Dealing with Death
Yes, doctors mourn too
But deep involvement is crucial to healing process
By Javeed Akhter
When Danielle's mom called that April afternoon, I knew I had to go. I had
promised myself that, as her physician and her friend, I would go to her home
when the end appeared inevitable.
The shadows were lengthening, but the sun was still bright when I arrived. A few
people were out lounging or tending to their gardens. Kids were playing, their
shouts and laughter punctuating the calm.
Her family was waiting for me and took me upstairs to Danielle's bedroom. She
lay in her bed breathing with obvious difficulty and, because of her failing
respiration, was unaware of her surroundings. Her mother was by her side.
Danielle was covered by a favorite purple and white afghan and surrounded by her
favorite trinkets, books, pictures of family -- even her three Chihuahuas.
Danielle was just 22.
Although I have seen many of my patients die, the experience is still searing.
Early in my career I had tried to erect a firewall between me and my patients.
Emotional burnout is not uncommon among caregivers dealing with serious and
fatal illnesses. I remember that, after the death of one patient, I was
depressed for days. But I came to realize how futile it was trying to distance
myself from the pain.
I now believe it is, in fact, necessary to get deeply involved, to get entangled
in the roller coaster of emotions my patients and their families are going
through. It is part of trying to be a healer, not just a technocrat physician. I
have to be there to utter the words of encouragement, to provide the shoulder to
cry on, to remind people that they are not alone in their sorrow.
Months earlier, Danielle and I had talked about the inevitable end. After the
last complication of her illness, when we used a catheter to remove fluid from
the lining of her lung, she decided she did not want a needle stuck in her ever
Her cystic fibrosis was complicated by severe rheumatoid arthritis that
precluded the option of a lung transplant.
We agreed to deal with her illness at home with pain medications, oxygen and
other comfort measures. Danielle wanted to be active in her job as long as she
could and wished to die at home. She worked until a day before her death.
When I had first met her, she was very quiet. Gradually, she came to trust me
and was comfortable enough to playfully insult me from time to time, something
she took great pleasure in. I still treasure the small framed note she gave me
once that said, "When I count my blessings, I count you twice."
Danielle had endured her long and difficult illness with uncommon class and had
come to terms with it.
After a few minutes in her bedroom, I walked downstairs, where the rest of the
family was gathered in the kitchen. I gave them the phone number where the
funeral home could reach me so I could take care of the death certificate. I
said my goodbyes and walked out.
I stood leaning against my car for a few minutes. I gradually became aware of
the street. The kids appeared to be moving in slow motion, the voices seemed
distant. Everything looked slightly out of focus. No one out in the street would
have guessed Danielle was dying inside.
Physician, family member
When someone is dying, I know I should be the
strongest in the room. But my eyes mist up, and I have to look away to regain
These experiences are rewarding because I feel I have provided a tiny bit of
solace and comfort. I feel humbled when families allow me the deepest access
into their lives and consider me a friend. This was the case with William and
his family. Only a few months before he died at age 19, I had gone to William's
house when he invited me to his high school graduation party.
I was impressed at William's energy as he first played ice hockey and later
tennis in high school. He was excited that he had just been accepted into a
computer program at a downtown college.
When he learned I had arrived at his party he ran out to greet me and gave me a
hug. I noticed him looking around and asked what he was looking for. He said,
"Your car." I had my Toyota, and he was looking for a Ferrari or Bentley. We had
a good laugh. This was before we discovered he had colon cancer.
When we realized that William had come down with cancer on top of his cystic
fibrosis, it seemed like an uncommonly cruel fate. Predictably, he went through
anger and depression. Initially he was hopeful that he might be able to beat the
cancer, but he later knew the end was inevitable.
Although I gave him the opportunity, William never talked to me about death
directly. His parents told me, however, that he wanted me to assure him that
when the end came he would not feel as if he was suffocating.
Although William did not care whether his death came at home or at the hospital,
his parents did not want him to die at home. They wanted home associated with
positive memories. They felt his room would be haunted with painful memories if
he died there.
Nurses and physicians were attentive to William's and his family's needs.
William did not want to be left alone even for a moment and was surrounded by
his family to the end. We were able to give him enough sedation and a breathing
assist device that allowed him to die in peace, without the feeling of
suffocating that he so feared. William's dad wanted to walk with his body to the
morgue, and we walked with him.
At William's wake, his dad introduced me as a family member.
I felt that roller coaster of emotions again
when it came to the death of my youngest sister, Parveen, 49.
For her, the decision to die at home was not a difficult one. When she realized
nothing more could be done for her colon cancer, she wanted to go home to be
close to her family. She had fought the cancer with extraordinary fortitude but
was now exhausted.
Even through her pain and fatigue she worried about her children more than
herself; nothing else seemed to matter.
At home her condition worsened quickly and I could see her slipping away. During
the last hours I could not tell if she was aware of her surroundings. As our
family kept vigil in her room, I kept thinking of her simple life; the
adjectives "selfless" and "noble" kept coming to mind.
It felt so unfair that she could not buy a few more years to celebrate the
achievements of the children she loved so much. I felt despondent, helpless and
guilty that I was in good health and had already lived years longer than she
As time seemed to pass ever so slowly in that room, I recalled a verse from the
Quran about the moment of death: "[God] is nearer to him/her than you, but you
cannot see." And I felt God was with her.
She, like Danielle and William, passed in peace surrounded by her family.
Javeed Akhter is director of the cystic fibrosis program at Advocate Hope
Copyright © 2007, Chicago Tribune