The Case I Can’t Forget is a weekly series that hears from the people working at the coalface of public service about the cases they have carried with them throughout their careers.
This week, intensive care doctor Matt Morgan explains why he chose to attend the funeral of his patient, Roy – the only patient’s funeral he has ever attended.
If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com
As I opened the door, the room seemed filled with memory rather than sadness. A photo album was being passed from table to table, aged photographs providing a glimpse into a past life well lived. I found an empty seat, feeling clumsy in my own skin as I sat down in an uncomfortable black suit. In my jacket pocket was an order of service from the last family funeral I had attended some years before. As I looked around the function room, there were family members I didn’t recognise, friends with whom I had not shared any memories and work colleagues that I had not worked with. Why did I feel the need to come at all? Why did I come to Roy’s funeral, someone I had known for just one year? For the first time since becoming a doctor, why did I decide to go to a patient’s funeral?
When working on an intensive care unit, death is always a reliable companion. Whilst we strive for life, around one in five of our patients will sadly not survive. Staff find themselves uncomfortably familiar with people, both young and old, passing through their lives whilst their hands are held by family and friends. Whilst we always care for patients, we also find ourselves helplessly caring about them. As I reflect on the fifteen years since becoming a doctor, a handful of faces from poignant cases appear in my thoughts. There are some patients that we can’t help but carry along with us. Sometimes it is because they were very young, sometimes because they were very old, sometimes because they said something memorable, and sometimes because they could not speak for themselves.
We are taught in medical school not to treat family or friends except in dire emergencies. But what should we do when those you care for become almost like friends? Whilst working in a big, bustling intensive care unit in Wales as a consultant I met Roy. I spoke to Roy most weeks for over a year as we tried to help his heart and kidney failure with machines and complex operations. Although now in his seventies, as a younger man he had travelled the world by ship and had plenty of stories to tell.
And so did I. I had told him things that normally I would only share with my family. I told him about events from my past and hopes for the future. I’m not sure why I did this. Roy felt like a stable, familiar feature in an ever changing melee of other patients. He felt like part of the team as well as a patient.
I was there when his wife cried after we broke bad news and helped her smile when Roy eventually pulled through. This wasn’t unique to me. Many members of the team had grown even closer to Roy and his family than I. Despite a new heart valve being fitted, this wasn’t enough to allow him live outside of the intensive care unit. And so his life continued inside of it. He spent time with his long-term partner Lesley. Roy would have good days and bad days. He would even marry Lesley in a wedding held on the unit after a stag party in his bed space. Then Roy died. I felt like a part of the intensive care died with him. The bed space in which he spent over a year would forever hold a reflection of Roy. Many hospital staff also came to his funeral, representing a phase of his life that Roy had not chosen nor wished for, but one that one day will come to us all.
Am I an outlier, spending my day off not with my own family but with a patient’s? A large Australian study in 2016 suggests not. Overall, 60% of doctors had attended at least one funeral of a patient. This varied from over 70% of general practitioners to 50% of surgeons with only 20% of intensive care doctors like me. It is certainly more difficult to form bonds with critically ill patients who you may only ever meet in life whilst deeply unconscious. Surgeons and GPs have the privilege of meeting healthy patients before illness robs them of personality.
Understanding this variation in attendance is complex. Death is seen as a failure rather than a part of life for many doctors whose prime industry is delivering a cure. Some argue that a funeral belongs to the family not the professionals. Emotional distance between doctor and patient may foster better, unattached and less emotive care, but it can also leave both sides cold. Doctors are not immune from emotion and forcing this facade is hard. What is clear is that we have scant places to share them.
Medical school and national guidelines are designed with clear questions and answers. “How do you treat a heart attack?” the exam paper asks. “Like this,” we respond with confidence. The humanity that wraps medicine is seldom so simple. Even the most basic ethical questions have complex answers. It is only through experience that doctors recognise the best answer they can provide may be: “I don’t know.” There is no professional guidance other than a coffee room conversation after a long shift on whether doctors should go to patient’s funerals. If I am asked in the future, I will simply offer a “maybe.” For Roy, that maybe fell onto the side of “yes.”
When the trays of sandwiches had been cleared away, I waited in line to wish his wife well in the difficult time that would follow. Only then did I realise why I had gone to the funeral. Going was a two-way street. I felt part of a community, part of a life more than part of his death. His family also seemed to draw solace from our role that extended beyond his life. To my surprise, the real reason was not to represent the hospital, or to play my part, but because “the patient” had become something else. Despite the arguments for and against going to his funeral, what compelled me to go was simple: Roy had become a friend to me and to many others who had helped care for him. I had simply gone to a funeral for a friend.
Critical: Science and stories from the brink of human life by Dr Matt Morgan is published on 30 May by Simon & Schuster UK.
The Case I Can’t Forget is a weekly series from HuffPost UK that hears from those on the frontline of public service about the cases they have carried with them throughout their careers. If you have a story you’d like to tell, email lucy.pasha-robinson@huffpost.com.