Attending to a Patient's Funeral

Doctors have a special relationship with death. In May, I wrote about the difficulties that Doctors and others have in their responsibilities to inform patients and families of death and the prognosis of death. Doctors also have a unique perspective on the aftermath of death because of their relationships with the deceased and the expectations of their role in prolonging life.

"Country Doctor" W. Eugene Smith 1948

I am very pleased to be able to share with you a post from The Examining Room of Dr. Charles. Dr. Charles is a physician who writes an insightful and informative blog about his experiences and perspectives, and he has graciously granted me permission to share this moving post on doctors and funerals.

On the way to the funeral you wonder how you’ll be received by the grieving. Although you are confident that your care for the deceased was sincere, professional, and adept, you still question if others will so assume. There is silence in the car. This is a trip you make alone.

You manage a bitter smile as you recall stories the patient shared in unguarded moments, behind the door of a small examining room. How he beamed with content at the thought of his grandchildren; how her eyes glowed as she remembered the view from the Eiffel Tower; how the tears and sobs and memories of a lost child wracked his otherwise impenetrable façade. Sometimes you knew his spirit as well as you knew his medical illnesses, and often he hoped you would tend more to the former.

You walk into the funeral space. Many people are gathered. You sense pockets of light humor and recalled happiness amid dark clouds of sadness and gloom. Although you know this is not about you, your ego can’t help assessing how others perceive you. Most of those present barely notice, but others recognize you. Is it surprise registering in a few faces – that you’ve come to observe your patient’s defeat, that you’re emotionally invested in the person who once called you their doctor, or that you’re willing to dirty your powerful white coat with the stains of ultimate impotence? Or is it gratitude, that even in this darkest of reflective hours you’ve come to pay your respect to another who trusted you, confided in you, and who reached out to you for whatever healing you might bring?

As you shake the warm and cold hands of family and friends, you are reminded of the wide, verdant, chaotic world that existed outside the person’s small doctor-patient relationship.

It’s not just the hubris of the doctor that defines death as defeat. Very few persons seek out a physician to help them die well, at least in the beginning. And even when it is apparent that Time has overpowered us, it is only very late that we let go of the spiraling merry-go-round.

As you approach the coffin you are keenly aware of your own mortality, and yet in a state of denial. You think that your purpose is to mediate between life and death for others, and that somehow you exist in a space between. But as you bow your head in front of the lifeless body, placed serenely into its luxurious coffin, you are reminded of your illusions. You hear the sniffling misery, taste the salty ocean, and glimpse to where you’ll return.

You bid the family well, express your genuine sympathy, and leave. The air never tastes fresher, sweeter, more living than it does outside a funeral.

Back in the office you must move on. You have hundreds, thousands of other patients forming a queue that you imagine stretches across the fabric of the community. You are indispensable, and worthless.

But before moving on, you study the deceased patient’s chart one more time. It is certainly not literature, but if you read between the lines you can find poetry. You retire another legend of the examining room, slinging a stethoscope around your neck as you knock on the next door, hoping to be of some service while you too struggle on.

For more from Dr. Charles, please visit his blog at http://www.theexaminingroom.com/

Mass Graves in New York and Haiti: Disposition and Disposal

Mass Burial in Haiti

In the wake of catastrophic earthquakes in Haiti, government officials have made a difficult and unpopular decision to bury the bodies of thousands of unidentified victims in mass graves. The dead are left in the street where they are loaded like so much garbage into dump trucks. The trucks file into the landfill all day long, dumping the bodies into pits as fast as they can be excavated, and then the graves are filled in with earth as well as time permits.

Due to this policy, families will lose forever the opportunity to identify their loved ones. They lose the chance to say goodbye and to take part in many of the comforting rituals that help them deal with their grief, and which allow them to return back to life. Religious leaders in Haiti and all over the world are raising their voices together against this practice, but so far it has had little effect.

No one wants to make a decision like this, and not being aware of the logistics involved I will refrain from criticism. It could well be the case that there is no other feasible alternative. Certainly the dead cannot simply be left to decompose in the street, and as devastating as it is for survivors, the focus of limited rescue efforts should be on the living. Avoidable or not, though, this is a horrible tragedy.

Metal debris from the World Trade Center

In New York, we find a striking parallel. At the Fresh Kills landfill on Staten Island, debris deposited from the World Trade Center attacks on 911 has been shown to contain human remains. Families of the victims allege that authorities knowingly mishandled and co-mingled remains of the victims; plowing them into the landfill and even using them in road repair and construction projects. They have sued to have the debris removed from the landfill to allow for sifting out and identifying whatever remains are left, but so far, have not sought damages. Courts have disputed the right of families to sue without being able to identify the remains of specific victims.

The WTC families are in much the same situation as the Haitian survivors. They have been denied the opportunity to identify their loved ones, to say goodbye, to perform the rituals of their faith and traditions. They have had no say in where their loved ones are laid to rest, and must visit them at a landfill.

Workers sift through the debris at Fresh Kills

In our society today, more and more of us choose to dispose of our loved ones. We scatter their remains to the wind, or leave them unclaimed in the closet of a funeral home. We think we can forgo the rituals of the past., "Don't cry for me" "Don't let anybody look at me" "Remember me as I was" "Don't go to any trouble" "Just throw me in a ditch", these are the things we say to each other. We don't understand why anyone would want to cry over our body, or set flowers on our grave, or have to take the day off work to sit in a suit and get all choked up.

The need to say goodbye to our loved ones becomes obvious, though, when we see the heartache experienced by those who are denied the opportunity to do so. The need for a place to visit becomes clear when we see the WTC families going to a landfill to be near their loved ones. The need to engage in meaningful rituals is apparent when we realize the suffering of families who cannot perform the rituals of their tradition due to catastrophes like 911 and the Haitian earthquake.

So let us be grateful that we do have the opportunity to say goodbye, and let us pray for those who don't.

For the ABC News story on Haiti's mass burials, visit abcnews.com

For stories on the litigation and consequences surrounding WTC debris at Fresh Kills landfill, visit NY Times and NY Press

Artwork for this article was based on photos from abc.com and the EPA

Mbam's Funeral

Here is a neat excerpt from the Limbe Wildlife Center Blog. The blog tells the story of a chimpanzee named Mbam who died from a respiratory illness, and the service held to mark his passing. This story illustrates beautifully the importance of ritual, no matter who has died, or what the religious tradition happens to be. The funeral service serves to help the survivors to acknowledge their loss as a community, to mark the passing, to pray for their safe passage to whatever awaits them, to share the sadness, and to move forward back into life.

http://limbewildlifecentre.wildlifedirect.org/2010/01/20/mbams-funeral/

Yesterday we buried Mbam and, as we always do when an animal dies, we did a tradional ceremony for him. Stephen, a son of the soil, offered some whiskey to the fore-fathers and asked them to take good care of Mbam on his way to the other world.

It feels good to do a ceremony like this with the keepers. Just as it feels really good to know that you are all there and thinking about us. It is great to have friends like you. As we say in Cameroon: we are together!