Saying Goodbye

Last night I said my final goodbye to a beloved patient.

I’ve had my fair share of loss of family members, close friends, and patients but somehow this was a bit different. This was a sweet 86-year-old woman with a lovely daughter who was always present by her side diligently taking notes. The patient was one of the first to welcome myself and my (at the time) fiancé to their small town. She told me about her years working at the local Catholic school where her children and grandchildren attended. She was excited for me when I got married and was ecstatic hearing that my wife became a teacher at that little Catholic school she spoke so highly of. She showed up when we moved our clinic across the street from our ancient 1950’s building into a brand-new building.

As I walked into the hospital and made my way towards the elevator, I began to feel unprepared. What would I say to her family? How would I console her crying daughter. What prolific last words do you leave with a patient crossing over to the other side? Maybe she had already passed.

I walked into a dark room seeing my patient fast asleep with her daughter by her side. She was under hospice care with comfort measures in place. The patient had suspected metastatic esophageal carcinoma and elected not to undergo surgery. Solid foods were discontinued 4 days ago, intermittent confusion was setting in and now it was only a matter of time. She was in the active phase of dying. 

Her daughter saw me and immediately embraced me. She proceeded to tell me how well her mother was taking things. It’s almost like she bypassed the whole Kubler-Ross grief cycle. The patient had made her rounds seeing all of her children and grandchildren. As her condition deteriorated, she decided to spend her final days in the hospital so she wouldn’t burden her loved ones. “She is ready to go Dr. Daniel”, her daughter said. “Mother has been singing songs and laughing with us. She has planned her whole funeral and even picked out the songs we will sing. She’s going on her own terms and even told the Chaplain this morning she was ready to meet Jesus.”

I held tears back as her daughter explained to me how fond the patient was of me. She wagged her fingers and warned me that her mother would hush anyone who cried in her presence and demanded they step outside. This was a sobering experience. In any other world, our paths would have never crossed. I am a young African American male, city boy and she is an elderly Caucasian woman of a different generation who grew up in a small town. It’s kind of cool when barriers like this are broken. 

Medicine allows us to intimately know other human beings. To be by their side from cradle to the grave. Medicine exalts humanity and has the ability to unify. It is interesting to see one’s soul before leaving this world. They can’t take anything with them but they can leave a lasting impression and a legacy. I learned no matter how many times you say goodbye you can never prepare yourself to say that final one.

I told her daughter it was a great privilege caring for her mother over the past few years. I held my patient’s hand and told her I hope to see her again in heaven one day.

May she rest in perfect peace.

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Sara Rashidi

Love and respect this post a lot. As a pre-med student, I always find it a privilege that I was able to accompany a patient in his dying phase to his last breath, as well as holding a mother’s hand while she was delivering her new-born into this world.

1 month ago

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Sara Rashidi

Love and respect this post a lot. As a pre-med student, I always find it a privilege that I was able to accompany a patient in his dying phase to his last breath, as well as holding a mother’s hand while she was delivering her new-born into this world.

1 month ago

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Dr. Daniel

Thank you Sara Rashidi. It’s hard to describe these moments. They are priceless and they really make you appreciate life and the practice of medicine. Dr. Dale, I’m curious how you handle death in the ICU. 

1 month ago

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Dr. Dale

Never gets easy.  Dealt with a few this past week.  I’m a man of faith and personally find my strength in  Jesus.  I find myself praying for patients and on occasion with family members.  Right or wrong, it’s easier to deal with when the death is expected.  It’s the unexpected deaths (e.g. patient is not chronically ill) that really hurt.

1 month ago

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William Faulk

Experiencing life and death in medicine is what made Francis Collins change from Atheism to Christianity. Not trying to get into a large discussion of faith because I respect everyone’s choice of faith, or their choice not to have faith. But what I can say is that sometimes being in these situations, people can find a lot more than they may have actually been looking for. This is one reason I plan to strive to do so well in medical school. Not so much for the scores and the ability to get into a good residency. Of course that’s part of it. But what’s more important to me is having the knowlegde and the skill necessary to give my patients the very best care I am capable of giving them, even if that means that I am not the one giving them that care (such as referring them to a specialist or someone who knows more than I do), to the point that when I do have to say goodbye to a patient, I know I have done everything I possibly could for them and that it is just their time. Thank you for that post Dr. Daniel.

1 month ago

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Dr. Daniel

Very powerful William Faulk! There is a deep sense of purpose one gets witnessing a patient die after you’ve done your best for them. It means a lot to their family too. You will be an amazing doctor one day.

1 month ago

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William Faulk

Thank you very much Dr Daniel.

1 month ago