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Full circle

BMJ 1994; 309 doi: (Published 26 November 1994) Cite this as: BMJ 1994;309:1446
  1. Liam Farrell

    They told me, Heraclitus, they told me you were dead,

    They brought me bitter news to hear and bitter tears to shed.

    I wept as I remembered how often you and I Had tired the sun with talking and sent him down the sky.—W CORY

    A patient of mine, a good friend, died recently. I had looked after his wife during her final illness and we had got to know each other really well. We waked him as he would have liked, sitting up by the fire all night spinning yarns, and drinking tea and whiskey. If we were not triumphant, we were not defeated either.

    Leaving the house in the early hours, I was not surprised to find myself crying, for not all tears are an evil, and grief is one of the great wild emotions that ever demands our allegiance. It was as if grief was wearing my friend's clothes; a consolation only, but surely better than the void. Would we rather forget, and in our own turn be forgotten? As William Faulkner said, “Between grief or nothing, I choose grief.”

    On that morning the order and anarchy of nature had never seemed so precious as when viewed against the razor's edge of loss. The elderflowers were never so radiant, the birches never so slender and lissome, dawn's first light never of such scalding beauty. I also felt a keener insight to the less tangible gifts: the company of friends, the laughter of children, the tender grace and promise of a lover's kiss. All these became more lustrous, more poignant, when gilded with memories, and all were the sweeter for being commonplace. Being constantly close to death lends us a greater intimation of the transience of our own existence, and of the inexorable progress of universal entropy; a thing of beauty may not remain a joy for ever.

    Here lies the paradox of the human condition; we can spend our lives in the pursuit of happiness (and the American way) but in order to be truly happy we must first know what it is to be truly sad, and taste the bitter to truly enjoy the sweet. Love and loss, joy and grief, are like two sides of a playing card, and both have to be dealt in the same hand.

    General practice, especially rural practice, is probably different from most other medical disciplines in that our patients often are our neighbours and friends. Working within a small community, where we meet them every day in their other roles, makes it impossible to maintain absolute equanimity and detachment when their role changes to that of sick and dying patient. Such vulnerability does not make us less effective doctors; sustaining such personal and professional loss should rather make us more understanding and compassionate.

    And what goes around, comes around. We also have the great consolation of seeing the new generations; so often a death seems to be followed by a new grandchild, a reminder to us that the circle of life continues, even though we all don't arrive at the end at the same time. Our memory, with our DNA, travels down the generations, and death can achieve no victory over our genetic pool.

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