though, staying in touch with the patient’s family
has helped him to cope. One of the first losses Dr.
Dunn experienced was with a patient on whom his
father had operated years before. After the funeral,
the family invited him to dinner, where he heard
them talk about the man’s life. He and the family
kept in touch for years.
Dr. Dunn said he also became an early believer
in the value of a condolence letter, which serves as a
tribute to the patient and a source of comfort to the
survivors. In those letters, he makes sure to recall
qualities of the patient and offers a way to keep in
“Death is not a final, defining point for the individual or the relationship that occurred around it,”
Dr. Dunn said.
Developing a relationship with a patient’s family
also helped Danielle Saunders Walsh, MD, FACS, get
through the loss of a patient. Dr. Walsh, a pediatric
surgeon who has been practicing for approximately
10 years, is an associate professor at Brody School of
Medicine, East Carolina University, Greenville, NC.
Dr. Walsh said the death of every child affects
her, regardless of how well she knows the family.
“Children bring a different perspective in dealing
with death. In general, we view them as innocent.
We see it as a loss of an opportunity for someone to
experience a full life,” she said.
One of her first experiences with loss occurred
with a teenage patient who had a birth defect that had
become increasingly problematic as the girl matured.
No other physician whom Dr. Walsh consulted was
able to help. The girl died suddenly while Dr. Walsh
was performing a procedure.
Dr. Walsh said that losing this patient was extreme-
ly difficult, and she contemplated whether a career in
surgery was right for her. “If this is so painful, why am
I doing it?” she wondered. But at the funeral, the girl’s
mother could tell she was hurting. “She said, ‘I hope
you don’t give up,’” which reassured Dr. Walsh that
she should continue in her chosen career.
Dr. Walsh said that in her experience, many conversations with patients and families would be easier if
Americans could view death as a natural part of life—
no matter how brief or lengthy that life may be. But
we are not quite there yet as a society, she said, because
people tend to think there is always more, medically,
that can be done.
Patricia J. Numann, MD, FACS, FRCSEd(Hon),
FRCSGlasg(Hon), is an ACS Past-President and Lloyd
S. Rogers Professor of Surgery Emeritus, Upstate Medi-
cal University, Syracuse, NY, and State University of
New York Distinguished Teaching Professor Emeritus.
Dr. Numann said she has noticed that accepting the
death of patients seems to be harder now than when
she started her career as a surgeon. When she was a
medical student in the 1960s at the State University of
New York Upstate Medical University, there were no
intensive care units, according to Dr. Numann. “A lot
more people died. We didn’t have these extraordinary,
heroic things that we could do for people.”
Dr. Numann said she was always reasonably com-
fortable talking about death. As a child, she would walk
around Woodlawn Cemetery in the Bronx, N Y, with
her aunt, and they would look at the flowers on the
graves. When she was a third-year medical student, Dr.
Numann left school to help take care of her mother,
who had pancreatic cancer and wanted to spend her
remaining time at home. Dr. Numann’s mother died
shortly after she returned to school. Her mother was,
in a way, the first patient she lost.
From that experience, Dr. Numann began to see
that some patients do tend to cling to life, waiting for
certain events—babies to be born, graduations—before
they pass away. It can be important to the process that
they have something to look forward to, she said, and
she always made it a habit to visit dying patients at
home when she could. Many families want to know
Dr. Dunn Dr. Numann Dr. Walsh