Doctors and Sympathy Cards


Mark Geliebter, MD

Perm J 2003 Summer; 7(3):69-70

As soon as the Code Blue ends in the emergency department all of the housestaff scatter. During my training, I was always struck by how quickly the doctors would leave the scene as soon as the patient was pronounced dead. There was no lingering--as if no one wanted to stay in the room with the dead person. The strategy seemed to be to create physical distance from any associated feelings of failure as a doctor. There was no ritual to follow at the end of an unsuccessful resuscitation effort. There was never any discussion about the ritual of death. We would spend weeks and weeks discussing the Krebs molecular "life cycle" in medical school. However, discussions about the natural cycle of life and death were rare. After practicing internal medicine for many years at Martinez, CA, I was struck by my own lack of closure when my patients died. I too would not hover at the bedside when a patient of mine had died. I would not routinely connect with family members after a death. Many years ago, I became involved in physician wellness efforts at my facility and regionally. I realized that exploring our own relationship with death and dying was a key element in physician well-being.

One of the outcomes of that exploration was the decision to start a new practice for myself in 1995. I began to list the name of every patient of mine who died. I generally would include a diagnosis, medical record number, date and place of death. I started a folder labeled "Death and Dying." I also began to send a sympathy card to each family (I later found these cards available as a KP stock item!).

Initially, I began with brief statements of sympathy. More recently, I've been writing more personal comments, especially when I've had a longer relationship with the person or their family. I frequently mention that I felt privileged to have been their physician. I also try to call the families that I feel connected to. I have received frequent positive feedback from families for my personal note or call. They are most appreciative of my thoughtful acknowledgments.

This has created a ritual practice for myself at the time of a patient's death. It also gives me a way to remember my patients. When I review my list, I can usually remember something about them, their faces, their personalities, or some ethical or medical issues that may have been challenging. Even after many years, the list elicits those memories. I would have totally forgotten many patients that had died if it weren't for my list. At times, it reminds me of memorial plaques on some synagogue or other walls that list names of members or their families who have died. Sending the sympathy card and making the follow-up phone calls have become part of my own sense of responsibility as a physician. It helps obviate the need to run out of the room after an unsuccessful Code Blue, as I did when a medical student. Integrating the reality of death; embracing it as a natural process; developing coping strategies; not labeling death as failure; finding rituals; doing outreach during and after the dying process are all part of our role as physicians. All of these insights and rituals will add to our own personal wisdom of dealing with the inevitability of our patients' and our own deaths.


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