.

Last fall, when the results of a followup scan showed multiple tumors throughout her body and a new diagnosis of triple-negative breast cancer was made, I was still unconvinced -- despite my medical knowledge and training -- about the reality of the situation. My heart refused to believe what my mind knew as fact. It wasn't until she went to the ER with a seizure that I was able to accept what was coming, and it hit me hard.

As physicians, our families often turn to us with both simple and complex medical questions. In general, I am humbled and honored to be in this position, and I do my best to respect both my loved ones and my profession.

We are taught to be objective and to identify our own biases to ensure that the care of our patients is as uncompromised as possible. This is why it is widely recognized as unethical, and at times illegal, to provide anything more than minimal medical care for our family and friends.

Yet every clinician can recount scenarios that are not clear-cut, situations in which the complexity of managing expectations, objectivity and emotions can expose a real internal struggle. Sometimes, the difficulty lies in setting boundaries.

With my aunt, it was about how to simultaneously offer suggestions to family members, communicate professionally with the on-call hospice physician, administer palliative medications and recognize that my emotions -- including the nervousness that I, too, was feeling about the inevitable -- were profound.

As a resident, our family medicine service worked closely with and covered for the hospice department, and as such, I was present during the intimate final moments of many patients' lives. I learned how to recognize signs and patterns that are hallmarks of the end of life. I developed a respect for the process of death. What my training could not prepare me for was how to process, in real time, the emotionality of being present when a family member is dying and how to navigate caring for that dying family member while also supporting her other survivors.

This experience, though difficult, will enhance my ability to empathize with patients and their families during similar times. The perfectionist physician in me tried to debrief myself and learn from any possible medical mistakes I may have made during the process. But as I reflect on my aunt's last months, weeks, days and even hours, I have learned an important lesson that I will carry with me in memoriam: It is OK to take off your physician hat, to feel your emotions, and to let go. It is OK to make mistakes. It is OK to feel overwhelmed by the loss and the love of your family.

Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services at community health centers in the San Francisco Bay Area with a focus on providing evidenced-based care for underserved communities.

Posted at 11:03AM Sep 14, 2016 by Margaux Lazarin, D.O., M.P.H.

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