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Personal Health
Grace Notes is a series of essays by Sound Medicine contributor Dr. Larry Cripe, an oncologist specializing in palliative care at Indiana University Hospital in Indianapolis. Dr. Cripe reflects on how we might make the experience of dying more livable and meaningful, before, during and after a person passes.

Speaking of Loss

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I knew that a child had died by the way that she paused and glanced at her husband when I asked “how many children do you have?” She was eighty-four years old and had been referred for a low platelet count. Her husband’s wide tie imprinted with schooners reminded me of the tie I wore to my sister Sarah’s wedding when I was seventeen.

He stared straight ahead, his well-worn three piece suit bunched at his waist. And then she said, “four but our oldest, Margaret, we called her Maggie, died when she was ten.” A car had struck her while riding a bicycle more than fifty years before. But I knew it felt like yesterday.

My sister Berd’s son Brian died nineteen years ago this week. Before Berd died six and one-half years ago, she would light a small flame which burned in front of a heart-shaped mirror when family and friends gathered. I am not sure why exactly. All these years later we remember Brian without fail and with an immediate and palpable sense of loss. 

I feel I am too young to have to think about my answer when asked how many brothers and sisters I have. I am of an age, however, when people assume my parents are dead and ask “are your parents still alive?” They are not. My father died of complications related to the treatment he received for recurrent lung cancer. My mother died from a rapidly progressive dementia. It is not surprising that my parents are dead, so speaking of the loss of my parents is more straightforward.

My sister Meri died almost two years ago. So I have six sisters, but two are dead. I didn’t anticipate needing to say that so early in my life. It is also difficult to say much more. I often stumble on whether to use past or present tense. Is it that Berd and Meri were 13 and 8 years older than I am or is it Berd and Meri are 13 and 8 years older than I was? I never think about this when I speak about my parents. That is one of the ways in which it matters whether we speak of parents or siblings when we speak of loss. 

When I speak of the death of my sisters, I speak of the ongoing loss I experience. I am telling a story about who I believe I'd be if I could finish my conversations with them.

Another is what we are saying when we speak of loss. I am old enough now that I can imagine there are questions I might ask my parents if they were alive. But I probably would not. There are, however, lots of questions I’d ask Meri and Berd, especially about our parents. Parents are about who we were. Siblings can help us make sense of how we became the people we are. Siblings can also help you make mid-course corrections. When I speak of the death of my sisters, I speak of the ongoing loss I experience. I am telling a story about who I believe I’d be if I could finish my conversations with them.

We rarely speak of the dying when we speak of loss. My sisters were alive. My sisters are dead. There is a gap. I fill it when speaking of the loss of my parents. My father died reluctantly when he was seventy four. My mother died gladly, I believe, when she was eighty four. Her last voluntary act, I recall when I tell the story of her dying, was to refuse food and drink. 

There’s much we can share about who we are in the way we speak of the dying. My mother’s mother, Ruby, died of a heart attack the summer before I started medical school. I accidentally saw the medical team trying to resuscitate her. The image of her naked body bouncing chaotically on a bed surrounded—assailed may be a better verb—by a group of strangers has definitely informed how I practice medicine.

I want to speak more about how my sisters died than I do. I wonder if we wouldn’t do better if we all shared more about how our loved ones died. If we spoke more of how our loved ones died, we could practice the vocabulary necessary to speak about loss and what it means to us. And when we listened to ourselves and others speak of loss we could prepare ourselves for a future when we will become the lost ones. Perhaps we would make better choices.

Larry Cripe, MD is a hematologist and oncologist specializing in palliative care at Indiana University Hospital in Indianapolis.