To attend or not to attend a funeral

The crematorium wasn’t very far. It was at a time of day convenient to me. But I dilly-dallied, sending several non-committal messages

Sanjay Nagral
July 17, 2023, Hindustan Times

Last week I received a rare request. From a patient’s son inviting me to attend his father’s funeral. I was looking after his father for almost five years. He had multiple hospitalisations for long periods of time. Articulate and talkative, he had discussed politics, films and climate change with me. His cancer which was operated five years ago had come back rather early. He had undergone two further surgeries and chemotherapy. His last few months were full of pain and distress. He faced it with the remarkable equanimity so common among our patients.

I ruminated a lot about the son’s wish. The crematorium wasn’t very far. It was at a time of day convenient to me. But I dilly-dallied, sending several non-committal messages. Finally I did not go. Using a classic alibi, I sent a condolence message with a fictitious excuse of being busy with surgery. Did I do the right thing? Is attending a patient’s funeral a good gesture? How would you feel if the doctor treating someone close to you is at the funeral? Will it help the grieving process or resurrect bad memories?

In my specialisation which can involve prolonged treatment, I tend to develop a certain familiarity with patients and their families. We often get talking about matters strictly out of the boundary of disease and treatment . Families open up on other challenges in their battle against the disease. Also in their lives. Sometimes advice is sought on completely unrelated issues. I have been asked for suggestions on illnesses of other family members, marriage proposals, even the career choice of children. I operate on a fair number of elderly patients. Where failure of treatment is not uncommon. If the patient passes away in the hospital, the news is typically broken by a junior doctor. If I am around, I talk to the family. Or else I call. But the conversation is very brief. And then the phone calls and messages stop rather suddenly. An interaction of months has abrupt closure. I have often wondered why.

I remember being invited to few condolence events and prayer meetings. But an invite for a funeral as far as I can remember has happened only once before. Last week’s request raised several questions. How do others respond? I asked a few surgical colleagues whether they had ever attended a patient’s funeral. Except one, they all said no. Even the one who attended admitted that it was not just a patient but a neighbour. I asked a senior family physician. She said that she would receive several requests but would decline. I even asked on a doctors’ WhatsApp group and many said they have never done it. Some went on to suggest it’s a bad idea. A few even talked about how doctors may face violence at the funeral. The practice of medicine in India is socially intertwined. But the hierarchy between a doctor and a patient is still quite wide. Whatever the reason, doctors attending funerals of patients seems rare.

The idea of modern medicine having evolved to an organised profession leads up to tenets of ‘professionalism’. And in turn ethics codes and even boundaries in the doctor-patient relationship. The concept of ‘boundaries’ is to prevent misuse of an unequal power dynamic inherent to the relationship. It has been mainly discussed in the context of a sexual relationship between a doctor and a patient. But boundaries also come into play when it comes to gifts and favours from patients. This is a bit challenging. Should one deny symbolic expressions of gratitude when we are otherwise steeped in a gifting culture? As medical professionals, we are supposed to be able to face death at work with equanimity, control and a certain aloofness. Or at least outwardly maintain that persona even if they feel otherwise. But for a family it is different. They mourn in many ways. They express sorrow, angst and disappointment. Notions of ‘professionalism’ and ‘boundary’ in a sense imply maintaining a distance from a patient. The territory of grieving could also be a victim of this distance.

Not surprisingly there is a fair amount written on the subject of doctors being present at a patient’s funeral. Most of this comes from the Western world. There are even surveys and attempts to find patterns on which specialities are more likely to attend. Not surprisingly palliative care physicians top the list in most studies. It may be pertinent to note that these are individuals who have been with a patient as carers, not necessarily with a promise of curing. Maybe death as a defeat of the doctors’ ability and competence is not at stake here. And neither is the embarrassment of costly invasive interventions. But there is another important finding across studies. A majority of families appreciated the idea of the doctor being present at the funeral and felt that it helped them to grieve.

The doctor’s role after death is currently largely restricted to the mechanical acts of declaring death and certifying it. In the variety of worlds we inhabit in India, this plays out differently. At home, it is the family doctor who usually provides this service. In the wards of public hospitals, it often ends with a ward boy putting a screen around the bed and an overworked sleepy resident doctor filling up a death certificate. In private hospitals, most deaths happen in intensive care units as that is the protocol.

A health provider’s participation in post death rituals is after all a reflection of what is imagined and understood as our role in illness. But the abrupt snapping of the connection the moment someone has passed away may be another tragic victim of an increasingly reductive way of providing care. On second thoughts, I think I should have accepted the request.