Correspondence
Letters of Condolence
N Engl J Med 2001; 345:374-375August 2, 2001
- Article
To the Editor:
The Sounding Board by Bedell et al. on the doctor's letter of condolence (April 12 issue)1 was distressing to read. My wife of 40 years died at a prestigious teaching hospital. For nearly four years she had struggled with carcinoma of the fallopian tube. There were 26 hospital admissions for surgery, chemotherapy, or emergency rehydration. When standard approaches ultimately failed, she managed, largely through her own research, to become enrolled at another distinguished hospital in a high-risk experimental protocol: high-dose chemotherapy followed by transplantation of autologous bone marrow. But the regimen turned out to be lethal. She died after three days in the emergency cardiac unit.
Neither the hospital management nor the attending physician or anyone from the house staff ever troubled to write or telephone to express sympathy or offer an account of what had gone so wrong those last disastrous days. The effect of that bizarre silence was to make me wonder whether some monumental mistake might have been made in preparing the dose that was to end her life.
The next of kin are entitled to some expression of sympathy or concern, even when it is not deeply felt. Those close to the deceased can only be baffled, resentful, or suspicious when no condolences are expressed.
1 ReferencesArnold Lerner
202 Winding Rd. S., Ardsley, NY 10502
ardsman@earthlink.net 1
Bedell SE ,Cadenhead K ,Graboys TB . The doctor's letter of condolence. N Engl J Med 2001;344:1162-1164
Full Text | Web of Science | Medline
To the Editor:
The article by Bedell et al. is both moving and practical. As an attorney whose focus is on the defense in medical-malpractice litigation, I have seen time and time again how the perception by a patient or family member that a physician is indifferent contributes to litigation. In my view, appropriately written letters of condolence should be sent not only because it is the right thing to do but also because it is the smart thing to do.
Ritchie E. Berger, J.D.
Dinse, Knapp & McAndrew, Burlington, VT 05402-0988
rberger@dinse.com To the Editor:
As a general internist in a small town in Colorado, I heartily concur with Bedell et al. that some sort of contact with the bereaved family is necessary but often avoided. It has been my practice to contact the surviving spouse or another close family member by telephone within the first few days after a patient's death. These calls are well received and give family members an opportunity to accept my condolences and concern as well as the chance to express any concern they might have about the course of the patient's illness and his or her death. Although a letter is permanent and a keepsake, I find it somewhat stiff and impersonal. My telephone calls have always been well received, and family members typically comment afterward that the call was meaningful to them.
C. Scott Harrod, M.D.
High Country Internal Medicine, Sterling, CO 80751
csharrod@kci.net To the Editor:
The article by Bedell et al. is an invaluable resource for clinicians who see many elderly or chronically ill patients. In contrast, pediatricians caring for younger, healthy populations, particularly in small communities, may find a letter of condolence too impersonal. Attending the funeral of a young patient who has died is a proper courtesy during this saddest of times.
Yet there is little in patient care that is more dreaded and draining. Funeral homes become inundated when a child dies. Seeing a former patient lying in a casket surrounded by somber, tearful family members is humbling and overwhelming. Also, physicians are not taught appropriate expressions of sympathy at funerals. Nevertheless, a visit by the physician shows immeasurable, comforting support. Calm reassurances — “I don't know why,” “What a wonderful child,” “No pain was felt,” “I shall pray for . . .,” “I remember when . . .” — will become part of the child's legacy.
Writing a letter of condolence is a difficult task. But, ultimately, just being there, holding hands, and saying kind words may be what matters most.
Stan L. Block, M.D.
950 Templin Ave., Bardstown, KY 40004
slblock@pol.net To the Editor:
After the death of my father, the nurses who had cared for him, as well as those who just knew our faces, sent letters, poems, and cards. I hope they know that I keep these very personal gifts in a special box. Simply knowing they are there brings me incredible peace.
These letters meant so much to my family and me because at no other time in our lives did we experience such pain, grief, frustration, and fear. The letters made it clear that my father's life and our emotions were not just trivial matters in the busy lives of these nurses and that they recognized our loss. I know that we all would have appreciated letters from the wonderfully dedicated and compassionate doctors who cared for my father. I implore physicians to revive this valuable and powerful gift to bereaved families.
Kirsten A. Hickerson, R.N., M.S.
University of Pennsylvania, Philadelphia, PA 19104
hickerso@mail.med. upenn. edu To the Editor:
Although in the past, I would on occasion send a note of sympathy or even attend a patient's wake, it was only when my father died that I fully understood the significance of these acts. A few years ago, after a lengthy illness, my father died of prostate cancer. After his wake and funeral, the one thing that my mother talked to me about repeatedly was the fact that his long-time internist and his oncologist had both come to the wake. It was clear how comforting this was to her. Seeing his physicians at that time reinforced for her that he had fought a good fight and that we had done everything we could.
I certainly do not remember any of this being discussed during my training. Maybe I was just too caught up in the science of medicine to have it register. However, on the basis of my personal experience, I have changed my practice and am only hopeful that the article by Bedell et al. will be discussed at medical schools and in residency programs throughout the country.
James F. Hyla, M.D.
310 S. Crouse Ave., No. 200, Syracuse, NY 13210
jhyla@twcny.rr. com Author/Editor Response
The authors reply:
To the Editor: We appreciate the positive and consonant responses to our article. These letters reflect the comments sent directly to us, as well as an article in the New York Times.1 We share Hyla's hope that our article will be “discussed at medical schools and in residency programs throughout the country.” Like Hickerson, we have learned that nurses often send letters of condolence, and we have seen the additional support provided when each member of the team writes a letter of condolence. Although Block is correct that attending a funeral is ideal under some circumstances, a letter may be the only way of “just being there.”
1 ReferencesSusanna E. Bedell, M.D.
Lown Cardiovascular Center, Brookline, MA 02446Karen Cadenhead, Ed.D.
Concord, MA 01742Thomas B. Graboys, M.D.
Lown Cardiovascular Center, Brookline, MA 02446- Citing Articles (1)
Citing Articles
1
Thomas W. LeBlanc, James A. Tulsky, David L. Simel. (2011) Autopsy and Grief: A Case of Transformative Postmortem Examination. Journal of Palliative Medicine110812065218006
CrossRef
