Am I a better GP after my father’s death?

Claire Denness

23/12/2019 12:49:17 PM

Dr Claire Denness wonders whether the rawness of grief has helped her as a doctor.

Stormy seas
In the wake of a storm of grief, this GP ponders what it means.

‘Practice on me, use me as a guinea pig,’ Dad would joke, presenting himself on the sofa for my nervous first-year-medical-student fingers to palpate and percuss.
‘Did you learn anything?’ he’d ask, his eager questioning draped in a thin veil of anxiety.
‘It all seems okay,’ I would murmur, wondering if I actually had the skills to find an abnormality if there was one.
Twenty-two years later, he said the same thing: ‘Learn from me.’
This time, however, his anxiety was not veiled, but exposed for all to see.
This time, my father was a shrunken figure, sinewy hands resting on a distended abdomen that would have been a medical student’s delight. Within it lurked a huge, aggressive liposarcoma.

Hugging his cardigan for warmth, he patted the skin stretched tightly across his abdomen.
They say it’s rare and there’s not much they can do. But maybe you can learn something from me. Maybe I will be useful for your patients, somehow.’
And afterwards, as I adjust, shakily, sewing tentative stitches into a life that is differently shaped, I wonder if my dad’s death can be the silver thread in this new landscape. If it can help to sharpen my clinical skills, slow down the time meted out by the consulting room clock, soften and embolden my touch.
‘How many patients have you had with a sarcoma?’ Dad once asked me.
I vaguely recalled someone who had had a lump on their arm which was thought to be a lipoma but had turned out to be a sarcoma when excised. That was maybe 10 years ago. He went off to the specialists, did well and we GPs didn’t get too involved.
It made me reflect and ask myself: Would I recognise sarcoma symptoms?
Ever analytical and practical, my dad would have openly questioned anything I wrote that focused purely on consultation skills, or the emotional aspects of being a GP.
So, before I reflect on these, here’s the practical bit for you, Dad.
Sarcomas are rare cancers developing from bone, cartilage or soft tissue (eg fat, muscle, blood vessels) and can develop anywhere in the body, at any age. The Australian and New Zealand Sarcoma Association (ANZSA) estimates that sarcomas comprise 1% of adult cancers – but 20% of childhood cancers.
The UK’s National Institute for Health and Care Excellence (NICE) provides guidelines on when to suspect a sarcoma and refer accordingly.
In brief, any unexplained, palpable lump which may (or may not) be tender, growing and deep in the fascia should raise suspicions of a sarcoma and should be referred urgently. Unfortunately, some sarcomas are hidden deep in the limbs, so patients may experience a delay by being misdiagnosed as having a sporting injury or growing pains. This impacts on treatment options and survival rates. 
Sadly, this was the case for Dad, whose distended abdomen and swollen legs were initially thought to be the result of congestive cardiac failure.
Five months after his diagnosis, and many hospital appointments later, we shifted our focus from hoping for a cure to providing the best possible end-of-life care.  
I would hope that I have always treated the palliative care teams that I have worked with the utmost respect. It was different, though, as I was not the observer, but the observed. I was there, hovering uncertainly and tearfully, offering tea, as the team built their first-class hospice at home around us.
Occupational therapists wheeled in equipment I had heard of but never seen. A hospital bed appeared within hours of being ordered. Night-sitters came to bear the responsibility and let us, his exhausted family, sleep. They would vanish in the morning, only to re-appear again the following night.
Dad’s palliative care nurses saw every grimace, heard every rattle and, seamlessly, relieved it all.
We could not give Dad all of his last wishes – we never got to have that last cup of tea with him overlooking the ocean – but he did die peacefully at home, with his family around him and, for that, I will forever be indebted to his wonderful palliative care team.
On what turned out to be Dad’s final night with us, one of the palliative care nurses asked me about his life.
I held Dad’s hand, silhouetted by the almost-dark sky, as I told her about the Catholic boy from Belfast who sang Irish folk songs, and who left to join the RAF. About the young man who married a Protestant, moved to Cyprus, ran the gliding club. I told her of distinctions in Latin and fluency in French and German.

The letters from my Dad’s specialists had noted ‘interesting clinical signs’, including nicotine stains on his fingers and nail-clubbing, but, oh, what those fingers could do. They could play the piano, the guitar and the bagpipes. They could fix washing machines, hamster cages, watches, car exhaust pipes – anything.
Since Dad died, my patients have also lost loved ones. Fathers, sons, partners, best mates, beloved pets. Old age, inherited neuromuscular conditions, catastrophic gastrointestinal bleeds, lung cancer, ischaemic heart disease. Some of them I knew and some I didn’t. I used to trot out the reliable platitudes, conscious that I needed to show the patient I was acknowledging their loss.
Now, it hurts a bit more keenly. Now I know that my patient wants their loved one to be remembered, wants their name to be used out loud, not side-stepped.
They don’t want platitudes, just as I didn’t and still don’t. Maybe they want space and silence, maybe they want to cry and gulp back big, ungraceful tears, raging against a world that carries on revolving, regardless.
I try harder to find the time for that silence. The space to ask them if they want to talk about it today or maybe tomorrow. And I remember Dad, as he was, asking me to learn from him.
I am very lucky to work in an incredibly diverse, busy, inner-city community health clinic. The stories that my colleagues and I hear, daily, can be hard to hear, stories that show us the very best, and the very worst, of humankind.
When my patients heard my news they showed me, in their own way, their kindness and empathy too. Firstly notes, cards and gifts appeared, rippling in on the tide of each new day: flowers, Greek biscuits, brownies, a vegetable peeler (‘Cooking helped me get through my own Dad’s death’), a Chinese acer tree (‘This was my beloved mother’s favourite plant. She would have liked you’), a fridge magnet of a cat from Cyprus (‘I remembered your Dad had worked in Cyprus’).
And then, from a community in which so many members have been damaged, forever, by actions of their own parents, or other trusted adults, came the spoken words and the physical gestures of kindness.
The 184 cm, 135 kg, heavily-tattooed motorcyclist who was subjected to horrendous abuse by his own father, and then incarcerated, aged 16, for attempted murder who, with the lightest of touches on my shoulder, whispered, ‘I’m sorry for your loss, mate’.

And the ex-heroin user who never knew her own Dad, and has acquired psychiatric labels throughout her life ranging from ‘borderline personality disorder/complex trauma disorder’ to ‘paranoid schizophrenia’. The lady who, by her own admission, hates physical contact, but asked me if she could hug me when I returned to work.
So maybe this is it. Maybe I can be a better GP for having felt the raw grief of a parent dying, for realising that I am loved a little bit less in the world now, that part of my harbour wall has gone and so I am less sheltered from life’s storms.
Maybe I have really understood now the beauty of life, its transience and fragility, and the immense privilege that is afforded to us when we become doctors. A privilege that is easy to lose sight of, sometimes.
Maybe I really understand now that grief is an inevitable human experience, but, from my patients, I have seen and felt the capacity of the human heart to heal, repair and love once more.

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Dr Hsin-yu Sally Wu   4/01/2020 10:00:16 PM

Thank you for this beautiful piece of reflective writing. I have also recently lost my father to pancreatic cancer. I feel changed but yet to understand how it impacts on my daily practice. Thank you ❤️🙏

A.Prof Christopher David Hogan   7/01/2020 9:34:08 AM

What a beautiful piece. You do not need to be eloquent to tell people that you care but it helps.
When we involve ourselves in other peoples' lives, they involve themselves in ours. This is inevitable & how we react to that involvement defines us as doctors & as people.
I am in my late 60's now & just recently lost my mother while my father died a few years ago. I miss them dearly

Dr Marlene Wessels   7/01/2020 12:08:56 PM

This profound!I lost my father 10 years ago in South Africa, violent and unnecessary.He was my champion ,was always honoured to be seen with me-jokingly saying "look at all the men thinking :why does this old man have such a beautiful young partner." Always believing in me and encouraging me ,from doing Advanced Ballet exams to medical school and helping a me cope with raising and autistic child.After he died ,I lost my compass, glad I could come to Australia and start a new life.I the deepness of pain that I have experienced has made a much deeper and more empathetic person in the incredible journey which we have the absolute privilege to walk as GPs with our patients through their lives.I still truly believe the GP is the spill and the conductor of team involved of health care to patients-coordinating everything .Long live the compassionate ,caring ,involved GP.

Dr Lisa Meriah Fraser   7/01/2020 9:46:06 PM