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

Geroscience and it's Impact on the Human Healthspan: A podcast with John Newman

Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day).  While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical.  Well, today that changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician here at UCSF and at the Buck Institute for Research on Aging.

In this podcast, John breaks down what geroscience is and how it impacts how we think about many age-related conditions and diseases. For example, rather than thinking about multimorbidity as the random collection of multiple different clinical problems, we can see it as an expression of the fundamental mechanisms of aging. This means, that rather than treating individuals diseases, targeting …

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Becoming an Advocate for Older Adults: A Podcast with Joanne Lynn

Geriatricians in the 2030s may be able to prescribe very costly medications for older Medicare beneficiaries who cannot get supper. Most older Americans who live with disabilities will not be able to pay for adequate housing, food, medicine, and personal care. All who serve older adults must shoulder the responsibility to help avert this oncoming suffering and social disruption. The window of opportunity for effective change is already narrow; procrastinating for a decade will be too late.
These are the words of Joanne Lynn, a geriatrician and palliative care physician, who leads Altarum’s work on eldercare. She wrote a recent JAGS editorial titled The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States” which is very much a call to action for those who care for older adults.  We talk with Joanne about this article and some meaningful things clinicians in both geriatrics and palliative care can do to be advocates for a growing popu…