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On the Death of a Spouse: Reflections of a Medical Oncologist

From the University of Wisconsin Medical Foundation, Madison, WI.

Address reprint requests to Peter A. Beatty, MD, FACP, University of Wisconsin Medical Foundation, 1 S Park St, Madison, WI 53715; e-mail: peter.beatty{at}uwmf.wisc.edu

Here's the Case

She struggled against a high-grade, estrogen-receptor negative, node-positive breast cancer for 2 years before she closed her eyes, went to sleep, and died of widely metastatic disease. Although delirious, short of breath, and in pain, Karen somehow hung on until the early morning hours of our 21st anniversary before she finally died.

Although I have been a practicing medical oncologist for 20 years, throughout her ordeal I attempted to be at her side as her husband, but not as her physician. I understood, better than other husbands, her disease and her treatments. I understood the side-effects that she experienced as well as the manifold aggravations of waiting rooms, of well-meaning trainees, and of laboratory mishaps. I even understood her anxiety as she felt death approaching. These are all parts of my daily professional life. These are conditions or circumstances for which I trained, or at least, which I learned on the job.

What I was not trained for was the aftermath of death—the loss. Colleagues and friends have often approached me in bewilderment about the irony of this particular agonizing illness visited on the spouse of someone who cares for these individuals for a living. The irony is perhaps real, but it ended abruptly with her death. Afterwards there was only grief, and the grief I still have is purely personal and bears no relationship to my training in medical oncology. I had no training in personal grief and despair; they are not medical entities. The medical syndromes ended with her death. The real irony for me, as someone who cares for terminally ill patients, is that I had so little personal understanding of grief and loss at a time when I needed to apply such to myself and my own family.

My initial reaction was a superficial grief based on an intellectual understanding of her death that had no reality for me. She was simply "gone" for a while. This unreality was abetted by the many distractions and activities following the funeral: friends bringing cold cuts and casseroles, attorneys calling about estate issues, grief counselors calling about the children, life insurance, health insurance, overdue bills, missed dental appointments. I was too busy to notice her absence. I had thought that I had missed her, but the real awareness came later.

Gradually, reality settled in. She was, in fact, gone. By this time, most of our friends from our life as a couple had stopped calling and moved on with their own busy, complex lives. The men of these relationships, like most men, generally don't talk about real issues, and women feel uncomfortable somehow befriending a man whom they related to through a deceased spouse. My social world contracted with the death of my spouse. This contraction reinforced a sense of isolation and loss, which in turn made the reality harder to ignore.

As time has passed, my longing for Karen has not lessened, but rather increased. I am now more fully aware of the enormity of her death and its implications for my life and our children's lives. Her absence has developed a physical presence of its own, such that I am constantly aware of her not being here with me. It is an odd sensation, living with an absence, a former presence that used to fill up the house and our lives. This absence is present on a personal level for me with the loss of a lover and a companion. Additionally, I am now the sole parent of our children, and her absence is especially difficult for me in the realm of family matters and decision-making. Knowingly or not, parents share in raising their children, and an inability to share decisions with one's spouse can be a painful burden. I wonder constantly what she would have wanted as I confront the many daily and weekly decisions I have as a parent. Her absence prompts me to consider her perspective with each decision in a more deliberate manner than I did when she was alive. Her point of view seems more convincing and logical to me now, because her absence has such a presence. This shift in my viewpoint is certainly one of her lasting gifts to our children and me. It partially compensates for her absence. It is a daily reminder of our life together.

These thoughts had never before been my thoughts as a practicing medical oncologist. I had never reflected in a meaningful way on what the death of my patients meant for their surviving family members. These family members are not generally my patients, and I had focused primarily on my patients, not their families. It had not been my role to care for families in the aftermath of a death, and, in fact, I had no training in this area.

However, I am now mindful of an emotional territory I had never explored professionally as a physician—a landscape of grief, loss, and longing. I am beginning to understand the meaning of the death of a cancer patient on a spouse's personal life and on the family's life. I now make a point of talking to the children of patients who are dying. Their parent's death is not their fault, and they need to understand that; they also need to understand that they and their siblings will need to communicate with, and rely on, each other more in the future than they may have up until now. I tell patients to be sure to leave something concrete by which their families can remember them. I make sure that patients and families are aware of all the services with which attorneys can help in terms of estate planning, advanced directives, and trusts to protect assets (especially for children). I have social workers discuss death benefits from social security and other insurance products to which they may have access. In addition, I am more conscious of sending condolence letters and facilitating bereavement care for the families of my patients. I believe that my personal understanding of what happens after the death of a spouse has made me a better oncologist, on both a technical level as well as an emotional level. Karen's death and its aftermath comprise the elements of my personal fellowship in grieving for a beloved spouse: a final, necessary training for all of us with families and long-term relationships. That understanding, bitter as it is, is another one of the many gifts that my wife gave to me.

Author's Disclosures of Potential Conflicts of Interest
The author indicated no potential conflicts of interest.

NOTES

Author's disclosures of potential conflicts of interest are found at the end of this article.

Submitted May 21, 2003; accepted January 8, 2004.

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