Abstract
Entering his room with the briefest of introductions—“I'm Doctor Johnson, the hospitalist on call”—she went to his bedside and placed her stethoscope on his cold chest. She listened for what she knew she would not hear. She used the flashlight on her iPhone to verify that his pupils did not react. Touching the side of his face, she softly said, “He's gone” and confirmed what I already knew: my father was dead. But gone?
Yes, parts of him were gone: his laughter; our frequent phone conversations, when he would reminisce or talk about the weather; his day-old coffee, prepared the night before and heated the next morning in the microwave; and the carefully selected, wrapped, and mailed birthday gifts for each of his 15 great grandchildren. Yes, these are all gone. But some of him remains.
My brothers and I spent childhood summers with our parents in the Sangre de Cristo Mountains of northern New Mexico. We witnessed their love for the out-of-doors and their reverence of God in nature. My dad eventually published a book detailing the day hikes we had taken. His interest in photography and my mother's expertise in wildflower identification led to another publication about wildflowers of northern New Mexico. These books are still on sale. Unquestionably, the parts of him that inspired these works aren't gone. They live on in his sons, passed to his grandchildren and their children, shared with hundreds of readers.
For nearly 40 of his 93 years, my father served as a primary care internist in Texas. When I was a teenager, I once accompanied him on a house call to see Miss Rogers, an elderly woman who lived alone. We had just left a Boy Scout meeting; I was still wearing my uniform. Though I don't recall her problem or anything about my dad's ministrations, I distinctly remember that as we were leaving, Miss Rogers said, “I'm so sorry that I can't pay you. But I baked you a red velvet cake.” It was my dad's favorite and Miss Rogers knew it. Periodically he would bring home a red velvet cake, accompanied by a smile for kindnesses exchanged. Today, many of his great grandchildren love red velvet cake. Their taste and the importance of kindness were passed to them from their great-grandfather, parts of him that aren't gone.
When I was in medical school, he invited me to accompany him on hospital rounds. We saw a patient who was confused and febrile. I witnessed my dad perform a lumbar puncture, successfully obtaining cerebral spinal fluid on his first pass into the L3-4 interspace. “Impressive,” I thought. Little did I realize how impressive it really was. This became increasingly obvious to me later in my medical career when I struggled with difficult lumbar punctures. “It's all about patient positioning and proper landmark identification,” he'd said, advice I later shared with medical students and residents.
My dad loved teaching physical diagnosis, a trait I see in his three physician grandchildren. The fun and intellectual challenge of making the right diagnosis, the importance of providing competent compassionate care to patients, irrespective of ability to pay, these parts of him persist, handed down to other doctors, not gone.
When Dr. Johnson said, “He's gone,” I felt the reality and sadness of his death, a permanent separation, but not an obliteration. Perhaps the Negro Spiritual's “crossed over to the other shore,” is more accurate: separated, distant, but still visible to us on this side.
Then she turned and gently said, “I'm sorry for your loss.” I had heard exactly the same phrase at the time of my mother's death several years before. Five words that we teach medical students to help them deal with this emotional situation. But it also wasn't exactly accurate. “Sorry” suggests an apology and Dr. Johnson had nothing to apologize for. The phrase also conveys sadness. But it just sounded a bit formal for such an intimate sacred moment. The nurse's, “My dad died 10 years ago, and I still miss him every day,” seemed more comforting and genuine. I resolved to think about the words we say when patients die, and share these thoughts with medical students the next time I served as instructor in their communication course.
I thanked Dr Johnson and added, “I'm sorry if you were awakened for this,” a genuine apology. She briefly smiled and said, “No, I was already up.”
Shortly thereafter, Dr. Johnson would open my dad's electronic health record, and type the obligatory death note that would likely begin “Called to bedside for cessation of respirations…” She would record a time of death, an approximation at best. Several days later she would inherit the somewhat burdensome obligation of completing his death certificate, assigning a cause of death. I like to think that as she paused to ponder this, she would again connect with some part of my dad—not gone, not lost.