Why I Don’t Go to Funerals

For Nick

Some things are just so damned hard to write about.  People often ask me, “Why do you have so many animals?”  The current count is 4 dogs, two horses and a cat.  I used to say, “Because it’s good for my children to learn responsibility.  Having a dog, whose life is so much shorter than our own, teaches them about love, and about death.  They get to PRACTICE parenthood, before it’s for real.”  The fact is, now my kids are grown.  My animals are for me.  They teach me about love, and acceptance, and courage, and stoicism and yes, about death.  But how can one ever prepare for the death of a child?  It shakes a person to the very core of his soul.  I don’t practice pediatric radiation oncology.  I am just not constitutionally suited for it.

So it was with remarkable dread two years ago, that I faced a consultation regarding the role of radiation therapy in a 25 year old man, who was the favorite nephew of one of my medical oncology colleagues.  This young man had been a student at college when he suddenly lost sight in one eye. Initially he was misdiagnosed as having had a retinal detachment.  Sadly, that was the result, and not the cause of the problem.  The real problem was that he had a malignant melanoma, a very aggressive skin cancer that sometimes arises from the back part of the eye.  By the time he was properly diagnosed, the disease had taken away all chance of preserving sight, and the eye was removed.  It was an extraordinarily difficult choice for a young man to make—his eye, or his life, but he chose life.  Or so he thought.

By the time I was asked to see him, about six months later, he had a different problem.  The cancer had spread to his spine, and he was in excruciating pain.  He had been on chemotherapy which had not halted the progression of the disease.  Although melanomas are not thought to be very responsive to radiation, it was felt to be the last resort to try to get the pain under control.  What I remember about that first meeting was his incredible demeanor,  his grace under pressure, his forebearance, and his calmness.  Here was a young man who already knew that he was going to die. If he was angry, I certainly couldn’t tell.   This young man had decided to fight.  And fight he did.

Fortunately, his spinal tumor responded to radiation and his pain abated.  Despite the brief respite, his disease progressed –in his liver, his lungs, his bones and his skin, inexorably, site after site.  His doctors tried experimental protocols, vaccines, immunotherapy, every conceivable treatment available.  And each successive treatment failed—one after another after another.

The last time I was asked to see him, it was for pain resulting from a massively enlarged liver, loaded with cancer.  My staff bent over backwards to make sure that he could be seen, planned and treated all in one session.  In a radiation therapy department, this requires the coordination of at least 7 or 8 people, from the secretary, to my nurse and me, to my physicists, and finally to my therapists on the linear accelerator.  Everyone wanted to help this boy.  Despite his discomfort, and the shortness of breath caused by the liver constricting his lung capacity, he apologized for inconveniencing so many people.  We treated him at the end of the day.  I was surprised in the end that we were able to treat him at all, since it was so difficult for him to lie down and to be still, despite the fact that he had lost the use of his legs a few weeks earlier and was confined to a wheelchair.  The plan was to give him a single palliative treatment of radiation then return him to hospice care.  But it was far too difficult for me to say goodbye.  Instead I said, “if you’re better next week, come back and we can give you another treatment.”  I did not say goodbye.  I never said goodbye.

That last treatment was Thursday October 27.  He died on Halloween, October 31, nearly a year ago.  His uncle, my colleague was kind enough to tell me that the last treatment helped him, even if only psychologically.  Until the day he died, he talked about coming back to see his friends in radiation therapy, and me.  He passed peacefully, surrounded by his friends and family.

Doctors are notoriously awful about dealing with death and dying.  The experts say it is because we do not like to admit defeat and we do not like to face our own mortality.  As a group, we detest funerals, and we do not typically go to funerals of our patients, particularly in the field of cancer medicine.  The day came that this young man’s memorial service was held, in a beautiful garden at a public park, on a lovely fall day.  There was not an open chair in the garden.  Every single physician who had cared for this boy was there, and every last one of us was crying.  Sometimes, we just cannot run away.

When I was sixteen years old, and in high school, my history class was shown 16mm footage of the liberation of the Nazi death camps by American soldiers at the end of World War II.  I saw the hollow eyes, and the starved bodies of the survivors, too numb to even react.  And bodies of the dead, piled beside the road.  I remember that grainy black and white footage like it was yesterday.  Because that was the day I began to question the existence of God.

I know that when people die, the survivors say, “He went to a better place.”  Or “This has served a higher purpose.”  But really, what do you say when a child dies a hideous death from cancer?  If there is a higher purpose, I would really truly like to have it explained to me.  My friends and acquaintances say to me frequently, “Isnt it SO hard to do what you do? “  Most of the time, it is not.  But sometimes it is.  This was the one that was the hardest of all.

5 thoughts on “Why I Don’t Go to Funerals

  1. There is nothing that can be added to this beautifully written and extremely sad story except to add one note for those of us who are still here: WEAR SUNGLASSES
    and make sure your children/grandchildren wear them. I know it is not a cure-all for ocular melanoma but why take chances when we know that sunlight is a big contributing factor.

  2. Someone who was legally dead once told me what it was like to die, saying “You go to sleep. There’s nothing else.” (story, http://fastfilm1.blogspot.com/2010/06/last-interview-with-paul-kossoff-mia.html) This fed my nihilism and skepticism on religious matters; i.e., why is the supreme being a sadist?

    This may relate to your question of higher purpose. You already are fulfilling an earthly purpose of great importance to others, and with grace, intelligence and compassion. Why be preoccupied with someone else’s definition of higher purpose? You’re already living it…

  3. In seeing my parents’ reaction to my sister’s untimely death at 39 I thought that the most horrible thing is for a parent to outlive their children. I don’t think many of us deal with death very well and it is a funny/sad thing that we somehow think that Doctors, because of what they do, should be better at it. Death sucks, premature death of a life filled with promise and potential is a tremendous loss. My wise husband said to me once, when I was struggling to deal with the unfairness of these things, that if only bad people died we would never appreciate life and all it’s beauty. I have tried to remember this in all the sorrows I have experienced since. It is true but it sure doesn’t hurt less.

  4. As a veterinarian I deal with death a LOT more than most people, and perhaps even more than most physicians.

    And I also am called upon to euthanize (i.e., kill) animals. Some near death. Some not so near.

    All these years of exposure to death may be why I am so practical when it comes to life and death. I know people will die. I know I will die.

    This was most apparent to me when I was dealing with my own mother’s end-of-life decisions.

    I’ll have to tell you those stories privately some day.

  5. My father passed in 1983 when I was 21. My mother passed in 1988. I’ve been to a lot of funerals for other family members and close relations but have stayed away from quite a few also. I know we all have to go one day but it still feels terrible to even think about it. In some cases when the deceased is someone we know it hits so painfully close to home that it’s almost unbearable, but take a peek at the news and people die every single day, worldwide and in staggering numbers. Four seasons. Spring is birth, summer is the time of youthful bliss, fall is the maturation of the life process, and winter, even as beautiful as it is at times, seems to signify death. Just have to accept it I guess. What else can we do? Oh, I know. Enjoy life while you still can.

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