After Pronouncing

The following post is adapted from something I read at the San Francisco Veterans Affairs Geriatrics, Palliative, and Extended Care memorial service.  The case has been anonymized to protect confidentiality. 

– Alex Smith @AlexSmithMD

Many of the veterans we care for are fortunate to have family and friends with them during their last days. Some of you are here today.

Some veterans have no family or friends. Over the years, these veterans have either pulled away, or been pushed away, from their loved ones. Let us take a moment to remember the these veterans.

Last year I was asked to come and pronounce that a veteran had died in our hospice unit. I had just taken over for another attending physician and had not met this veteran while he was alive.

“Did he have any friends or family?” I asked. “No,” said our social worker, “we contacted everyone we could reach. We’ve tried for weeks. None of them would come. They are too angry.”

I went in the room. He appeared to be at peace. I conducted my examination. Then it seemed as if there should be more to do, some way to remember him, and acknowledge who he was as a person.

Who would grieve for him? It was obvious that his life had been difficult. He had been homeless. His face bore the ravages of his time on the streets.

Every person, if you go back far enough, was loved, at least by someone in their life. Even if they are not loved now. Before the anger and the arguments and the illness. Before the isolation.

Hopefully, if you go back far enough, a mother held this person, then a child, in her arms and loved him.

I held that thought of this veteran being loved by his mother in my head, as I thought of this poem, by Joan Siegel, about a dying mother.  About the love between a mother and her child.  About how we hold on to memories of our loved ones, take them with us, and leave a part of ourselves behind.

To My Daughter by Joan Siegel

When it comes time

let all the words be spoken

that must be

so that I may take your voice with me

for the next ten billion centuries

mine will be with you

like a packet of letters

handwritten over the years

to unfold anytime

read

hear me speak

in the voice that used to put you to bed

telling the story of all our days

fingered in the retelling

like pages of your books

the best parts dog-eared

pressed smooth by thumbprints

and the refrain of all our nights

as you slipped away

I loved you before dinosaurs 

Even before the stars