The Coroner called. Someone died. Will I sign the death certificate?
The note was attached to the front of a thick chart. I saw the name. "Why would he die?" I thought and a microsecond later I had the probable causes of death in mind. It was not a real surprise.
They would come together for their visits. One stayed in the truck with their dog while the other saw me, then they switched places. The last two visits, the dog was in the exam room. Six months ago, all three were in the exam room for her visit. She was progressively sicker with recurrent hospital admissions which were getting closer and closer together. He knew he had to be present that time. She didn't survive the next admission. I had mentioned hospice as an option on three occasions and they opted to follow the full pathway with ICU's, ventilators, home BIPAP, etc. The home BIPAP added five years to her life (five years of life after I initiated the first hospice conversation) and amazed several of us.
He brought the dog to his last visit, too. He was lost without her. Could the cause of death be a "broken heart"?
Family physicians are aware that sometimes the death of a spouse is followed by the death of the surviving spouse within a year. In couples who are very close, a "broken heart" may be a significant factor in the second death. It isn't a medical diagnosis, though- it can't be on the death certificate, which is restricted to medical diagnoses. Too bad. Things like "Old Age" aren't allowable, either. All deaths are "medical". Too bad.
In Family Medicine, we develop insights about people that go beyond "medical" phenomena. It's part of our essence-- knowing people, and their stories, and their meaning.