Fathers, Doctors, and Time

One Saturday morning in late October, when I was 12, I went hunting with my dad. It was the last thing we did together. He was 49, and usually I had trouble keeping up with him because he always walked so fast, happily energized, just from being out in nature. He always carried his gun as if it weighed nothing, and he would never come home before dark, no matter how early in the morning we started or how awful the weather. I, on the other hand, would heave my gun from shoulder to shoulder, frequently dropping it in the snow, or dragging it on the ground like a small artillery piece. Near the end of particularly long outings, he would often carry both our guns. Also unlike him, I usually couldn't wait to get back home to eat whatever my mom was cooking or watch TV.

That Saturday morning things were different. My dad lacked his usual vigor. This time it was he who seemed unable to keep the usual pace. Normally we'd chase our quarry over mountainsides all day, nonstop. This time we rested every 100 meters or so, even though it was still early in the morning and our first ascent. We went home shortly after reaching the top. Great, I thought, home before noon; I can still catch a few cartoons. It was the shortest trip I could recall. For the first time, he asked me if I would carry his gun. We finally got home, and the remainder of the day passed without the usual sights and sounds of my father working on the farm.

My father was no stranger to illness and injury. When I was 5, I remember watching, afraid and confused, as the paramedics closed the back doors of the ambulance, with my father lying on the stretcher, unresponsive and in shock from a perforated duodenal ulcer. A year later, he almost drowned as he tried to save my friend, who had gotten caught in a strong current in the local river where we used to swim. When I was 7, I recall being terrified when he fell out of a tree and fractured his spine trying to put a tire swing up for me. I didn't realize that a simple compression fracture was not life-threatening. All I knew was that I had never seen my father in so much pain. I was scared and asked the doctor in the emergency room if my dad was going to live. After hesitating for what seemed like hours, he responded with an unreassuring “probably,” then quickly left the room.

My dad's accident rate continued unabated. We spent more time in hospitals, and such curt doctor–family member interactions typified most of my early experience with physicians. I began to wonder if that wasn't how doctors were supposed to be. Although each of these incidents was extremely upsetting to me, I grew accustomed to them. After repeatedly seeing his vigor and zest for life quickly return after each tragedy, I came to view my father as invincible. I began to wonder if that wasn't how fathers were supposed to be.

Somehow, that Saturday was different. Something was more wrong, more frightening. I found my father lying in bed, sallow, with shaking chills, bleeding gums, and hot, fetid breath that permeated the room. The dried blood on the corners of his mouth and pillow terrified me so much that I immediately ran out of the room.

A few days later, a doctor called. He spoke very briefly and matter-of-factly, like a postmaster calling to say a package had arrived, and said my father had acute myelogenous leukemia. I didn't know what this meant or what to expect, and again the doctors weren't much help. Although my father spent the next 4 months in the hospital, I can't remember much about the doctors who cared for him, not even their names. Neither can my family. We hardly saw them. But there were several nurses we'll never forget. I'm sure the doctors provided excellent medical treatment, and I'm sure they really cared about my dad. But unlike the nurses, they never let us know it. The nurses weren't afraid to show a little emotion once in a while. They took time to explain things. Perhaps the most memorable thing about the nurses was that they continued to offer assistance and keep in touch with my family even after my father died. It seemed that the emergency room doctors thought their job was suddenly over when my dad's condition had stabilized. It seemed that the oncologists thought their job ended at the time of his death.

But I can understand this. Physicians are under increasing pressure to be more productive, to see more patients in less time. Often we barely have enough time to care for the patient, let alone to adequately address the concerns and needs of the rest of the family. But it doesn't take much to make a big difference. A quick phone call a few days or a week or two afterward, to see if any new questions or concerns have arisen, can be more valuable and helpful to the family of the deceased than hours of explanation or consolation at the time of death. Perhaps nowhere is the care of the family more important than in the setting of a terminal illness. As doctors, we must not forget that after a terminally ill patient dies, the family still goes on living—living with the loss and living with an entirely new set of problems and conditions that time does not necessarily heal.

This year, the anniversary of my father's death hurt more than ever. I began to wonder how often I appeared to the children of my seriously ill patients like the doctors who took care of my father had appeared to me when I was a boy. Most of all, this same boy finally began to realize that the opportunities he keeps waiting for will never occur—another hunting trip, a brief visit, or just a phone call. The most painful moments in losing my father did not come at his death. Somehow time has intensified, not eased, the pain of loss. When my dad died 22 years ago, I didn't realize how permanent death was. I'm beginning to now.

• Copyright ©2004 by the American College of Physicians