Goodbye in the mist

Sometimes you say goodbye.  Not often, just sometimes.  If the diagnosis is plain, the prognosis clear and the choices limited, there might be a time in to say goodbye.  It has to be a particular patient with whom you share a bond and then, maybe, there is a precious moment.  Then, sometimes you say goodbye.

He has been my patient for many years.  During that time I saw him monthly, or perhaps not for a half a year.  We fought off one cancer, and the complications which followed.  Drove it into remission, and added a decade to his life.  He enjoyed books, grandchildren, laughter, sunrises, and great meals.  Terrible golfer.

I love him.  The love of soldiers that have shared battle. The love of travelers who see the same world.  Patient and doctor, who rejoice in life, expect and mourn suffering, would lose all for family, and believe in building on frank words. Two people who cope with a wry smile, a bad joke, the occasional tear and the sweat of the brow. We hold, as with Woody Allen, that “Life is full of misery, loneliness, and suffering – and it’s all over much too soon.”

Now, a second cancer ravages his body and he will soon die.  Because he is the type of man who knows that life will pass and can speak of a world thereafter, because I believe dying is a part of life and we can talk of it without folding, and because we are close, it is time to say goodbye.  Thank him for wonderful years together and the wisdom he has shared.  Thank him for his teachings and support.  Make sure he knows I am sorry to see him go.

Except, I cannot say goodbye.  I do not lack words, desire, or courage.  I know exactly what to say. I cannot say goodbye because the illness, the malady, has taken his mind.  In its first rapid attack, the new cancer has poisoned thought, and while he is still my friend, and perhaps recognizes who I am, he is already drifting away.   No precious special time, he is almost gone.

I sit at his side, hold his hand, and look into his gentle round face.  Expression slack, baffled scowl, eyes adrift, he focuses on blank space.  It is a shared moment, without sharing.  Does he understand my love, my loss, my pain?  Perhaps he is already too far.  The burden is on me to remember, to touch, to feel.

We sit quietly, his breathing shallow disturbed by an occasional cough, my breaths deep, disturbed by tightness in my throat.  We do not talk of family, sunrise or sunset.  No travel plans or food. No smiles or joy.  No hope or dreams.  Two friends, share not goodbye, but silent moments at the end of life.


  • The unspoken connection is no less deep and as you make less important...x
  • So moving. So touching. Yet another wise reminder to not put off saying what needs to be said. The "end" is rarely the scenario we expect.
  • DebRN
    I think this is one of the most touching, soulful, pieces that I have read in a long time. Powerful moment. Words are not needed. Thank you.
    • James Salwitz, MD
      Thank you very much. jcs
  • How touched I am that you care so deeply. To be so open to love your patients and share in this way is a rare gift. My oncologist is like you...warm, witty, smart and full of compassion. I feel blessed.
    • James Salwitz, MD
      I am very happy you have that kind of relationship and support. jcs
  • Lin
    How many times in my 72 years have I sat in that chair and held the hand of a loved one, a friend, a patient and shared those silent last moments loving, praying still hoping for the beautiful eternal "awakening" that we all hope awaits us. Reading Dr. Salwitz's words brought to mind my first husbands "physician" who gave him four more years putting him into an expermental program when he was beyond terminal. They both knew the limitations of the program and developed a wonderful friendship along the way. Towards the end I don't know who the goodby was harder on. Dr. C came to the funeral. I never saw him after that. I did speak with him again a few years later. He is doing Cancer research at Anderson. I will never forget him.
    • James Salwitz, MD
      Thank you for sharing your story. jcs
  • IBS
    Your friend, your patient, knew you were there. May G-D Bless You
    • James Salwitz, MD
      I hope. jcs
  • Incredibly beautiful !
  • Goodbyes sometimes have to made to the living. When mental impairment and brain impairment interfere with communication. Recognition. Closing the door in the face of a seriously damaged man whose behavior has deteriorated to the point that he becomes dangerous, directly or indirectly is also a hard goodbye.
    • James Salwitz, MD
      Very interesting observation. Thanks. jcs
      • Your beautifully expressed thoughts and feelings on a very difficult and very final ceasing..brought to mind a personal situation...the goodbye inevitably did end in the death of the individual...a bit down the road.
  • Thanks for this. Your words always touch me, this post especially.
    • James Salwitz, MD
      Greatly appreciated. jcs
  • Angela Evans,R.N.
    I never cease to be amazed at the depth of your caring and compassion. O to blessed with more physicians,nurses,& ancillary care providers like you.
    • James Salwitz, MD
      Thank you very much. jcs
  • Dear Dr James You are like a round peg in a round hole as an oncologist .
  • [...] via Goodbye in the mist – Sunrise Rounds | Sunrise Rounds. [...]
  • My hope is that other doctors read this. My regret is that the doctors I love may be far away when a goodbye time comes. My wish is that the way you care for your patients would be contagious - easily caught by other doctors.
  • I've found writing about the loss of a loved one to be a cathartic experience. Sharing it perhaps could be likened to receiving consoling, comforting hugs. I hope both have been true for you. And in remembrance of your warriors lost in their battle to stay alive . . . just a suggestion for a compilation of these priceless jewels written with so much sensitivity and love. Best seller material Dr. Salwitz . . . honoring the loss and suffering of so many, and also a timely contribution to aid in needed support/donations with government research assistance threatened now. Of course writing sunriserounds alone is certainly a worthy contribution.
    • James Salwitz, MD
      Thank you very much for your support and comment... I am flattered. I will have to consider your words. Interestingly, I find writting about the patients I love helps in two ways. The first, by helping me deal with my own pain from what I have experienced, and the second by making me more sensitive and open to the next patient. Thanks again, jcs
      • Does it help you feel sanctified?
        • This was not intended to be of a negative nature..I went back and read these comments..spiritual awakening would have been more apropos.
  • I am moved beyond words. Please consider publishing these writings. You have a special gift that begs to be shared!
    • James Salwitz, MD
      Thank you very much ... I am deeply honored. jcs

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