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Acknowledging the pain of a loss is often healthier than trying to remain objective.

Fam Pract Manag. 2000;7(5):78

It's during residency training that we learn how to act as professionals, yet many of the lessons learned are covert rather than overt. In my residency program there was an unspoken assumption that caring too deeply for your patients represented an unhealthy dependency. It seems to me, however, that for family physicians who follow patients for years, caring is unavoidable. And with caring, comes the prospect of real pain when that person dies.

Maude was a special patient to me. She died last year. I never knew why Maude selected me to be her physician. At the time, I was an unknown in an area with several established physicians.

Shortly after she became my patient, poor vision and numbness in her feet made her immobile and I began making regular home visits. She always fixed me a meal or snack to prolong the visit. I talked about my children and my church, and she talked about her children and grandchildren and her church.

In her 80s, Maude had already outlived her life expectancy, and I realized that I would probably be around when she died. She talked often of death and how she wasn't afraid of it. In fact, she sometimes talked about how she longed for death to release her from her body, which gave her more pain than pleasure.

At times, with objectivity, I could ponder her death. What would cause it? Would she die at home or in a hospital? If she died at home, would they let me know right away? I fretted that she might become critically ill and that my skills would be insufficient to save her. Other times, with objectivity gone, I would have a premonition of the sadness I would feel when she passed out of my life.

Fiercely independent, Maude refused to leave her little house until she became so frail that it was clear she could no longer live alone. She was admitted to a nursing home, and three days later, I received a page notifying me that Maude had died.

I attended the funeral, visited with the family and then went home. As a physician, that was the outlet for my grief. None of my colleagues knew of my loss. I would have been embarrassed to talk about it, either with them or with my family.

But soon after Maude died, I began to realize how much I wanted a reminder of her. I contemplated calling her family and asking for a small memento of this person whom I loved and who had chosen me as her physician when I was new and inexperienced. But I didn't call, fearful the family would misunderstand my request.

Months later I told this story to a group of family physicians who encouraged me to act on my impulse. Finally, I called Maude's older son. He greeted me with warmth and gratitude. Several days later he showed up at my office with a small bag of gifts. I ushered him into a room and one by one he took from the bag items he'd selected for me. First, there was Maude's lacquered butterfly brooch. Next was a cut glass candy dish filled with York peppermint patties, her favorite. Last and most precious of all was her prayer book, perhaps the most fitting memento of who she was.

I keep these objects close to me. I wear her brooch on my lab coat; I keep the candy dish, always filled with peppermint patties, on my bookshelf; and the prayer book is in my desk drawer. I'm warmed by their presence and the remembrance of this person who meant so much to me.

As physicians, we're so inundated by the needs of others that we fear becoming overwhelmed. But detaching ourselves from normal human emotions leads only to burnout, not relief. Perhaps we can teach residents that while overidentifying with patients can be unhealthy, the warm and caring feelings that naturally pass from one human to another should be nurtured for their healing potential.

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