I think I probably read more obituaries than the average person my age. They're mostly the obituaries of patients I have known. For the most part they are very similar. I've always appreciated the ones that are more creative. I've never thought of them as a form of art and I never really thought about who was writing them (don't families write them sometimes?). I recently discovered the Society of Professional Obituary Writers (SPOW), an "organization created for folks who write about the dead for a living."

I must admit, my first thought was, why? Is there a society for those journalists that write for every other section of the paper? But after perusing their website, their cause became more clear. "We want those who write articles about the recently deceased to regard obituaries as once-in-a-lifetime stories that should be researched, reported and penned with as much care and attention as any other newsroom assignment." Oh my! Well put. Could obituary writers be to journalism what palliative care is to medicine? I suddenly feel very sympathetic to the plight of the obituary writers.

Every year SPOW gives out awards for the best obituaries in different categories, such as Average Joe, Celebrity and even Broadcast media. Since I discovered their website, I've devoted some time to reading some of the award winning obituaries about people I've never met. I have been trying to appreciate them more as an art form, a work of nonfiction. I was amazed by how clear a picture some of these gifted journalists could paint even though I didn't know the subject of the articles.

Below is an excerpt from Fair Thee Well, Ex-Father-In-Law by Daniel Asa Rose (from Obit) which won for the Best Tribute/Memoir/Column (Long):

"So it's easy, is it not? To pick up where you left off. There is no earthly reason to stop communicating with a man just because you divorced his daughter, no reason in the world not to keep the dialogue going ad infinitum. Except one. For this bullying bruiser who was going to live to be 100 suddenly dropped, just like that. Before I could send off my package, this unstoppable man with his burly chest and nasty brilliance was cut down, the private nurse un-caught, the hurtful snare drum of a laugh shut down at last. I had meant to pick up where we left off: Now we were just leaving off. Wesley Love died, and what was music and what was not would have to wait some later debate.

Here's to you, ex-father-in-law. I'm sorry we never recognized each other for what we were. Probably you were not the ogre I thought, just a mortal straining to suck in your gut in your canary yellow La Coste shirt. I was just a kid trying to lock horns with one of the big guys. Why didn't we know that then? Why aren't we all more gentle with each other now?"

Although it's too long to post here, I appreciated Carol Smith's article (which won for Best Average Joe Obit Short) Dying vet planned a final mission.

So to all you obituary writers out there, my proverbial hat goes off to you. You do important work and I hope you have the appreciation and respect that you deserve.

In 2003, writer Joan Didion's husband died suddenly of a heart attack while sitting down for dinner. Didion wrote The Year of Magical Thinking detailing the year that followed his death. The book starts with the first words she wrote after her husbands death.

"Life changes fast.
Life changes in the instant.
You sit down to dinner and life as you know it ends.
The question of self-pity."

While grieving for the loss of her husband, Didion is also dealing with the critical illness of their only child who is in the ICU with pneumonia. They had, in fact, just come back from visiting her when John had the heart attack. Quintana's lengthy illness is a subplot throughout the book. While the illness definitely complicates Didion's grieving, it also seems to serve as a distraction. (Quintana died shortly after the book was published.)

Didion seems to describe every impulse and emotion of the first year of grief.

" ...Grief has no distance. Grief comes in waves, paroxysms, sudden apprehensions that weaken the knees and blind the eyes and obliterate the dailiness of life."

She weaves memories of her life with John and Quintana together with her present day grief in a way that could have seemed choppy if done by a lesser writer. Didion's account flows very naturally as if we were reading straight out of her mind. It feels that honest as well.

She has a remarkable insight into her own thoughts and feelings, her magical thinking. Below, she describes the painful process of clearing out her husbands things.

"I stopped at the door to the room.
I could not give away the rest of his shoes.
I stood there for a moment, then realized why: he would need shoes if he was to return.
The recognition of this thought by no means eradicated the thought.
I have still not tried to determine (say, by giving away the shoes) if the thought has lost its power."

As I read Didion's book, I couldn't help but think that writing it must have been painful but also like therapy for her. A way to process through her thoughts and her grief. While some may come off as self-absorbed, writing a book entirely about ones grief experience, I think Didion comes off as generous for sharing something so personal with us. At the end, she doesn't offer any answers to her grief, no big bright light at the end of the tunnel, but sort of sums up her life with John.

"I think about swimming with him into the cave at Portuguese Bend, about the swell of clear water, the way it changed, the swiftness and power it gained as it narrowed through the rocks at the base of the point. The tide had to be just right. We had to be in the water at the very moment the tide was right. We could only have done this a half dozen times at most during the two years we lived there but it is what I remember. Each time we did it I was afraid of missing the swell, hanging back, timing it wrong. John never was. You had to feel the swell change. You had to go with the change. He told me that. No eye is on the sparrow but he did tell me that."

References: The Year of Magical Thinking. Joan Didion. 2006.

In 1918 when the influenza epidemic hit Philadelphia, Isaac Starr was a third-year medical student. With so many medical practitioners away in the army, the third and fourth year students were called upon to act as nurses and interns. Starr wrote about his experiences in an essay that was published in 1976 then republished in 2006 (free PDF) in the Annals of Internal Medicine. (Picture: Emergency hospital during 1918 influenza epidemic, Camp Funston, Kansas)

As a third-year, Starr was assigned duties of head nurse. The epidemic started mildly with most of his patients admitted with just a febrile illness because their families were all ill and there was no one at home to care for them. This soon changed. He vividly describes the progression of the illness.

"As their lungs filled with rales the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth."

The physicians he had supervising him were mostly retired specialists. "I recall a laryngologist who seeing herpes labialis on a gasping cyanotic patient was much interested in it and prescribed application of guaiac." He was taught "cupping" by another physician. He was reprimanded for not leaving the windows open as this was the practice of the time for treating pneumonia (perhaps treating the dyspnea associated with it?).

Starr had few therapeutic options available. "When the pulmonary froth endangered life I gave atropine; when the patient was moribund and the pulse weak I injected camphor in oil." At the peak of the epidemic, the death toll was over 25% per night.

Starr wrote his account of the 1918 epidemic to share his experiences so that we might be better prepared if this should happen in the future. In reading his essay, I can't help feeling the helplessness they must have been experiencing. To see such death and suffering and know that there wasn't much that you could do to make it better, or even slow it down. I can't imagine what it was like to be still in medical school and charged with caring for a ward of dying patients. Even with all our medical advances, I find Starr's descriptions to be terrifying. It seems that an influenza epidemic is just as much a threat today as it was in 1918.

Reference: Starr, Isaac, Annals of Internal Medicine 2006; 145:138-140