It's been almost exactly a year since I posted. Last year was the year of my mother. We celebrated her 100th birthday in April and mourned her death in December. There is always a tension between actually writing and communicating about writing but when I am under stress, it is the communicating that suffers the most.
Last fall, The Threepenny Review published one of my medical essays, "Faithful to the Corpse", which was inspired by a comment (from an artist) that only artists think about death. As a primary care physician and geriatrician, there were times where it felt like death clung to me, the way the smell of formaldehyde penetrated our clothes in anatomy lab. Since my essay appeared, I read Atul Gawande's lovely book Being Mortal, which argues for a more thoughtful approach to end of life care. I was surprised to find that he, too, discounted the current role of doctors, primary care doctors, in particular, in this realm. Although an MD, he portrays himself as previously unaware of the work of geriatricians and looks to the new specialty of palliative care to fill what he perceives to be void in this area. The community hospital where my mother spent some of her last weeks didn't even have a palliative care team. It's not clear how well the model that was developed in academic medical centers will function in other settings--that was the problem with geriatrics, too. Fortunately, the primary care doctors in our family were able to reach out to my mother's outpatient primary care provider, a nurse practitioner, who helped the family in our mother's last illness. The NP engaged with us out of the goodness of her heart, since she couldn't bill for our conversations. Dr. Gawande does not discuss finances in his book, but unless we as a society are willing to pay for end of life care, rather than depending on the goodness of the hearts of providers, the impetus for palliative care will fizzle, like the geriatrics movement I joined 25 years ago.