key: cord-0753189-9r30gswo
authors: Sherman, Fredrick T.
title: Comment on: Virtual funerals: A feasible and safer option during the COVID‐19 pandemic
date: 2021-02-21
journal: J Am Geriatr Soc
DOI: 10.1111/jgs.17040
sha: 3b798f0ee85678acb3a3c2e6f0e8fab28fff3661
doc_id: 753189
cord_uid: 9r30gswo

See the Reply by Freeman et al.

To the Editor: The commentary that discusses the feasibility and safety of virtual funerals during the COVID-19 pandemic omits the time-honored approaches that physicians have used for centuries to communicate with, console, and help the relatives of our deceased patients with their bereavement process. 1 Lest we forget, physicians have used the telephone to call and posted handwritten condolence notes to the next of kin, and joined family and friends at their patient's funerals and memorial services as part of our responsibility to help the bereaved. 2, 3 As far back as 1875, William Osler, then a 26-year-old practicing internist, sent a transatlantic condolence note to a father in England whose son died of smallpox in Montreal. 4 Thirty years later the boy's sister met a doctor named Osler in England who had cared for her younger brother during a fatal illness. She recalled that his sympathetic letter had been the greatest solace to her parents. 5 Besides expressing my sympathies and relating some memories of my deceased patient, the main purpose of both my personal conversations and telephone calls and my personal condolence notes, was to assuage any guilt feelings the survivors had about healthcare decisions they made with or on behalf of their relative. Recognizing that guilt feelings can last a lifetime, I told them that their advice and counsel was always in the best interest of their relative and that their devotion to their relative was exceptional.

Before and during the COVID-19 pandemic and in the future, we may have the option of virtually attending our patient's funeral and post funeral gatherings and listening to eulogies and testimonials of what our patient meant to their relatives, colleagues and community, developing an appreciation and understanding far beyond the problem list and social history in our electronic medical record. 6, 7 For example, three daughters gave eloquent eulogies lauding their father's humor and business savvy, traits that never poked through his profound dementia and hepatic encephalopathy when I cared for him. His octogenarian buddies then rose to tell of their regular beatings at the strong hand of his squash racket. As their memories of his muscles tried to bulge throw my memories of his stooped, sarcopenic frame, I imaged his athletic prowess and competitive spirit. Or there was the bedbound, old doctor whose fecal impaction and anticoagulation regimen were the focus of my care. At his funeral, I learned that he had devoted his medical career to improving the health of the poor and underprivileged directing the largest urban healthcare system in the country. In awe of him, I felt privileged that his wife, a nurse, had chosen me as her husband's doctor.

The mere presence of the physician or a member of the healthcare team at the virtual funeral, even if they choose not to speak, sends a message to the mourners of how much they cared about their patient. While hospitalists may be uniquely positioned to provide needed psychosocial support to the bereaved family member immediately after death from COVID-19, the primary care physician has and will remain critical to the successful, long term management of bereavement in the survivors whether in person or in a virtual forum. The physician who has known the patient and her family for years, if not decades, is uniquely positioned to communicate compassionately, assess risk, educate about bereavement resources and refer surviving relatives for mental health counseling when appropriate. 8 While the physician's black bag has passed on, telephonically consoling the next of kin, sending a condolence note and attending the funeral will remain in every physician's toolbox now and in the future.

The author has no conflicts of interest to disclose.

The author is solely responsible for this manuscript including concept, authorship and revisions.

Virtual funerals: a feasible and safer option during the COVID-19 pandemic

The doctor's letter of condolence

The attending at the funeral

Sir William Osier's philosophy on death

The Life of Sir William Osier (I)

Attending the funeral: you may be introduced to patients you thought you knew

Death during a pandemic: virtual shiva calls and funerals without mourners

Bereavement care in the wake of COVID-19: offering condolences and referrals