Endings

June 7 was no ordinary Friday; it was my daughter’s last day in high school. Remember that day in your life? Endings are important, aren’t they? As a sports fan, endings are part of some famous quotes such as Yogi Berra’s quip, “It ain’t over ’til it’s over,” or Dick Motta’s inspiring quote for the 1977-78 Washington Bullets, “The opera ain’t over until the fat lady sings.” This flight of ideas from family to sports is leading straight to where my mind tends to flow . . . back to oncology. This undertow takes me to this question: when is the ASCO Annual Meeting really over?

Is the Annual Meeting over when I head back to the airport? Or, is it when my online evaluation is filled out? How about when the #ASCO13 hashtag traffic tapers off, or when I’m done sifting through the various notes I took about stuff that I should follow-up on or watch on Virtual Meeting. I suppose you can guess where this line of reasoning is headed . . . the Meeting is never really over. The ideas and connections created in Chicago ripple on and on.

One specific topic from the Annual Meeting that ripples through my mind connects with the idea of endings—attendance at funerals. Dr. Don Dizon mentioned this topic during a marvelous session, The Power of Words. He recalled that he went to nearly every funeral for patients he lost during the first year of his faculty career. He shared that this burned him out, and that he now does not generally attend funerals for his patients. I struggled with funerals early in my career, too, but I had the opposite problem. I decided not to attend funerals because it seemed inequitable to attend some funerals but not others. Whether it might be true or not, I didn’t want to think that some patients mattered to me more than others. This pattern was broken, however, when a colleague who was my patient died. Along with other colleagues, I attended this person’s funeral. It was an emotional experience that I didn’t expect, for I felt grief for all of my patients who died. It was a composite grieving experience. This broke the spell, and now I attend some funerals (for whatever reason), and when grieving, I am very inclusive about the target of my grief.

I discussed this funeral issue with some ASCO colleagues during a reception in Chicago, and it is remarkable how we all seem to have evolved some sort of strategy for dealing with this question of funeral attendance. Few others in medicine or otherwise face this kind of death density and have this particular dilemma to sort through. With progress in cancer care, we all hope that this density will change and future oncologists will focus on other sorts of endings to reflect upon (like transitions to survivorship clinics).

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Comments

Don S. Dizon, MD, FACP

Jun, 10 2013 8:42 AM

Dear Mike, 

Thanks for your thoughtful post and for attending the session on Communication. It was nice to see thought leaders in the audience, alongside a diverse audience of peers, patients, and advocates. I came away from it inspired myself- especially with the incredible work that Tony Back and Mary Politi are doing.

You frame the issues of endings so well and I think that with time, and the passage of years as an oncologist, we find our own ways to say goodbye. I just hope that fellows and new attendings have the same support as I fortunately did with my mentors at Memorial Sloan-Kettering (shout out to Drs. David Spriggs, Carol Aghajanian, Paul Sabbatini, and Martee Hensley) for helping me when I felt it was hardest. 

Best- DSD 

Luis H. Camacho, MD

Jun, 10 2013 10:41 PM

Dear Mike,

How interesting human mind is!. I find that attending as many funerals as possible help me turn the page, say goodbye to my patients, honor and thank their loved ones for the priviledge of allowing me to treat their family member. I usually attend with my family and occasionally with our kids. They see another part of what I do and become more familiar with death as part of our existence and life in general. I also find that those last moments are very spiritual and bring out the best of very intimate memories shared by the patient, his/her family, and myself.

I started attending funerals many years ago because I felt that it is usually at this time when the family looks around and they see all involved in their day to day cancer journey except for the physician. Having said that, I also acknowledge our busy schedules and long days. And hence, viewings become a more feasible option.

As a fellow, one patient's widow told me the worst thing that hapenned to her after her husband's death was to receive only bills from the hospital and not one sympathy call or even a card. It got stuck in my mind. Our research and clinic staff also send sympathy cards. As you well know each patient has good stories, plenty of lessons to teach, and wonderful moments to remember. Am I an outlier?

Best,

Luis 

Michael Jordan Fisch, MD, MPH, FASCO

Jun, 11 2013 12:25 AM

Luis, I think it is really a nice touch to attend some funerals with your family and to allow your children to experience this aspect of life and of the work you do.  If you are an outlier, it is in a really positive direction it seems to me.  All my best--Michael

Michael A. Thompson, MD, PhD

Jun, 11 2013 11:02 AM

Great post as always Mike F.

I have generally avoided funerals except one that I attended for a very dear patient.
Little grandkids (whom I had never met) of the patient came up to me and hugged hard -- like their lives depended on it.
That was somewhat unexpected and really hit me with the broad impact we have on social communities outside the confines of a clinic office.

All of the family was aware of who I was despite me never meeting them.
It was very emotional. I left the funeral relatively early. 
I think everyone there really appreciated my presence, but I also felt like I was distracting from the focus on the family and the remembrance of the patient before cancer.

I'll have to dwell on Luis's comments more. Great perspective.

Mike T.


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