Older Adults Read the Obituaries

I had long witnessed this behavior from my father, who had set up multiple email and text message alerts on his phone, encompassing seemingly every Eastern and Central Massachusetts newspaper. He was often, as a result, the first to know when someone from his Barnstable High School class of 1966, or an old neighbor, or a fellow parishioner, had sadly passed away. He said he did this because… well, I was never quite sure. He said he just wanted to know.

In the days after March 31st, when my dad died from a cardiac arrest in the evening of Easter Sunday, and I took possession of his iPhone, it was truly as if he had died a second time when he – or, well, I – received the email notification of his own passing. Normally, I knew he would have been the one to see this first. There was an added finality to this Legacy.com email alert.

We had a beautiful Easter celebration – he watched his granddaughter and grandson scavenge and claw each other for Easter eggs, attended church as a Eucharistic Minister, and presided over the ham and turkey at dinner. It really was a beautiful day. I remember him saying as much to me on the deck in our backyard.

In a sense, my father’s passing was, by definition, very sudden. In another sense, it wasn’t sudden at all. He had suffered his first heart attack on the day I was starting my medical school orientation in August 2000 at Tufts. At age 51, he was in the CCU after his major heart attack while I was set to attend lectures on the floors below. He used some memorably colorful turns of phrase to tell me that he had worked too hard for me to miss my orientation to med school. I knew that was an accurate assessment, even if it was not easy to focus on the terms of my financial aid repayment later that morning.

My dad’s 24 years of ischemic heart disease certainly influenced my own practice style over time. But this is not mostly about that (although I do always fondly remember how he was the favorite patient of every nurse who ever took care of him: he was consistently appreciative, kind, and quick to tell how proud he was of his son and daughter to any member of the interdisciplinary team). I was his healthcare proxy, and he had shared, multiple times, with me what his goals were and how he would want me to make medical decisions on his behalf. I genuinely found that those parts were never the hard parts.

I went back to work at Saint Vincent Hospital in mid-April. And it turned out that older adults do indeed read the obituaries.

As a geriatrician, I have the privilege to regularly talk to my patients about loss and grief. There can be lots of losses associated with aging, but to be present with a patient after they’ve lost a spouse, a sibling, a friend, sometimes even a child, is humbling. I’m usually the one inquiring, leading, trying to listen. Only, after my father’s passing, I found something unusual happening: many of my patients were inquiring, leading, trying to listen. All of which was a bit hard to know what to do with, and how to choreograph. I knew they were trying to be helpful because they had read my father’s obituary. Many patients had even come to my father’s wake –including some patients in their 90s, and many of whom were caregivers who either brought their spouse or arranged coverage for their spouse. They met my mother, my wife, my sister, and my children. I know I had shown the newborn nursery photos of our daughter, now 15, and our son, 12, back when I first met some of them.

We are taught that we are not to be friends with our patients. The doctor-patient visit is most certainly designed to not be about us, and our own troubles, or losses. And yet.

“How are you doing, Dr. B.?”

For some patients, I found I would reflex into a narrative that I was gradually forming when other people would ask me that question. It’s not possible to function and finish a day if you were to actually answer that question every time it is posed. And, with my patients, after all, I also see them on a schedule. So I would usually stick to my evolving script, one that didn’t require any new emotions to be shared or previously unformed thoughts to be expressed. I did certainly appreciate their asking.

But I found that sometimes, for some patients, I did not always stick to the script. I even found myself saying things that I hadn’t quite said before.

There is a line. Of course there is a line. But having relationships with patients who I’ve known for 15 years, I found the contours of that line to not always be as easily demarcated for me as when the line was first neatly sketched out during my orientation at Tufts (I remember my mentor, Dr. Joel Popkin, explaining the dilemmas of the line to me during my residency about some patients for whom he had known for 40+ years).

I walk into a room and try to ask myself, ‘What can I do to try to be most helpful for this person today?’ Oftentimes, that involves mostly listening, and trying to understand their perspective, their worries, their struggles. And, in these moments, it felt at times as if what I could do to be most helpful to my patients was to share a bit about myself and how I was doing. It seemed to be therapeutic, and cathartic, for both of us. It reminded me of the value in our patient-physician relationships, rather than just our patient-physician visits.

I worried about the line during these visits. I still do. But I also know that I was glad that older adults read the obituaries.

Gary Blanchard, MDDirector, Geriatrics and Palliative Medicine, Saint Vincent HospitalKelley House, Head of House, University of Massachusetts Chan Medical SchoolEmail: Gary.Blanchard@stvincenthospital.com