On the death of a spouse: reflections of a medical oncologist.

She struggled against a high-grade, estrogen-receptor negative, node-positive breast cancer for 2 1⁄2 years before she closed her eyes, went to sleep, and died of widely metastatic disease. Although delirious, short of breath, and in pain, Karen somehow hung on until the early morning hours of our 21st anniversary before she finally died. Although I have been a practicing medical oncologist for 20 years, throughout her ordeal I attempted to be at her side as her husband, but not as her physician. I understood, better than other husbands, her disease and her treatments. I understood the side-effects that she experienced as well as the manifold aggravations of waiting rooms, of well-meaning trainees, and of laboratory mishaps. I even understood her anxiety as she felt death approaching. These are all parts of my daily professional life. These are conditions or circumstances for which I trained, or at least, which I learned on the job. What I was not trained for was the aftermath of death—the loss. Colleagues and friends have often approached me in bewilderment about the irony of this particular agonizing illness visited on the spouse of someone who cares for these individuals for a living. The irony is perhaps real, but it ended abruptly with her death. Afterwards there was only grief, and the grief I still have is purely personal and bears no relationship to my training in medical oncology. I had no training in personal grief and despair; they are not medical entities. The medical syndromes ended with her death. The real irony for me, as someone who cares for terminally ill patients, is that I had so little personal understanding of grief and loss at a time when I needed to apply such to myself and my own family. My initial reaction was a superficial grief based on an intellectual understanding of her death that had no reality for me. She was simply “gone” for a while. This unreality was abetted by the many distractions and activities following the funeral: friends bringing cold cuts and casseroles, attorneys calling about estate issues, grief counselors calling about the children, life insurance, health insurance, overdue bills, missed dental appointments. I was too busy to notice her absence. I had thought that I had missed her, but the real awareness came later. Gradually, reality settled in. She was, in fact, gone. By this time, most of our friends from our life as a couple had stopped calling and moved on with their own busy, complex lives. The men of these relationships, like most men, generally don’t talk about real issues, and women feel uncomfortable somehow befriending a man whom they related to through a deceased spouse. My social world contracted with the death of my spouse. This contraction reinforced a sense of isolation and loss, which in turn made the reality harder to ignore. As time has passed, my longing for Karen has not lessened, but rather increased. I am now more fully aware of the enormity of her death and its implications for my life and our children’s lives. Her absence has developed a physical presence of its own, such that I am constantly aware of her not being here with me. It is an odd sensation, From the University of Wisconsin Medical Foundation, Madison, WI.