The Doctor, the Patient, the Funeral

By BARRON H. LERNER, M.D.

hen my patient Martha died at the age of 93, she left behind a fascinating medical story of countless recoveries from the brink of death. I knew, of course, that her story was more than medical. I had been her doctor for nine years. But it was not until I attended Martha's funeral that I obtained a complete picture of her life.

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I first met Martha in 1993 when she was 84. At that point, her main problem was blindness, which had occurred 10 years earlier, despite cataract surgery. But as Martha approached the age of 90, she began to develop a series of other medical conditions. First, she became confused, a sign of early dementia.

Then, in succession, she developed blood clots in the lung, an infected (and later amputated) leg and a twisted intestine requiring surgery. She pulled through every time.

Despite Martha's worsening health, her family continued to choose aggressive treatment. But her daughter and granddaughter, her closest relatives, were well aware of her condition, especially the worsening dementia. My office charts contain numerous notes from them asking for help with problems at home. Only excellent home care services kept Martha out of a nursing home.

My notes also document a series of discussions I had with Martha over the years. She loved to brag about her accomplished children and grandchildren and to tell stories of her earlier life in Nevis, a Caribbean island. Food was also a frequent topic. Martha had a great appetite. Pound cake was a particular favorite.

I last saw Martha in my office in September. The end came suddenly, a few days later, probably from a stroke.

Although the funeral had moments of sadness, it was surely a celebration of Martha's life. The family termed it a "home going service." What struck me first was Martha's picture on the cover of the program. In it, she is looking right at the camera. I was reminded that I had neither met nor ever seen a picture of this younger Martha, one that could see.

The service itself was entertaining and moving, full of religion and West Indian culture. Martha's daughter, Pamela, I learned, was still her mother's "pickme," an affectionate Caribbean term for one's child.

Martha was one of 19 children. She had outlived all of her siblings. Martha had immigrated to New York in 1951, hoping to become a nurse. But after having two children, these dreams were supplanted by the need to work — first as a housekeeper and then as a dietary aide at Calvary Hospital.

Martha had clearly been the matriarch, holding together a geographically scattered and at times contentious family. Even after her dementia set in, her presence remained a kind of glue. I now realized why it had been so important for the family to keep her alive and at home for as long as reasonably possible.

Most physicians do not routinely attend their patients' funerals. There are logistical reasons for this, including time constraints and competing commitments. Yet there is another, less valid, reason. Because physicians tend to see their role as keeping patients alive for as long as possible, death somehow becomes a defeat. The funeral, then, becomes uncomfortable.

But given the intense relationships that physicians and patients often develop, attendance at a funeral makes perfect sense. What better way to say goodbye to a longtime friend and to express one's grief to that person's family?

And attending a funeral sheds light on patients' lives — their passions and quirks, their aspirations and compromises. Of course, physicians should not wait until funerals to explore these issues. Questions about family members and fond memories are almost always welcomed by patients. Another excellent way for physicians to become familiar with their patients' lives is through home visits, which, fortunately, are now being encouraged by medical schools and financed by foundations.

Martha never was able to pursue an education. But her wisdom seems to have been passed down through Pamela and Danielle, Martha's granddaughter, both of whom became teachers. The most moving moment of the funeral came when Danielle read a letter she had received from one of her sixth-grade students after Martha's death. "I know how you feel," he wrote. "It's hard to lose a grandparent because they are the ones who taught us almost everything. Your grandmother's memory will live in all of us."

Martha did not get to hear this final postscript to her story. But I'm glad her doctor did.