The great truth doctoring has taught me about death

Too often as an oncologist, I have approached the gates of death with one of my patients.

When a patient’s death is approaching, I can often see its coming shadow in a tint of the skin, a spike in certain tests, proliferation of spots on a CT scan.

I have committed to myself that, in these moments, I will tell my patients in so many words. When the end draws near, I must say something like: “While I always hope I am wrong, I am afraid you may be dying.”

I hate to have to say these words — the part of my heart that longs to heal and comfort recoils when I must use them.

When I first began to practice, I found myself possessed in those moments of a reflexive urge to dilute the words’ impact by saying also: “I know this is hard to hear, but I think there’s a silver lining.”

And, in the case of some very old patients who may be settled and at peace with the news, I might say just that.

For most, though, talk of a silver lining rings tinny — what can be silver about a young mother leaving her children or a college sophomore not living long enough to collect his diploma?

Instead, doctoring has taught me it will not do to divert our eyes from the sorrow by pretending “things are really not that bad.”

The moment of discussing death demands stillness — and often silence.

I wait — watching the words land on my patient’s heart and offering only my presence as a witness to their grief.

My mind has been brought to these thoughts these last weeks as the omicron tsunami engulfs us.

Bone-tired parents dread another school closing, while exhausted nurses and doctors wonder if our thinned ranks can care for all the sick and dying. The alone may again be alone. And now nearly 6 million across the world have died.

We strain, together, under the back-breaking weight of sorrow.

In some ways, of course, the pandemic situation differs greatly from the plight of a dying patient. The pandemic will wane — hopefully soon — and a return to more normal life beckons.

Still, none of that will change the concrete reality of the irretrievable losses of the last two years.

I think of the ghostly empty playgrounds that greeted our initial lockdown.

Of friends who’ve moved away, disappearing like phantoms into mist.

Of a preschool year with the world’s greatest teacher cut short by three months — time we can never regain.

Of my wife’s first Boston marathon — initially postponed, then canceled, then made “virtual” (she was to run it here alone). And then, when the 2020 wildfires turned the bay into an orange apocalypse, she finally ran the marathon on a treadmill in our living room.

Of the rituals and daily graces suddenly gone: hugging a friend, singing in a choir, worshipping in person, sending a child to play with a friend.

Added together, these and a million other losses great and small accumulate like snowflakes, settling together on our shared cultural consciousness, blanketing us under the weight of what we’ve lost.

This is a moment for stillness and silence.

And yet, here is the other great truth doctoring teaches me:

Shared presence — really being there with and for each other — at a moment of loss can sanctify sorrow.

Some alchemy can wring from the stone of shared suffering something like love.

And in these gray days, what could we need more than that?