Caring for the Dying

UCSF clinicians share personal reflections

Last week in the Medical School’s Foundations of Patient Care course, second-year students attended a panel discussion on death and dying staffed by an intensive care unit pediatrician, a fourth-year medical student, a gynecologic oncologist, a critical care anesthesiologist and a psychiatrist. They each shared personal and powerful stories of their own clinical experiences with death.

To protect the privacy of the patients about whom they were speaking, as well as the clinicians themselves, the specific details of their stories will not be recounted here, but themes included how death could be a meaningful, spiritual and tender experience for physicians, patients and families, and how support within medical teams is essential for working through the emotions of caring for the dying.

After the large group discussion, students broke into smaller groups and wrote about their own experiences with death. My own group is not often a very emotional one, but as we read our entries to one another, we shared tears, moments of thoughtful silence and the knowledge that in recounting these heavy memories, we had created human bonds together. My classmates’ stories are their own to keep or tell, but I would like to share two of my short stories of dying.

My younger sister Arathi was born in 1984. Roughly a year later, my mother, father and I were on our way to India to introduce her to our extended family. She was the first and only granddaughter on my mother’s side, and everyone was very excited to meet her.

We learned of my grandfather’s passing when we landed in Bangalore. He had died while shaving just hours before we arrived, his final journal entry reading, “About to meet my granddaughter Arathi. Happy happy happy.” We like to say he died of happiness.

When we arrived at the home he had built in memory of his late wife, Saroj, his body had already been placed in the vehicle that would take him away to be cremated. I hadn’t previously been faced with a real death, and I don’t remember all my thoughts. I do remember the one suggestion I made to my mother in hopes to lighten a situation that I understood was very somber. I tugged at my sobbing mother’s leg, and when she kneeled down, I whispered, “If they took the cotton out of his nose, at least maybe he could breathe.” The vehicle pulling away from the house is my last memory of that visit to India.

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Grandpa Mike and Grandma Bess (obviously not biological grandparents of mine) had been married since November 19, 1929. They set their hopes and dreams during the Roaring Twenties, wed in the wake of the great Stock Market crash, and raised their five children through the Great Depression and World War II. They moved west to Los Angeles after farming in South Dakota and Minnesota proved unsustainable, and they lived together until Grandma Bess passed away in 1998.

It was not a surprise to anyone — her health had been deteriorating during her final year of life. Visits to her house would include the same four stories told over and over again, an ever-increasing tremor of her hands and the occasional smell of urine.  

Her funeral was where she would have wanted it, in a church with flowers, family and generations of friends. Seemingly everyone had something wonderful to share about Grandma Bess, and in the front row sat a frail Grandpa Mike, almost 93 years old, listening — quiet, reserved, blank.

When the hall began to clear, Grandpa rose slowly to his feet, hunched over his cane, struggling but determined to make his way to the casket. When he reached her, he looked lovingly at his bride of almost 70 years for the final time, leaned over slowly, kissed her on the forehead and cried.

He went on to live another two years, but I knew as I watched him kiss Grandma goodbye I had watched him die.