Blog by Eileen Barrett
About fifteen years ago, I attended a patient’s funeral mass and was touched to hear her family mention me in the eulogy. I felt honored and grateful, but also a little embarrassed because I had treated her and her family the way any of my colleagues would have during her care. I was reluctant to share this immeasurably meaningful experience because I didn’t want to seem self-promoting or, if asked about the experience, to have to answer truthfully that I spent time listening, speaking, and in shared silence with them, an undeserved honor.
Years later, I realized that my workplace had created a special bond by allowing something so simple—physicians and nurses had flexibility in their schedules to spend great lengths of time with patients and families. And they could spend the time as they saw fit, educating families about diseases and prognoses, having hard end-of-life conversations, and perhaps participating in the process of mourning. I also learned that, in many other organizations, it was unthinkable to allow physicians to cover for each other to attend funerals during work hours. I realized that while we advocate for having this necessary time with patients for relationship building, we can also create time during our working days to memorialize patients.
I don’t know where I first heard about hosting a patient memorial service, but I recall being connected with a surgical oncologist who had developed a patient memorial service to help residents acknowledge and process their grief. I also learned that a rural hospital chaplain coordinated and hosted patient memorials to introduce survivors to the hospital’s grief support services. I admired their work very much and began floating their ideas with my residents. There was universal interest and support, so we determined our goals: to allow residents an authentic remembrance of patients who had passed away and to foster feelings of our shared humanity.
With these two goals in mind, I developed a guidance document and received feedback from residents, other attending physicians, and a hospital chaplain. I quickly realized that my plan was helpful but overstructured. In the end, the most important features of the memorial service were: (1) holding it at the same time and location as a regularly scheduled meeting to ensure support for attendance, (2) making attendance voluntary, (3) asking attending physicians to hold on to pagers so the residents could be fully present, (4) providing spiritual and mental health support on an opt-in basis. A last but crucial decision—residents would facilitate the actual service and have the final say on what was done, though the planning stages were up to me.
Our service was in lieu of the usually scheduled Morbidity and Mortality Conference, and included readings, music, and a moment of silence. There was also semi-structured time for reflection and optional sharing (similar to a Quaker meeting), and the option to write a reflection or memory that would be collected (unread) and then respectfully burned. Amazingly, over thirty learners attended (all had attending physicians hold on to their pagers), as well as multiple attending physicians and administrative staff. About fifteen participants wrote reflections. Informal feedback was overwhelmingly positive. I ended up leaving the institution, so am unsure if the practice has continued, but I hope it has.
Although I heard such heartwarming comments from the residents who participated, I am certain I am the one who benefited the most. My heart felt full seeing the residents share their grief and express their common humanity. Whatever clinical setting you are in—and whether you are a physician, nurse, student, or administrator—I hope that you consider a similar practice and welcome you to adapt ours for your own purposes. I look forward to hearing how it goes.
Eileen Barrett is a rural internal medicine hospitalist and President-Elect of the American Medical Women’s Association. Her writing has been published in JAMA, Journal of Addiction Medicine, Annals of Internal Medicine, Modern Healthcare, and others.