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Retired surgeon, psychotherapist, and author Patrick Hudson discusses his article, “Why we fear being forgotten more than death itself.” The conversation explores the profound difference between the biological act of dying and the existential fear of vanishing from the story of the world. Patrick explains that for many, the true anxiety surrounding death is not about the end of life, but the end of mattering. He shares how his own heart attack transformed this question from a medical abstraction into a personal reality, revealing that dying is often a slow erosion of self that happens long before our final breath. The discussion delves into how our need to leave a legacy is an attempt to outlive ourselves and how the only antidote to the fear of losing control of our narrative is to live with clarity, love honestly, and forgive early. This episode offers listeners a chance to reflect on mortality not as something to be fixed, but as a concept that can teach us how to live more fully in the present.

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Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Patrick Hudson. He is a retired surgeon and psychotherapist. Today’s KevinMD article is “Why we fear being forgotten more than death itself.” Patrick, welcome to the show.

Patrick Hudson: Good morning.

Kevin Pho: All right, so let’s briefly share your story and journey and then tell us the events that led you to write this article on KevinMD.

Patrick Hudson: OK, so I’ve been a plastic surgeon, a hand surgeon, for decades. And then obviously time passed, and I retired. I started to explore other aspects and dimensions of my life that had been put to one side as a result of the plastic surgery. Medicine’s all-consuming, right? I mean, it takes you over.

It gave me an opportunity to think about other aspects. A lot of this came from the fact that I had an MI myself, and I began to have this understanding of what death meant. It wasn’t just the issue of being dead. I mean, that, as such, has very little meaning. It was this process that I’ve been going through for a long time of slowly vanishing, of disappearing, no longer seeing my patients after I retired and things of that kind. And that’s what stimulated the story.

Kevin Pho: So tell us what this article’s about for those that didn’t get a chance to read it.

Patrick Hudson: OK. Well, the essence is that death is as much about fearing disappearing as it is actually the death itself. It’s that sense that we don’t want to be forgotten. And, you know, as physicians, we’re so involved in our life that the idea that we would be forgotten, that we no longer have relevance, is very significant to us.

I’ve seen death. I mean, it’s not like I haven’t seen lots of patients who’ve died or been aware of that. It’s that the emotional meaning of this, the significance of this, was what was significant. And I don’t mean that biologically; I mean, sort of existentially. You know, that’s what became this piece, this realization of something much deeper.

Kevin Pho: You mentioned in your piece that dying, like you said, is not a single moment but a slow erosion, right? This was all triggered when you had your own MI. So what made you come to that realization? Tell us the steps that led you to this observation.

Patrick Hudson: Well, I think as you said, death isn’t a moment. It’s this slow loss of all of the things that have given meaning to us. I mean, we don’t retire from medicine; we retire from being seen more than anything else. And I think that, from my own part, it was this realization: I wanted a legacy. You know, we all want a legacy, right? We want to leave something behind. We don’t want to be forgotten.

And the realization that we never experience that legacy, so how can we experience it? The key is that we show up now. Legacy isn’t something that we leave; it’s something that we do. It’s something we do now, and that, to me, was the understanding that was most significant.

Kevin Pho: And when you say that legacy means showing up now, what are some examples of that?

Patrick Hudson: Well, it’s the kind of thing that we do in our everyday life. It’s the kind of things that we want to demonstrate that we have a real value in our life. And that I’ve found in all the work I’ve been doing with physicians for decades now, this sense of wanting a meaning, a purpose, is number one for almost every doctor that I see. And if they come to me for other issues, such as, you know, being angry or wanting to learn leadership, it’s all about actually having meaning. And that comes to a head when we start to face death.

Kevin Pho: So when it comes to showing up and being present, it could be simply how you interact with your children, how they remember you, how you interact with your patients, how they remember you. Is that on the right track?

Patrick Hudson: That’s precisely it. And an example I have: I had a family member that was going through a divorce, and they asked me how, you know, how do I manage this kind of a situation? And they were worried about the experience with their children, what the children would think.

And I said to them something that I say to physicians all the time: that it’s the role-modeling that’s the most important thing. Show the children the right way to do it, and ultimately the benefits will be there from that. Just behave properly. You know, in the world we live in these days, it’s hard to say that to children because they see so many examples of bad behavior outside, but they can see in a family what is the appropriate way to behave in these circumstances.

Kevin Pho: One of the themes that you write about in your piece is a loss of control, right? So how does that loss of control influence one’s deep-seated fear of death?

Patrick Hudson: Well, you know, the nature of medicine is to be in control. It’s part of our DNA, as it were. We always need to be in control. It’s frightening for us to be in a surgical situation or in the ER or dealing with a code, and we are not in control of that situation. So that aspect of it that we cannot control, the ultimate aspect of our life, is what I think is the most significant. We lose control.

Kevin Pho: Now when patients come to you with a fear of death, how do you counsel them? Are you telling them the same things that we’re talking about today? Give us an example of what it means to be in your exam room or office when a client or patient tells you that they fear death.

Patrick Hudson: Well, the first thing I’d like them to do is to recognize the truth of it. They have to acknowledge what’s actually going on. The aspect of denying death is something that we as physicians often do. We don’t even like to face the fact that we can’t succeed with patients, let alone with ourselves. So, first of all, I think we have to be prepared to acknowledge the reality of it.

The second thing is that we have to come to grips with the idea that no role lasts. I mean, you’re not going to be in a white coat forever. You know, whatever you do, you’re not going to be doing this forever. You’re not going to sit with a microphone and talk to docs. I mean, these roles all end, and that sense of an awareness and acceptance of that, I think, is crucial.

And finally, I think you have to learn to be present. You have to be in the moment. It sounds so cliched these days, but the truth of it is that we spend so much time thinking about the future, worrying about the past. Did we make mistakes? How can we do differently in the future? What’s going to happen when we retire? Just live your life day by day. It was William Osler who said, “Live life in day-tight compartments.” I think that was in his Aequanimitas address at Yale. But it’s so simple: you just live day by day.

Kevin Pho: Give some tips to those physicians who have trouble doing that because, like you said, so many responsibilities are on their plate. They’re under so much pressure, both in the office and hospital, as well as at home, especially if they have a family and are raising kids. How can they live in the present? What are some tips that you could share?

Patrick Hudson: Well, I think the first one is to want to do it. Very often we’re frightened of living in the moment. It sounds extreme, but the reality is it’s much easier for us to be constantly on the move, looking for something different. So slow down and live in the actual moment that you are in, especially with children. I had a client the other day who said that their child said to them, “You are missing all of our childhood.” I mean, the child said that to the parent. And it’s true. We are missing all of these things, but if in the moments that you are actually with the child, you are present, then it doesn’t matter whether it’s 10 minutes or 15 minutes or an hour and 30 minutes. It’s just being there for that. So I think being present is number one.

I think the second thing is that we have to recognize that we’re more than just being doctors. This has become so much for us. It takes us over, as I said earlier. That’s the essence of medicine. I mean, if it doesn’t, you’re not really a very good doctor, I think, these days. And I remember going through medical school and the excitement of learning all of the things that I learned every day, and then the amazing experience of actually being able to go and examine patients and do minor procedures and things of that kind. There was no room for anything else. It just took me over, and we never really get out of that.

And medicine is, above all, the profession of postponement. I can’t tell you how many doctors I’ve worked with who have said to me, “You know, when I was in medical school, I said I couldn’t get married until I was out of medical school.” When I was in residency, “I couldn’t have children until I was out.” And we keep putting things off and putting things off instead of living in the moment. And at the end of the day, we end up not knowing what it was we wanted anyway.

Kevin Pho: You end your piece by posing a question: what if death isn’t just an ending, but a moment of clarity? So, talk more about that reframing of death.

Patrick Hudson: Yes, and I think that it’s important to think like that. When we start to have anxiety and fear and concerns about dying, we need to not just push it to one side but realize that perhaps it’s an invitation, maybe it’s a calling, but it certainly is an opportunity to decide what it is we want to do with our life. As physicians, my father died a few years ago, and I’m an only child, so I spent time with him at the very end. And I can honestly say, although I would never want to go through that experience again—it was hell—I certainly would not have not wanted to do it. I learned so much from him about courage and the process of slowly letting things go.

Kevin Pho: We’re talking to Patrick Hudson, a retired surgeon and psychotherapist. Today’s KevinMD article is “Why we fear being forgotten more than death itself.” Patrick, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Patrick Hudson: Yeah, I think if you are a physician and you are afraid of fading away, don’t ignore it. Speak up about it. Talk to people, recognize the significance of this, and use it. Use it as an opportunity to be able to grow in that last part of your life.

Kevin Pho: Patrick, thank you so much for that perspective and insight. Thanks again for coming on the show.

Patrick Hudson: Thanks, Kevin.