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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Friday, September 28, 2007

Emotional response: Journal readers write about dealing with a patient's death

Comments have flowed in from around the world in response to an essay in the New England Journal of Medicine about clinicians' emotions when they are faced with a patient's death. From Greater Boston have come notes on saying goodbye before death, staying engaged at the worst times, coping with suicide, crying and celebrating with patients, and turning the tables when the doctor's time comes.

Doctors, nurses, students and others offered their thoughts in an online forum on Dr. Katharine Treadway's
"The Code." She wrote that after a patient's death, she says aloud this phrase from a requiem mass: "May choirs of angels greet thee at thy coming."

Dr. Naomi Leeds of Massachusetts General Hospital commented that she wrote a letter to a patient dying of esophageal cancer to tell him how he had touched her life.

"I welcomed the opportunity for closure and was grateful that my colleague encouraged me to do this I would not have thought to do this on my own," she wrote. "I think that we would all benefit by having more training on how to say goodbye and thank you to our patients who we know are going to die."

Dr. Robert Truog of Children's Hospital Boston said the essay gave him a chance to reflect on why he chose to specialize in pediatric intensive care medicine. Initially drawn to the challenge and excitement of making life and death decisions on a moment's notice, he has changed.

"In the long run, however, what has kept me most engaged in my specialty has been the opportunity to work with children and their parents through the worst times of their lives, helping them make decisions when none of the choices are good, and comforting them through the unimaginable depths of loss and sadness that accompany the death of a child," he wrote.

Death is "often uncommon and often traumatic for all involved" in child psychiatry, Dr. Steve Auster of Wellesley wrote. After a patient's suicide, clinicians met to talk about it and some of them attended the wake.

"Hard to imagine all that being possible in disciplines where death is more common, however that doesn't lessen the potential benefit of this processing," he wrote.

Stephanie Gill, a family nurse practitioner in Norwood, tries to put herself in the shoes of her patients.

"I've cried with them when it's bad news and celebrated with them when it's good news," she wrote. "I think the fact that we can make such a difference in someone's life (and in their death) is amazing."

And Dr. Thomas Amoroso of Quincy Medical Center said that spiritual rituals make him uncomfortable.

"To be honest, at my passing I want someone to make either a good joke, or best of all, a really bad pun," he wrote. "Honoring someone's life takes many forms, and I feel it is important to acknowledge that as well."

Posted by Elizabeth Cooney at 12:19 PM
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