Thursday, September 13, 2007


My mother died in 1991 after a year long srruggle with cancer . Six years earlier she and my father moved into a small house they built on our farm so they could be close to Patience and me. They were both in their seventies, and as an only child we thought it would be good to have them nearby. We didn’t know at the time just how good that would prove to be. I was working two 12 hour days a week in an urgent care area and Patience was working part time as a recovery room nurse. So, when my mother’s illness progressed to the point where she needed more attention we were there to provide it. In addition, my daughter Beth was living with them at the time and was also available for additional help.

I graduated from medical school in 1965, completed 4 years of residency and 2 years in the US Navy medical corps, became board certified in internal medicine, and completed nine years of private practice, and in all that time I cannot remember one class, conference or other teaching experience in dealing with death and the dying patient. All that I knew came from reading Kubler-Ross’s book, Death and Dying. My mother was about to change all of that!

My parents managed to maintain some semblance of a normalcy in the early stages of the disease, in spite of several hospitalizations. But as the disease progressed, and her condition deteriorated, Patience, Beth, and I became more involved in her day to day care. Eventually our local hospice was called in. As my mother’s pain increased, managed by morphine, she never complained, even as she became increasingly dependent on others to manage the routines of daily living. In the weeks prior to her death we began taking turns sleeping in the bed next to her because of increasing mental confusion and unexpected needs. She began to withdraw from us, not speaking, and often calling out to her beloved Gace, a deceased older sister who was more like a mother to her during her childhood. When my mother died, my father, Patience, and I were at her bedside holding her hands. (The circumstances of her last few hours were remarkable and will be described in a later post on this blog.)

The relief I felt from her death was overshadowed by the sadness of our loss. We were all tired from the time and energy, both emotional and physical, that we spent on her care. But in the days that followed I realized how fortunate we were to be able to be by her side through all of the stages of her dying and death. She was not alone; we had the opportunity to tell her all of the things we wanted to say, especially how much we loved her. In her suffering, she gave us that gift, to be a part of her illness and her death. I cherish every moment of those final months, weeks, and days, as well as the final moment itself.

My mother also taught me everything I needed to know about death and dying, and how it effects both the patient and the family. That knowledge served me and my patients well when I decided to return to a full time general medical practice one year later. (We opened an office in the front part of the old pig barn on our farm, but that is also another story.) I learned how incredibly important is for both the patient (and the family) to be at home, surrounded by family and friends when they die, And, I learned that it is imperative that the physician caring for a terminal or near terminal patient also consider the family within the scope of his or her care.

Then there is her final gift, one I cherish every day of my life. Beth, who had been looking for her place in life since she completed college 2 years ago, turned to Patience and me at the dinner table some months after her grandmother’s death and said she knew what she wanted to do. We both looked at her in anticipation of this announcement, and when she said she wanted to go to medical school...I could not believe my ears! Even now, as I recall that moment, my eyes get rather moist. Beth is now practicing medicine (internal medicine) with a partner in Middletown, Delaware and she is a wonderful physcian.

These are only a few of the memorable gifts from a dying grandmother and mother.

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