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Stanford University School of Medicine

On death and dying: A discussion of giving news that no family members want to hear

The standing room only crowd at the Stanford Humanities Center had come to hear physicians read their own writing about the most difficult of topics: “I Am Afraid I Have Bad News: Death and Dying in Medicine.” The enthusiastic response to the topic demonstrated the interest in and need for such a forum. “This is a topic we just don’t talk about enough, in medicine and in society,” said Ward Trueblood, MD, a member of Stanford’s Pegasus Physician Writer’s group who curated the event.

Trueblood’s own experiences as a trauma surgeon, particularly during the Vietnam War, affected him deeply. “When I went to medical school, they didn’t teach you about death and dying,” he explains. Trueblood has found writing to be a powerful way to process his experiences. His memoir, Blood of the Common Sky: A Young Surgeon in Vietnam, will be published this year, and his book of poetry To Bind Up Their Wounds is available on Amazon. Trueblood appreciated being able to give fellow physicians an opportunity to share their experiences with death and dying through personal poetry and essays.

Gregg Chesney, MD, a critical care fellow, read two poems, including "Lost in Translation":

In trying to explain how “she hit the floor with a thud”

now means “she never woke up

and never will,” something was lost.

Yes, that is her heart tracing its beat across the monitor, but that swollen tangle

of blood, wrapped and knotted at the base of her brain

has pressed the leafless stalk of her medulla and left her

brain dead.  There is no one-more-test, no

chance-for-recovery, but at 2am, rendered in secondhand Mandarin,

that point might be missed, or left to dangle precariously,

soured and unplucked,

as he works out how to raise a 3 year-old on his own.

As Chesney finished the poem, his six-month old son cooed in his mother’s arms. The irony of the moment was not lost on the audience, as they contemplated the fate of the young father in Chesney’s poem.

Bruce Feldstein, MD, Stanford’s hospital chaplain, read “At My Father’s Bedside,” in which he shared what he had learned from his patients with his dying father:

The moment itself is peaceful, I’m told. No fear. Simply letting go. Smooth, like a hair being pulled from milk... You know, we human beings have been dying for a long time. Your body has a natural wisdom built right in for shutting itself down. The body knows just what to do. And there are medicines along the way to keep you comfortable.

During the Q&A session, an audience member asked Feldstein if there was anything he wished patients knew about their physicians. “Yes, how much doctors care," Feldstein responded. "And that this effects them too. How difficult it can be to be the medical professional in that instance, giving news that no family members want to hear about their loved one.”

In “Time of Death,” Kendra Pederson, MD recalled her first patient death, a young woman with sickle cell anemia. “I remember Sharon because she was the first, and because even then, I recognized that I was granted an enormous privilege to be so close to her story of magnificence and grief that is every life.” Pederson noted that her young patient’s outlook on life had a positive impact on her: “Her life philosophy was to pack in as much love and laughter as she could. None of us really knows how long we’ll live, I’d just as soon fill my life with good, she cheerfully proclaimed, and though the message did make sense to me I didn’t fully understand, yet, how I should apply it.”

Several high school students from Stanford’s pre-collegiate summer camp in attendance were particularly impressed with fourth-year medical student Kendall Madden, whose poem “Don’t Forget Persephone,” included the stanza:

I do not believe in one story

of what comes after death,

only that it is wide as the universe

and did not always have solid boundaries

so living souls could walk there on occasion

but never emerge unchanged.

“Seeing her and hearing her express her emotions in such a beautiful way was inspiring,” said Raven Leal, a senior from Nebraska who hopes to become a pediatric oncologist. When asked if attending the forum made them more or less interested in attending medical school, James Douglass from Shorewood, Wisconsin, said, “MORE. Definitely. This made me excited.” Douglass wants to pursue neurology and was particularly interested in Peterson’s experiences specializing in neuro-oncology. “What an opportunity, to hear this now, before even going to college.”

Jacqueline Genovese is assistant director of the Arts, Humanities and Medicine Program within the Stanford Center for Biomedical Ethics. Any patients described in the pieces referenced here are derived from the individual or composite stories of real patients seen by the physician-writers; identifying elements have been changed in order to disguise the patients’ identities and protect their confidentiality.

Previously: The woman in the elevator: dealing with death in medical training, Reflections on dying, contained in 140 characters, Literature and medicine at life’s end, Communicating with terminally ill patients: A physician’s perspective and Asking the hardest questions: Talking with doctors while terminally ill

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