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Lessons in Dying Well

Most physicians have far more experience with death than the average person does. Even so, when they experience the death of a parent, it shakes them personally and affects them professionally. Four physicians with Dartmouth ties share final, powerful lessons they learned from a parent—how best to care for someone facing the end of life.

By Deborah Lee Luskin

Physicians are trained not to share personal information with patients and most don't. They tend to keep their own counsel about everything from their health to family concerns.

But when a physician experiences the death of a parent, all bets are off. Physicians will often share such a close-to-the-heart loss with others—including their patients. Regardless of how many deaths a physician has attended, or how anticipated a parent's death may have been, when a parent dies it rocks a doctor's universe.

Their years of training, of applying evidencebased science to illness and injury, of supporting patients facing their own mortality—none of that offers any defense against the humanity that comes crashing down on us all when we face the loss of those who gave us life. Despite (or perhaps because of) that fact, the death of a parent seems to provide physicians with a new perspective on their work.

The poet William Blake wrote that someone "who would do good to another must do it in minute particulars."What follows are the "minute particulars" of several stories of parental loss experienced by members of the Dartmouth faculty. In each instance of death, whether due to illness or to advanced age, the physicians drew lessons from the experience—lessons they've since integrated into their daily delivery of patient care. In all these instances, "care" is the operative word. What these stories have in common is the realization that the dying need attentive care.

It is also clear from these stories that dying is a process, and that it can be a fruitful one for both the dying and the mourners left behind. Repeatedly, these are stories about a rich time in human development, for the parent exiting life and for the child taking another step closer toward maturity—and his or her own death. What is also clear from these stories is that when the mourners are physicians, their patients—indeed, all of medicine—benefit.

The photos in the image above depict, clockwise from the top, the mothers of four DMS faculty members—Drs. Katherine Little, Ira Byock, Dennis McCullough, and Deborah Peltier. The images on the succeeding pages are imagined still lifes suggested by each of their sagas, but the photos in them are actual family snapshots.

Dying is a part of living

"What I really needed to know about care of the dying I learned not inmedical school ormy residency training but from the care my parents had given to Leah, my maternal grandmother," Dr. Ira Byock writes in his 1997 book, Dying Well. He was eight years old when his grandmother had a stroke. For the next year, she lived with Byock's family, receiving loving care until she was able to rejoin her husband in their own home. Byock, his sister, and

their parents continued to visit them regularly and to help with shopping and household chores.

Years later, as Byock neared the end of his residency in family practice in California, he learned stillmore about the impact a terminal illness has on a family. "An individual receives a diagnosis," he says, "but illness happens to a family."

His father, Seymour Byock, had been diagnosed with and treated for pancreatic

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Deborah Luskin is a freelance writer, a commentator for Vermont Public Radio, and a visiting scholar for the Vermont Humanities Council. She wrote a feature for Dartmouth Medicine's Fall 2007 issue on the financial and regulatory pressures that impelled her husband—Dr. Timothy Shafer, a 1981 DMS graduate who is a family physician—to close his own practice and go to work for a hospital in southern Vermont. We are very grateful to the faculty members she interviewed for the loan of the family photos used here.

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