Monday, June 30, 2014

After Pronouncing

The following post is adapted from something I read at the San Francisco Veterans Affairs Geriatrics, Palliative, and Extended Care memorial service.  The case has been anonymized to protect confidentiality. 
- Alex Smith @AlexSmithMD

Many of the veterans we care for are fortunate to have family and friends with them during their last days. Some of you are here today.

Some veterans have no family or friends. Over the years, these veterans have either pulled away, or been pushed away, from their loved ones. Let us take a moment to remember the these veterans.

Last year I was asked to come and pronounce that a veteran had died in our hospice unit. I had just taken over for another attending physician and had not met this veteran while he was alive.

“Did he have any friends or family?” I asked. “No,” said our social worker, “we contacted everyone we could reach. We’ve tried for weeks. None of them would come. They are too angry.”

I went in the room. He appeared to be at peace. I conducted my examination. Then it seemed as if there should be more to do, some way to remember him, and acknowledge who he was as a person.

Who would grieve for him? It was obvious that his life had been difficult. He had been homeless. His face bore the ravages of his time on the streets.

Every person, if you go back far enough, was loved, at least by someone in their life. Even if they are not loved now. Before the anger and the arguments and the illness. Before the isolation.

Hopefully, if you go back far enough, a mother held this person, then a child, in her arms and loved him.

I held that thought of this veteran being loved by his mother in my head, as I thought of this poem, by Joan Siegel, about a dying mother.  About the love between a mother and her child.  About how we hold on to memories of our loved ones, take them with us, and leave a part of ourselves behind.

To My Daughter by Joan Siegel

When it comes time
let all the words be spoken
that must be
so that I may take your voice with me
for the next ten billion centuries
mine will be with you
like a packet of letters
handwritten over the years
to unfold anytime
hear me speak
in the voice that used to put you to bed
telling the story of all our days
fingered in the retelling
like pages of your books
the best parts dog-eared
pressed smooth by thumbprints
and the refrain of all our nights
as you slipped away
I loved you before dinosaurs 
Even before the stars 


Ruth Hill said...

How beautiful. Thank you for sharing. I'll recommend we read this at our IDG meeting when we remember our deaths

Marty Tousley, CNS-BC, FT, DCC said...

Touching and beautiful ~ and well worth sharing. Thank you so much!

Anonymous said...

How beautiful. Another friend of mine, also a palliative care doc, has gathered her team in a circle around the bedside of someone who died alone and read aloud a Mary Oliver poem.