Patients and their family members are impressed when doctors show up for memorial services. They tell me about it. “The doctor liked my mother so much that he came to her wake,” a patient recently confided in me as I examined her. She had been a sole caregiver for her aging parents for years, and her mother had passed a few months earlier. The physician’s presence at her mother’s service provided a source of comfort, and I could understand why.
Attending wakes was a deeply rooted tradition in the Irish Catholic community of my childhood. As a young girl, I can remember many times sitting in the car outside of a funeral home as my parents stopped in at a wake. We were always charged with one simple task: to behave for 15 minutes.
One memorable time while trying our best to behave, my youngest brother actually sneezed so forcefully that his chewing gum ended up packed deep inside his nose. We had failed our mother’s clear instructions. Luckily with some aggressive coaching upon her return to the car, my brother successfully coughed his minty gum out through his nose, thereby averting an ER trip. Although not all as noteworthy as this, I would estimate that between my many great aunts, uncles, friends, and neighbors, I had been to dozens of wakes by the time I graduated residency.
Years later, I have the pleasure of practicing primary care not far from the community of my roots. So naturally, after years of attending these services for loved ones, I continued to go to them for my patients, especially those who I had cared for most often in their final months. Two years ago, however, I had an experience that changed my mind.
I encountered Mr. L a few months out of residency. He had a joint injury that he attributed to an aggressive workout. His X-rays unfortunately suggested otherwise. A few tests and specialist visits later, this quickly snowballed into a diagnosis of metastatic cancer. I saw him dozens of times over a three-year period. As I tended to his various medical complications and complaints, performed a physical exam or prescribed pain medications, we chatted about planned vacations, his grandchildren or when he planned to take his boat out again. Mr. L held a special place in my heart, and I looked forward to his visits.
I was in communication with his oncology provider, and when all therapy options had been exhausted, we made plans for palliative care. Mr. L was too weak for travel, so my nurse packed some supplies in a makeshift doctor’s bag. I went to see him for a home visit. What a special moment: walking around Mr. L’s living room, seeing all his family pictures, meeting the son he had proudly told me all about, and seeing that boat he loved parked out front. We talked for a long time as I examined his failing body, and I left with a signed do not resuscitate order in my hand. I cried the whole way home.
Shortly after that, I received news that Mr. L had passed away. As usual, I attended the wake. I entered the funeral parlor and was immediately surrounded by a flood of photographs from Mr. L’s incredibly full life. I then looked into the eyes of his grieving children and all I could see was a mirror image of myself. Reflecting back at me was not only the love they had for their father but the love I have for my dad, the love I have for my children and the moments we have shared together. I attempted to keep composed as I said my condolences and quickly exited, driving the 30 minutes home to my waiting children who were smiling and playing with sidewalk chalk in the summer sun.
Reflecting back on my experience at that wake, I can fully appreciate the heavy emotional burden that comes with caring for patients in their final years. Most members of my staff can attest to just how much I love caring for patients in their 80s and 90s. Some days, I feel that if I could fill my whole schedule with octogenarians and nonagenarians, I would, with a few newborns sprinkled in as caring for this group of patients is pure joy. Our older population has led such a rich life, and I learn so much from our interactions. Their health is at times quite complicated, and I appreciate the mental challenge. Wake attendance for me does not seem like the ideal time to communicate in an impactful way to the surviving family just how much I cared for their loved one.
I have never been to another patient wake again. I break a lot of bad news, and I try to be available in the office to support patients. However, there are some things that are just too raw. I am early in my career and considering the few decades looming before me; I work hard to shield myself from the emotional burnout that so often affects those of us in primary care. Instead, when a patient dies, I call and share a memory or, most often, hand write a condolence card.
These condolence cards have become my controlled way of recalling those treasured moments for their family — how evident her husband’s love was every time he came in to get samples for his wife, the special times two sisters shared knitting scarves while one was under home hospice care, how his eyes lit up sharing the news of his daughter’s long-awaited pregnancy, the way their 90-year-old father always made me laugh with his grocery store escapades.
Wakes are exhausting, and the immediate grief can be overwhelming. Everything may seem like a blur. Perhaps in this small way, at a time when it seems like the outside world has moved on, my condolence card lets the family members know that their loved one is still remembered.
I think of my patients who passed often. I am thankful for the opportunity to be a part of their life and their dying process, and to help their families navigate through such a difficult time. As I signed a death certificate today for another longtime patient, I am already carefully considering the words I will write in my thank you card to her husband to reflect on the cherished relationship we had and the memories I am choosing to hold dear.
Lauren Kuwik is an internal medicine physician.
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