JOURNAL OF PALLIATIVE MEDICINE Volume 17, Number 8, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2013.0534
Journal of Palliative Medicine 2014.17:971-971. Downloaded from online.liebertpub.com by GEORGE MASON UNIVERSITY on 12/29/14. For personal use only.
I Really Hate Goodbyes Robert P. Shannon, MD, FAAHPM
You are the bows from which your children as living arrows are sent forth. The archer seeks the mark up upon the path of the infinite and He bends you with His might that His arrows may go swift and far. Let your bending in the archer’s hand be for gladness; for even as He loves the arrow that flies, so He loves also the bow that is stable. —Khalil Gibran, The Prophet
I
really hate goodbyes; I really do! Rather than saying goodbye, I surreptitiously exited a celebration in honor of our recent palliative medicine fellow, Lainie. Tis strange really; sad, yes—for many reasons coming to the fore only later. My first goodbye wasn’t really a goodbye at all; maybe that’s my issue. He didn’t say goodbye; my father just died. I was five. As a family physician, I have witnessed many first breaths, many final breaths. Being with them helped me focus on the living. Living well even as we face the last breath and preparing to say goodbye: Is this palliative medicine? To say, ‘‘Hello, how are you? I hope for what you hope for; let us live for that; we will help you.’’ This ultimately is why my path in family medicine led me to palliative medicine; it is the best of family medicine. Then it is over; we say ‘‘goodbye!’’ Teddy: ‘‘I’ll see you when you get back.’’ She said this with the calm assurance of a person who knows that she is correct; it comes with the wisdom that is cancer’s gift to those who are able to receive it. Teddy was a patient and friend that I had known for nearly two decades. We had shared many life events, family illnesses, and most recently her cancer diagnosis that ultimately led her to hospice care. In anticipation of a personal travel holiday to Ireland, I stopped at her house to say ‘‘hello and goodbye.’’ Being of Irish heritage, I told her that I would dedicate my first pint of Guinness in her name; I did and sent her a postcard from a great old Georgian Dublin pub too. About two weeks later, I again stopped by to visit. ‘‘I told you that I would see you when you got back.’’ She laughed with joy as we greeted each other. She was dressed simply and yet like a queen at court with a bandana covering her head, propped up with fluffy pillows in a grand old bed in the middle of the main living room that had become her ‘‘every room’’ surrounded by the family possessions and their as-
sociated memories. She wanted to remember with joy and be remembered joyously; she had told me earlier, ‘‘no tears or whines.’’ We visited. I said my goodbye and as I started to turn away she reminded me ‘‘to Keep the Faith.’’ Hey, that is my line. This is what I say to people. What made me omit it this time? This was her final message to me; she wanted me to hear it. Or, is it that she knew that I really needed to hear it. I did, of course. I keep hearing it too. How did she know this? It doesn’t matter really how she knew. It matters that I knew Teddy. A few hours later she died. Then, I cried. Cal: ‘‘I am proud of you, Robert.’’ After 22 years of family medicine in a small Minnesota college town, and after a handful of years at my current academic medical center, I was honored to receive from Cal these wonderfully benevolent and paternal words about a decade ago. While I had never forgotten him or his gentle wise ways, I was only recently reminded of these kind words when I visited his widow for a hospital follow-up at their home. I love home visits for many reasons, including the opportunity to integrate intensely the art, science, and inherent relationships of family medicine. Bev showed me a thank-you note she had saved that I had long forgotten that I had written to him thanking him for that most wonderful blessing: a parental one that my father never uttered (or had an opportunity due to his premature death). I never got a chance to say goodbye to Cal either. I think I hate not saying goodbye almost as much as I hate saying goodbye. Lainie: So this is not goodbye; it is only until we meet again. I shall ‘‘Keep the Faith,’’: your poster-sized admonition is in my office. I smile at your enthusiasm, your wit, your talent, your compassion; and know that your goodbyes will be filled with life. Goodbye my arrow.
Department of Family Medicine, Mayo Clinic, Jacksonville, Florida.
971
Address correspondence to: Robert P. Shannon, MD, FAAHPM Department of Family Medicine Mayo Clinic 4500 San Pablo Road Jacksonville, FL 32224 E-mail: [email protected]
Journal of Palliative Medicine 2014.17:971-971. Downloaded from online.liebertpub.com by GEORGE MASON UNIVERSITY on 12/29/14. For personal use only.
I Really Hate Goodbyes Robert P. Shannon, MD, FAAHPM
You are the bows from which your children as living arrows are sent forth. The archer seeks the mark up upon the path of the infinite and He bends you with His might that His arrows may go swift and far. Let your bending in the archer’s hand be for gladness; for even as He loves the arrow that flies, so He loves also the bow that is stable. —Khalil Gibran, The Prophet
I
really hate goodbyes; I really do! Rather than saying goodbye, I surreptitiously exited a celebration in honor of our recent palliative medicine fellow, Lainie. Tis strange really; sad, yes—for many reasons coming to the fore only later. My first goodbye wasn’t really a goodbye at all; maybe that’s my issue. He didn’t say goodbye; my father just died. I was five. As a family physician, I have witnessed many first breaths, many final breaths. Being with them helped me focus on the living. Living well even as we face the last breath and preparing to say goodbye: Is this palliative medicine? To say, ‘‘Hello, how are you? I hope for what you hope for; let us live for that; we will help you.’’ This ultimately is why my path in family medicine led me to palliative medicine; it is the best of family medicine. Then it is over; we say ‘‘goodbye!’’ Teddy: ‘‘I’ll see you when you get back.’’ She said this with the calm assurance of a person who knows that she is correct; it comes with the wisdom that is cancer’s gift to those who are able to receive it. Teddy was a patient and friend that I had known for nearly two decades. We had shared many life events, family illnesses, and most recently her cancer diagnosis that ultimately led her to hospice care. In anticipation of a personal travel holiday to Ireland, I stopped at her house to say ‘‘hello and goodbye.’’ Being of Irish heritage, I told her that I would dedicate my first pint of Guinness in her name; I did and sent her a postcard from a great old Georgian Dublin pub too. About two weeks later, I again stopped by to visit. ‘‘I told you that I would see you when you got back.’’ She laughed with joy as we greeted each other. She was dressed simply and yet like a queen at court with a bandana covering her head, propped up with fluffy pillows in a grand old bed in the middle of the main living room that had become her ‘‘every room’’ surrounded by the family possessions and their as-
sociated memories. She wanted to remember with joy and be remembered joyously; she had told me earlier, ‘‘no tears or whines.’’ We visited. I said my goodbye and as I started to turn away she reminded me ‘‘to Keep the Faith.’’ Hey, that is my line. This is what I say to people. What made me omit it this time? This was her final message to me; she wanted me to hear it. Or, is it that she knew that I really needed to hear it. I did, of course. I keep hearing it too. How did she know this? It doesn’t matter really how she knew. It matters that I knew Teddy. A few hours later she died. Then, I cried. Cal: ‘‘I am proud of you, Robert.’’ After 22 years of family medicine in a small Minnesota college town, and after a handful of years at my current academic medical center, I was honored to receive from Cal these wonderfully benevolent and paternal words about a decade ago. While I had never forgotten him or his gentle wise ways, I was only recently reminded of these kind words when I visited his widow for a hospital follow-up at their home. I love home visits for many reasons, including the opportunity to integrate intensely the art, science, and inherent relationships of family medicine. Bev showed me a thank-you note she had saved that I had long forgotten that I had written to him thanking him for that most wonderful blessing: a parental one that my father never uttered (or had an opportunity due to his premature death). I never got a chance to say goodbye to Cal either. I think I hate not saying goodbye almost as much as I hate saying goodbye. Lainie: So this is not goodbye; it is only until we meet again. I shall ‘‘Keep the Faith,’’: your poster-sized admonition is in my office. I smile at your enthusiasm, your wit, your talent, your compassion; and know that your goodbyes will be filled with life. Goodbye my arrow.
Department of Family Medicine, Mayo Clinic, Jacksonville, Florida.
971
Address correspondence to: Robert P. Shannon, MD, FAAHPM Department of Family Medicine Mayo Clinic 4500 San Pablo Road Jacksonville, FL 32224 E-mail: [email protected]
