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A physician of a certain age

When I interview medical students for positions in the family medicine residency, I often ask them to tell me the story of a patient who has been meaningful to them, or taught them something important. 

It is remarkable to me how often these stories are about death, and their first or early encounters with the dying. 

In our culture we have very little contact with death or with dying people. Illness is so neatly sanitized away in the hospital that very few medical students have experienced the death of a loved one before they have to deal with it in a professional context.

My own initiation to dealing with death was as a medical student on surgical oncology service at the old Royal Victoria Hospital in Montreal. Alone in the hospital with the resident at home and being on call one-in-two, I learned a lot about dealing with death and dying—although I was not exactly taught. 

As a family doctor, I’ve found many of my most profound experiences have been in caring for patients at risk of death or in the process of dying. I’ve always tried very hard to be there, and to do my best to use skill and compassion and to get people the help that they need.

Now, however, I feel like death is stalking me! Ever since my husband’s heart attack last year, it seems as if many friends, colleagues and relatives, have been faced either with life threatening illness, bereavement, or having to deal with a sudden profound change in the health status of someone they love. At my time of life, I guess this is only to be expected but, frankly, I liked it better when we were all going to each other’s weddings.

The last three weeks have seen a crescendo of losses. A colleague lost her brother, another colleague’s father became gravely ill the day she was covering L&D and we all scrambled to replace her so she could leave town and get to him. Last week, my husband’s beloved first cousin died in Minneapolis. When Dave heard the news, he hesitated less than 10 minutes before arranging to go to the funeral. He had plane tickets and hotel reservations within an hour. 

The next day he was going to take the plane, he called a cab but both the app and the phone options weren’t working. Suddenly all the stress, the anger, the sadness burst out of him. He was yelling and banging on the table. I held him tight. “It’s OK,” I said, “I’ve got you.” 

The rest of the week I struggled, I had a wretched sinusitis and had to function without the support of my husband who has spoiled me since his retirement at the beginning of the pandemic. Then, the mother of two of my friends died. This woman was a very important part of my life. Our group of friends spent many hours hanging out in the living room or kitchen as we discussed psychology, art, truth and how to run the world. My friends’ mum was always there, completely interested in us as people. She was one of my early role models of good communication skills. At the funeral and shiva, many of my friends from high school, CEGEP and university gathered to reminisce. “She is the only friend’s mom that I knew” said one of my old friends. “And certainly she was the only one who really knew me.” 

Sometimes people arrive in your life when you need them. At the “cinq a sept” as we call it in Quebec, I met a new young palliative care doctor, who has started as staff at McGill. We had a lovely chat about dealing with dying and dealing with new babies, (he has a six week old). He liked my baby imitations and I liked his ideas about how to guide people gently into the good night. I felt, somehow, better. 

The next day, after a clinic team building retreat, some of our group headed off to the nearest terrasse for drinks and snacks. I found myself sitting next to two of my colleagues who also work as palliative care docs. Again, I unloaded my sadness, debriefed about what had happened, what could have happened, what I could do now to help support the families. How do I manage without burning out?

When I went home, I read my favorite of John Donne’s Holy Sonnets: Hymn to God, My God, in my Sickness. The Holy Sonnets are Donne’s meditations on death, belief in God and the afterlife. I have always loved it because it describes how his physicians, “by their love are grown Cosmographers, and I their map.”

This beautiful poem uses an extended metaphor comparing the difficult process of dying to the exploration of the undiscovered countries of the world. Now I am trying to help my friends navigate their way through these straits. I hope when it’s my turn to take that voyage west I can have faith enough to bravely and serenely enter into that unknown country.