Embracing Eternity

Eonia I Mnimi (Eternal Memory) – Greek Orthodox Funeral Blessing


Sunset approaching after the storm, Falmouth, MA

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.


My uncle had been declining for several years with Lewy Body Dementia, and it had been accelerating over the past year or so. It was stealing him away, his mind anyway, though until lately his body remained strong. He wasn’t even on any medications, except the Exelon patch and Namenda to slow the dementia, remarkable for his 88 years. Last fall he had an “episode” for which he was hospitalized, and his doctors indicated that it was likely progression of his disease; so from then on, he had been cared for with hospice assistance. His death was certainly not imminent, within days or weeks, as one usually thinks with hospice involvement, but it was inevitable. There was not much to do from a palliative point-of-view, there simply wasn’t anything else to add to or to enhance his care. But as he declined, his family— especially my cousin — were going to face some hard choices about how best to care for him. The resources in the home, even with hospice and aides to help in his care, were rapidly becoming inadequate. As it turned out, they did not have to worry any more about breaking the promise they made to him.


That afternoon I went to see my uncle, who had been living with my cousin for the past few years. I had been texting and emailing with her over the prior week, after he had another “episode”—this time more severe, like a seizure or even a stroke, from which he was not waking. He had not had anything to eat or drink for about a week, and had stopped voiding for the past day or so. He would rouse slightly, then drift back to sleep. She indicated that his breathing had started to become irregular at times, with long pauses. He had small doses of morphine and ativan sublingually to ease his breathing, though it is hard to say if those tiny doses did much, or how much was even absorbed.

When I walked in to the room with her, to sit for a while and keep him — and her — company, the breathing pattern was immediately recognizable to me. It was the classic, end-stage pattern of Cheyne-Stokes respirations, the crescendo-decrescendo pattern punctuated by apnea, pauses ranging from 10 seconds to nearly a minute, before the whole pattern repeated. He was not in any discomfort, there was no distress. It bothered us more than him. It also meant that the end was coming soon, some time in the next hours. Continue reading

Remembering a Friend, Forever Young

“May you stay forever young…” Forever Young, Bob Dylan

“Eonia i Mnimi (Eternal Memory)” -Greek Orthodox Funeral Chant/Hymn


Maine coast, morning fog

In the holiday season and as the year is drawing to a close, a paradoxical melancholy creeps in amidst the celebrations and holiday cheer. We take even a brief moment to pause and reflect on the past year and on past holidays. It is a good time to dwell a little while with those memories.

At this time of year, social media is rife with posts and alerts reminding us all to be kind and gentle, sensitive to those around us who are in pain. There are many for whom the holidays bring no joy, no cheer, and symbolize stress and loss. We are asked to be on alert for those who may be in crisis instead of celebration.

In health care, it seems as if this time of year ushers in a spike of tragedy. More stress over more severe illness, more sadness over profound losses. It seems more acute, more raw, more shocking, as these sad events play out in stark contrast to the festivities celebrating the joy and cheer of the holidays around us. Even if the numbers don’t bear this out (though they might), it is this sharp contrast between joy and grief that etch these memories more deeply in our minds.

These memories color our reflections of the holidays. They are good reminders to be aware and sensitive to those around us.

Today’s musings are more personal than medical.

Continue reading

Lessons From Zachary: What a Physician Learns From the Death of a Dog

“You think that dogs will not be in heaven? I tell you, they will be there long before any of us.”Robert Louis Stevenson


My dog died three years ago today.  On this day I will remember him, and share a little bit of him with you. These are the lessons from Zachary that I learned during that fall three years ago, on the final leg of our journey together.

Zachary was the first dog of my very own. He was a flat-coated retriever, and a fairly typical example of his breed. Typical of the breed’s “Peter Pan” personality, never growing up. Smart and energetic and goofy and quirky and unique, all of which made him an absolutely typical flat-coat. I could write on and on about his qualities, both endearing and frustrating, and regale you with stories. We would have some good laughs. But let’s save that for another time. We will also hold off on discussing grief, or mourning pets, or the role of pets in our lives.

Let’s just say my dog was a very good dog, and that I still miss him.

He was diagnosed with cancer around September 17, 2011, and died on November 15 of that same year. I learned a lot in that eight weeks. He had malignant histiocytosis, a cancer for which flat-coated retrievers and Bernese mountain dogs share a genetic predisposition, as yet to be defined. It is an otherwise rare cancer, but it is also a rare and difficult-to-treat cancer in people. In fact, there is research at the NIH, as an offshoot of the Human Genome Project (the Canine Genome Project) which studies this cancer in hopes of unlocking the secrets to aid in testing, diagnosis, and cure –for both people and dogs. This research is in part funded by Flat-Coated Retriever and Bernese Mountain Dog breed groups. Zachary was able to contribute to this as a healthy youngster, and again later after he was diagnosed, in his final moments. My choosing to participate offered me some comfort at the time, and still does. Untreated, dogs usually have a life expectancy of 2-6 weeks; with treatment, that can extend up to 6 months, give or take. Zach did not respond to treatment, to put it mildly. He did not tolerate the chemotherapy. He made it 8 weeks from the time of diagnosis.

As a surgeon, I am no stranger to death and dying. I treat cancer patients nearly every day. I have cared for many patients and their families, from the initial biopsy on to the end. I thought I would be well equipped to handle this, given my background and experience. I understood the concepts and differences between treatment and cure, palliation, and hospice care. But I soon realized that I still had a lot to learn. I am still surprised at how much I had to learn, how different it was in dealing with my dog whose life was slowly and inevitably slipping away. Continue reading