Skip to main content

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
read
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 

Comments

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

Popular posts from this blog

Practical Advice for the End of Life: A Podcast with BJ Miller

This week we talk with BJ Miller, hospice and palliative care physician, public speaker, and now author with Shoshana Berger of the book "A Beginner's Guide to the End."

As we note on the podcast, BJ is about as close as we get to a celebrity in Hospice and Palliative Care.  His TED Talk "What Really Matters at the End of Life" has been viewed more than 9 million times.  As we discuss on the Podcast, this has changed BJ's life, and he spends most of his working time engaged in public speaking, being the public "face" of the hospice and palliative care movement.

The book he and Berger wrote is filled to the brim with practical advice.  I mean, nuts and bolts practical advice.  Things like:
How to clean out not only your emotional house but your physical house (turns out there are services for that!)Posting about your illness on social media (should you post to Facebook)What is the difference between a funeral home and mortuaryCan I afford to die?  …

Caring, and the Family Caregivers We Don’t See

Over lunch at a restaurant in Manhattan, my father and I talked about long-term care insurance and the emergence of senior centers and nursing homes across the U.S. that offer a variety of ethnic cuisines and cultural events, catering not only to a growing population of adults over 65, but also, to an increasingly diverse population of adults who call the U.S. their home. This conversation was different from many similar ones before it – we weren’t talking about my research; we were talking about our own lives.
My parents immigrated to the U.S. in the late ‘70s and early ‘80s, following their parents’ advice on professional opportunities that seemed unimaginable in India at the time. Although they considered moving back soon after to care for their aging parents and to raise children, they ultimately decided to stay in the U.S. As I chronicled earlier, my paternal grandparents lived with us until I completed middle school, at which point they returned to India and lived with my mater…

Top 25 Studies in Hospice and Palliative Care (#HPMtop25)

by: Kara Bishoff (@kara_bischoff )

Back in 2015 we wrote a post asking for input on what articles should belong on a list of the top 25 articles in hospice and palliative care.   We decided to focus on hospice palliative care studies and trials - as opposed to review articles, consensus statements and opinion pieces.

Here’s what we came up with. It was hard to pick just 25! We highly prioritized clinical utility and tried to achieve diversity & balance. Many others are worthy of inclusion. Take a look and let us know if you have suggested changes for next year.

Module 1: Symptom Management
Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi Y et al. JPSM, 2013.Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study. Currow DC et al. JPSM, 2011.Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomise…