How Do You Say Goodbye?

September 18, 2014
Rebecca Bechhold, MD
Rebecca Bechhold, MD

Oncologists should be experts at farewells. I often write a note of condolence if I have not made personal contact with the patient or family close to the time of death.

The first patient I remember having to say goodbye to was Sarah. She was in her thirties, three children, part of a big Catholic family, well known in our city through their sports and business accomplishments. Metastatic breast cancer. I still have the rosary she brought back to me from Lourdes.

When all treatments had failed, and I knew she would not be back to the office, we talked for awhile. She was so composed, peaceful. Almost beatific. She really did resemble the saints I read about as a child. She died at her home, with her family gathered around her praying the rosary. It brings me to tears as I write this. It is not the religious conviction that moves me, though I have enormous respect for it. More so, it is the dignity and courage she exuded. It felt like she was trying to make it easier for everyone around her.

Barbie was so different. Evangelical, emotional open book, a hugger with a huge laugh you could hear down the hall! She advised me to hide your favorite Easter candy behind the stuff that never sells so that it will be on sale the day after the holiday. That last visit was full of tears, laughter, embraces that never ended. Her husband still sends sweet cards on anniversary dates.

Paula is not-repeat not-a hugger. Hasn’t been for the past 15 years. Stoic, reserved, controlled. We bonded over books since we are both avid readers and shun “popular” reading for more substance. She slowly revealed all her dark secrets of her family over the 11 years of her metastatic journey, always with a new anecdote after a holiday gathering. When she said, “I’d rather be hit by a bus now,” I knew she was done with it all. We worked through it for a couple of weeks, but she finally said she was ready for hospice care at home. I try not to shed tears in front of patients and families, but this was a time for sobs and strong bear hugs, and it felt right to us both.

Oncologists should be experts at farewells. We want to do the right thing. I often write a note of condolence if I have not made personal contact with the patient or family close to the time of death. It is a chance to thank them for having confidence in me and allowing me to care for their loved one. I wrote to a family when the spouse of a long-since-passed patient died, and they responded with a lovely letter that I treasure. I had such fond memories of the mother, which all came back when I saw that her husband had died.

So many patients are impossible to forget. I try to keep all the mementos, funeral cards, and notes from patients to read through once or twice a year. They can be inspiring, sad, and nostalgic all at the same time. Not that I require tactile reminders. One day a woman approached me and after confirming my name said, “Do you remember Sue Paul?” My eyes opened wider. “Of course!” Sue had been a soul mate as much as a patient. We loved our visits. Her death was dramatic and horrible, and I felt scarred for a long time. “Well, that is one of her daughters over there,” the woman said. I was so excited. I had to stifle the urge to run over, hug the girl, and tell her how much her mother had meant to me. She certainly did not need to relive that part of her life. But I was profoundly grateful to the woman who recognized me so many years later and instinctively knew I would be thrilled to see Sue’s child thriving.

After 30 years in practice, I treat many surviving family members and friends of patients. Though I have a pretty good memory, sometimes it is stressful to place every past patient. I am certain you have all had the experience of a stranger walking up to you and saying, “You took care of my mother. Do you remember her?” Help me out here, people-maybe a name or date or some context! I learned long ago to make sincere, engaging conversation while coaxing them into revealing the exact nature of our past relationship and ending with, “Nice to see you.” Don’t add “again,” as you may never have spoken with them before. Truly, I often never figure out if the person in question is living or not.

It always feels good to see and talk with all of these people with whom I have had a relationship. It is a confirmation that I do this for the personal impact I can have. My income keeps shrinking, but the personal satisfaction scores I give myself for the work of oncology are still high and still make me excited to enter the room and say, “Hi, I’m Becky Bechhold,” and shake the hand of that new patient, even if I may eventually have to hug them and say goodbye.