Letters for the bereaved

I was brought up by a mother who believed passionately in letter writing. Right up to her death at 84 years she was laboriously writing letters every week. And she'd always write one or two drafts before scribing her final copy. Sadly the art of hand writing letters is fading fast to be replaced by the much less valued email. But as my mum frequently reiterated, people love to get letters.

So I was interested to read of an article published this week in  ecancermedicalscience and which was picked up by much of the print media. It was about how the practice of  Oncologists writing to the bereaved relatives of their patients. As one commentary put it in summary,

'For doctors, this overlooked practice appears to be an important -- and now acknowledged -- part of the cancer story'

I must say I have for many years tried to write to the recently bereaved and offer my sympathy and words of support. I think it would be a good practice for all GPs and it is one area where longevity in a practice  brings its own reward in terms of intimate knowledge of the family relationships and  their dynamics. Locums and short stay GPs just may not get the perspective.

A few suggestions

1. Don't send a standard letter merely signed by you (or worse, your secretary)
2. Do personalise it.
3. Try to find something true and interesting about the deceased which you can briefly state. It might be something faintly humorous (although of course humour at such times is incredibly delicate).
4. Find a non trite way of acknowledging the level of pain (for some our of patients the death of a loved one comes as something of a relief-so no standard, 'you must be devastated').
5. Chose your timing. For some as soon as possible after the death would fit, for others 2-3 weeks later might be more helpful when the initial attention and busyness has passed.
6. Think about hand writing it (currently I dictate but I'm thinking of changing this)
7. I prefer headed notepaper to a card. Not sure why except it brings a certain formality accompanied by warmth into the relationship.
8. It doesn't need to be long

I know patients appreciate these letters and have had many patients tell me that they read them over and over and keep them for years. It suggest that our patients matter to us and we are not merely professional with no soul.

Tears for fears

Its a long time since I read about the place of tears in the practice of medicine (and indeed in the practice of life). As a GP I have had the enormous privilege of listening to countess people pouring their hearts out to me, and often it means the tears flow. I am not expected to cry with them, although I confess I've been pretty close a few times. It seems I'm a professional tear gatherer. Indeed Matthew Sweet in The Economist writes,

'We would consider it a dereliction of duty if surgeons, nurses, police officers and soldiers wept during working hours. They have surrendered their right to cry in the same way that other employees might sign away their expectation of fixed hours or sick pay. Their restraint gives us the space to express our pain or gratitude, which we buy from them through taxation.'

Why humans cry has been a mystery for a very long time and was first investigated by Charles Darwin in his Expression of the emotions in man and animals. I don't think he ever quite cracked it. I am however, rather taken with this quote form The Shack (a book I'm re-reading and enjoying currently)

'Don't ever discount the wonder of your tears. They can be healing waters and a stream of joy. Sometimes they are the best words the heart can speak.'

There is something both wonderful, unsettling and relieving about our tears. And there is so much we still don't understand about how we humans function in this crazy, glorious and beautiful world.