Death and dying — it is one of the first topics I was taught about in medical school.  I was fortunate to attend a medical school that only made us spend half our time falling asleep in lectures.  The other half we were in small group sessions, working our way through real patient scenarios, trying to learn to think like a physician.

As part of our first-year curriculum we had to spend time doing some mock patient interviews and mock discussions.  This included reading a book called How to Break Bad News: A Guide for Health Care Professionals, which was about, you know, how to break bad news to patients.

We had mock discussions where we had to practice telling a patient their spouse died.  We stumbled artificial scenarios, and were taught some of the basics: take a moment to compose yourself; sit at eye-level; avoid euphemisms (he didn’t “pass away,” he died).

Though I work in a pediatric emergency department, I am fortunate that this doesn’t come up too often.  While I routinely break bad news, death is not a frequent occurrence.

While a cancer diagnosis is what jumps to people’s minds as the other awful thing, I’ve had teenage patients near tears when a fracture  meant a missed sports season, and parents in tears when their young child was diagnosed with Type 1 diabetes.  It’s easy to forget that everything is relative, including bad news.

With my medical training and parenting experience, I am of course completely prepared to handle all types of difficult and unexpected conversations related to death (sarcasm meter at 50 percent).  In fact, I’ve achieved complete serenity.

Rogue Two goes existential

I recently had to make a ~ 1.5-hour drive with Rogue Two, age 4.75 years.  With an hour left in the drive, he unexpectedly started a deep conversation, where I had opportunity to employ my communication skeelz:

Rogue 2: What do you do in heaven?

Me: What makes you think about heaven?

R2: Dadi (maternal grandmother) said Tez and Nero are in heaven (the two cats that have lived with my parents over the preceding two decades; Tez recently died).

Me: I think she’s right, they are in heaven.

R2: How do you go to heaven?

Me: You only can go there after you die

R2: What do you do there?

Me: I think you get to be happy there and be the person you want to be, or the person you wanted to be.  You can see the people you care about.

R2: That doesn’t make sense.  If you can only go there after you are dead you would be a zombie.

Me: Uhm, well, that’s a good point.  I think once you get to heaven you can be like you were here.

R2: What about you and mommy?  If you die and are in heaven can I visit you?

Me: Unfortunately no, you can’t go there if you are still alive.

R2: But how will I see you?

Me: You can always think about us and the good memories you have of us.  And you can come to where we are buried and visit us there and that will help you remember us.

R2: <Suddenly crying> But I won’t be able to see you?  Who will take care of me?  I’ll miss you

Me: <tearing up but not crying>  We aren’t going to die for a long time.  But when we do, you’ll be able to remember us and think about us.  You’ll have lots of friends and family here with you, and they will help take care of you.  But hopefully you will be a grown-up when we die and you can take care of yourself.

R2: <A little less crying> Ok. <Pause> Can I have a hug? (We’re in the middle of nowhere still 50 miles from our destination)

Me: Of course, as soon as we get out of the car.

<Crying stops>

Opiate of the masses

If you don’t believe in God/Allah or follow some other semi-organized religion, this discussion could go in a completely different direction.  Even if you do have a religious inclination, it could go differently.

Rogue Two is young enough to have a fairly clear picture of what is important to him — he’s aware of religion but not really aware of it. What matters to him is what he can see and what he can’t see.  He knows

Whether or not you believe in heaven, death is death.  When my wife and I die, he will not be seeing us on Earth anymore.

Promises of seeing us again in heaven would be nebulous; the thought of us “looking down” or “always being there” would likely be confusing (and if he thought we were zombies, it may be scary).

When an adult has a loved one die, thoughts of seeing our loved one again in heaven, or the idea of them looking down on us as an angel do not usually assuage our fears or feelings of loss.

Whether or not it’s true or whether or not you believe it, not only does it feel cliché to say, it doesn’t seem to really help a grown-up feel better, and I did not want to say that to him.

He did not ask about Hell, nor did I bring it up.   We moved on to other topics and listened to music.  The rest of the drive was uneventful.  We finally arrived at our destination — the Baskin Robins by our home.

As soon as I opened his door, he asked for a hug.  We gave each other big bear hugs, and went in for some ice cream.

“Rogue Dad, MD” is a physician who blogs at his self-titled site, Rogue Dad, M.D.

Image credit: Shutterstock.com