No Place for Goodbye

There are patients you take care of, and then there are patients who stay with you. I lost one of those today. Not just a patient, but someone I had known for nearly 20 years. She was in Florida for the winter. I hadn’t seen her in a while. With COPD, that can mean things are stable, or at least stable enough. But she was never really routine.

She texted me constantly. She asked more of me than almost anyone I’ve ever taken care of. She was sharp, a retired businesswoman, the kind of person who read everything and questioned everything. We didn’t always agree. She was pro-Trump. She didn’t want the COVID vaccine. We had real debates, the kind where you balance evidence with relationship, knowing that if you push too hard, you risk losing both. But she trusted me. And I respected her. Somewhere along the way, she stopped being just a patient.

This morning, I got a call from her physician in Florida, someone I’ve never met, telling me she had died suddenly of sepsis. He knew we were close. As a doctor, he knew I needed a phone call from someone who had been at her bedside, who knew what had happened. I have practiced medicine for over 20 years. I’ve lost many patients. So what surprised me was not the news, but the feeling. A small part of me suddenly felt missing. I keep thinking I’ll hear from her. Another text. Another question. I found myself scrolling my phone, to see her last text. Another point she wanted to debate.

But I won’t. And there’s no real place for that in medicine. I’m not part of her family. I won’t be at the funeral. I won’t sit in a room with people telling stories about her, the way families do when they’re trying to make sense of a loss. There’s no ritual for this part. No moment where you get to say goodbye. Just a phone call. And then… nothing.

Earlier this year, I lost another patient. Maybe we’re not really supposed to have favorites, but I’ll be honest, he was one of them. He was a pilot for a major airline, developed inflammatory interstitial lung disease, and was told would never fly again. We worked through it together. We got him off oxygen, and then triumphantly back in the cockpit. The FAA physicians told him they could count on one hand the number of pilots who had come back the way he had. He went from needing life saving oxygen around the clock to holding the lives of hundreds of passengers in his hands every day. But just like the patient I lost today, he wasn’t just a clinical success story. He was my friend. Every year he invited me to his holiday party. I don’t know why I never went. I found out months after he died that he’d suffered a heart attack. Looking back, I wish I had gone to just one of those parties.

But this is the part of medicine we don’t talk about much. Doctors are very good at building walls. We learn early how to compartmentalize, how to take the hardest moments and set them aside so we can keep moving. There is always another patient, another decision, another problem that cannot wait. And most of the time, it works.

But there are some patients who don’t stay where you put them. They follow you home. They show up in your thoughts. They text you. They challenge you. They make you better. And when they’re gone, the absence is not abstract. It is specific. It has shape. You feel it in the empty spaces where they used to be.

Recently, I saw one of my own physicians whom I’ve had the privilege of knowing for many years. I asked what I thought was a simple question, but for just a moment, something shifted. The composure gave way. A glimpse of everything she was holding. We are taught not to show that. To be composed. To be objective. To be steady. But we are not untouched. She didn’t want to appear “unprofessional.” I reminded her that long before she ever became my doctor, she was first my friend.

I think this is what happens when you do this work long enough. You do not just accumulate knowledge or experience. You accumulate people. Some pass through. Some stay. And a few become part of the way you understand the world.

We like to believe that professionalism means distance, that caring deeply is something to be managed, contained, kept from spilling over and that the boundaries we build are what allow us to do this work well. But I am not so sure.

Because in the end, those boundaries are not what I remember. I remember the patients who stayed. The ones who asked more, who pushed back, who trusted me anyway. The ones who blurred the lines I was taught to keep clear. And I wonder if that is not a failure of professionalism, but the point of it. Because no one really wants a doctor who feels nothing. And sometimes, the boundaries are not meant to hold.