The Search For Ceremony

It is interesting how, as humans, we need ceremony to accompany our major life transitions.  Weddings, baptisms, Christmas dinners and funerals…there is comfort in procedure.  There is support in the families and friends who gather.  There is probably also a part of us that feels something has been processed by the ritual of formal recognition…

I realized today why my job seems so lonely sometimes.  I build these intense relationships with families and patients that all eventually come to an abrupt ending.  For me, there is no ceremony.

This weekend, amid the busyness of life as a mom and a friend and a wife, one of my very favourite patients died.

Bert (**name has been changed for confidentiality**) came to me 10 years ago.  I scooped him up from a walk in clinic where he was being seen for the 5^th time for his bad knee.  I suggested to him that he might need a family doc – after all, he was in his late 80s – and I always had a soft spot for feisty older men.  They remind me of my dad.  I can relate.  I admire them.  I know how to talk to them.  They come with their own set of challenges I willingly accept.

Bert and I have been through a lot since then.  Bert survived repeated visits to our ICU; dopamine drips and last rites –he always managed to pull through. Our relationship survived my gentle nudging to retire his skis, my taking away his driver's licence and final my insistence that he move to a supported living facility.  We had our tiffs.  At time he came right out and told me he was angry with me.  I sometimes had to do the same to him.  But we always reconciled our differences and moved forward together in the quest to find the right balance of safety and autonomy that would allow Bert to truly live (in his own terms) the final years of his life. 

A month ago I admitted him to our hospital for what felt like the 50^th time.  (I know his 6-digit hospital dictation code off by heart…) He lamented to me that his good friends hadn’t been around to bring him in this time, because they had “all gone off to Mexico”. I tried to brighten his spirits by joking about Mexican drug cartels and the dangers of sunburns and he laughed before clarifying for me that fact that he didn’t actually WANT to be in Mexico right now.   “Nah,” he said, “I don’t think I’d feel safe being that far away from you.”

I should have known that he was nearing the end.  His fight was flickering as he allowed tears to enter our conversations and sometimes insisted on holding my hand during some of the more difficult chats.  He had about him this lovely gratitude I had never really seen before.  I should have known and warned him then that we were at the end.  I suspect he knew.  He probably assumed I did, too.

Today I unceremoniously had the task of dropping off his death certificate to the funeral home.  No one expects this to be the ceremonial event of this ending.  It became sandwiched in my to do list somewhere between taking Mia to a birthday party and getting groceries for the week.  I called first to see if someone could be there when I dropped it off.  That was an impossibility and the owner grew frustrated by my insistence on coming when someone was there. “Just put it in an envelope” he said, “And slide it through the mail slot.”   I explained that I didn’t want to fold the death certificate and he scoffed, “They get folded all the time, ma’am”

As I drove to the funeral home I took the long route.  I drove around the block once before I had time to process what my odd behaviour was all about.  For me, this was my ceremony. This was my goodbye.  People cry all the time at funerals, but no one cries when they drop mail through the mail slot of a funeral home.

I slid my final duty as Bert’s doctor through that door today and wished I could have had a moment to sit on the steps and weep.  For the relationship we had built.  For all of the conversations we’d had.  For all of the many times he had needed me and I had come.  For the many life stories he had shared. For his final words he had whispered to me just the day before, “Thank you.  Thank you.  Thank you.”

It’s impossible to invest fully in a relationship without becoming emotionally attached. And yet we are often not granted permission to grieve and celebrate the life we too have lost in the usual traditional ways.  Sometimes we have to make do with simple ceremonies we create for ourselves.

I paused in my car before driving away from the funeral home that day and said out loud right back at him, “Thank you. Thank you.  Thank you.”