The Goodbye Some Families Never Get
- andreweschmd
- May 11
- 4 min read
The Palliative Lens
By Andrew Esch, MD
Dawn
My cousin Dawn died unexpectedly April 18th.
Even now, writing those words feels strange. Abrupt. Incomplete. Like the sentence itself should continue.
Because that’s what sudden death does. It interrupts not only a life, but everything around it. There is no final chapter. No slow realization. No gathering around the bedside. No last conversations where families say the things they’ve been rehearsing quietly in their heads for years.
Just a phone call. And a coffee cup from that morning, still in the sink, with lipstick still on it.
And then before your mind can process the information, people start speaking in the past tense.
Death vs. Dying
As a hospice and palliative medicine physician, I spend my life around death. More than that, I spend my life around dying.
Those are not the same thing.
Dying is often gradual. It has texture and shape. It unfolds over weeks, months, sometimes years. Families adapt to it slowly, painfully, imperfectly. People say goodbye in pieces. There are hospital rooms and living rooms and whispered conversations at 2 a.m. There are reconciliations. There are moments of grace. There is suffering too, sometimes tremendous suffering, but there is also preparation.
Time becomes both cruel and sacred.
But sudden death is different.
Sudden death steals the preparation.
No one got to ask Dawn one more question. No one got to hold her hand and say the things families save for “when the time comes.” There was no transition from living to dying. One moment she was part of the future everyone assumed existed. The next moment she was gone from it.
A Good Death?
In palliative care, we often talk about a “good death,” though I’ve increasingly come to dislike the phrase. It can sound clinical. Performative. As if dying well is another achievement unlocked by enough planning and hospice brochures.
But what people usually mean is this:
Did they suffer?
Were they heard?
Did they know they were loved?
Did the family have time?
Time.
Time to absorb reality.
Time to forgive.
Time to say thank you.
Time to say I’m sorry.
Time to say I love you without pretending it’s implied.
I have watched families sit vigil for weeks around a dying parent, exhausted beyond comprehension, emotionally shredded, praying for it to end….and then later describe those same days as a gift because they got to be there.
That’s the contradiction of prolonged dying.
It hurts terribly. And it gives something back.
The goodbye.
Endings
As clinicians, we sometimes underestimate how important that process is. We focus on symptoms, logistics, code status discussions, medications, discharge plans. And we should.
But families are often trying to accomplish something much less medical and much more human: they are trying to emotionally catch up to reality before reality arrives.
Sometimes they can.
Sometimes they can’t.
And sometimes, like with Dawn, the opportunity never comes at all.
There is a trauma to sudden loss because the mind keeps searching for the missing moments. Families replay ordinary interactions looking for significance they couldn’t have known was there at the time.
The last text.
The rushed goodbye.
The unanswered call.
The often unremarkable, mundane interaction that became, unknowingly, the final conversation.
People carry that forever.
Working in palliative care has taught me that anticipatory grief is painful, but it also serves a purpose. It lets love reorganize itself around loss before the loss fully occurs. It gives families time to slowly become survivors.
Sudden death offers no such transition.
One minute you are a daughter, husband, cousin, friend.
The next minute you are grieving.
Just impact.
A Reminder
And yet, sitting with Dawn’s death has also reminded me of something uncomfortable: none of us are actually promised the long goodbye.
We build healthcare systems, advance care plans, and end-of-life frameworks around the assumption that decline will announce itself slowly. But biology and fate do not negotiate with our emotional preferences.
Some people die over years.
Some people die over months.
Some die crossing L street
As physicians, we often think the tragedy is dying too soon. But increasingly I wonder if the deeper tragedy is how often we postpone living because we assume there will still be time later.
Later to call.
Later to forgive.
Later to visit.
Later to tell people what they meant to us.
Palliative care has made me deeply aware of mortality. But losses like Dawn’s remind me of something even harder:
Mortality is not always gradual enough to prepare for.
And maybe that should change how we live now.
Maybe the conversations we reserve for hospital rooms belong at kitchen tables instead.
Maybe we should stop acting like love is understood without being spoken.
Maybe “someday” is the most dangerous word in the English language.
I don’t know what constitutes a good death anymore. I’m not sure any physician truly does.
But I know this:
The families who suffer least are rarely the ones who had perfect medical care.
They are the ones who left less unsaid.
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