Some time ago a patient told me she was really angry at her brother for not taking their father to the hospital.
“If he had got to the hospital in time, maybe they would have been able to save him.”
“I thought you told me your father had cirrhosis and hepatitis. Wasn’t he sick for years?”
“Yes, but that morning the doctor was there in the hospital. Dad was waiting for a liver transplant, and maybe if the doctor had seen him, he could have moved him up on the waiting list. Instead, he didn’t get there until the afternoon. My brother took away any chance he had to live.”
“The damn doctor. We’ve been telling him for years that my husband was not responding to the drugs. For years! George was puffing away up and down the stairs. Then Tuesday, the doctor gave him a clean bill of health. And Sam dropped dead in the doctor’s elevator about two minutes later. It’s the doctor’s fault he died.”
Still another patient:
“I kept telling him to go to the doctor. Month after month. Year after year. He kept getting GERD, that’s acid indigestion, but maybe a sign of a heart attack. But he ignored me until it was too late; and he got a stroke. It killed him. It’s his own fault he died.”
I was present myself at a funeral where a very tense young woman told someone—I think it was her brother—that he was responsible for their father’s death, “… He gave up hope because you didn’t even bother to visit him that last week in the hospital!”
I treated a middle-aged woman some time ago for obsessive-compulsive disorder. One of her symptoms was ritual behaviors which she performed over and over again in order to ward off infections and other vaguely possible mishaps. She had a 93 year old mother who was very seriously ill with a brain tumor that had recently recurred.
“I don’t think she’s being cared for properly in the hospital,” my patient told me. “She’s going downhill. What can we do to save her? Tell me.”
“I don’t know; but it doesn’t sound to me like anything can be done. She has a glioblastoma, which is usually fatal. And she is very old.”
“There must be something we can do.”
“Why? There comes a time when nothing can be done. People die.”
“There has to be something. There is always something.”
A few days later, her mother did die. The previous evening my patient had called the doctor to come to her mother’s bedside. Her mother had been having trouble breathing. He did not arrive until three or four hours later.
“It’s his fault she died,” my patient told me the next day. “I’m going to sue him for malpractice.”
What’s going on here? People die all the time—invariably, inevitably. Everyone is going to die. So far, six people have died over the course of man’s time on earth for every person who is currently still alive. They were not—most of them—murdered or the victim of suicide. It was no one’s fault that they died. People die naturally.
Yet, when someone dies of lung cancer, the first question anyone asks is: “Did he smoke?”
In other words, did he kill himself? Was it his fault?
There is something about death. In an odd way death seems unnatural-- uncanny, almost, because it is so far outside our experience. And so abrupt. The funeral service says, “…in the midst of life…” Even when a woman is 93 years old, and has been dying for months, her death seems sudden. There should be some sort of explanation, it seems. “Someone I loved has been taken away from me.” Somehow, someone must be responsible. Maybe God. I have known people who have lost all religious feeling after the death of a loved one because God was so unfeeling as to take that person away—too soon. When that person is loved, and needed, death always seems premature. And unexpected.
So, it seems to me sometimes that no one dies a natural death. But I really know that these people, who are searching for someone to blame, are really not very many. Most people can accept death. They are not inclined to say, “If only…,” and conclude that by all rights, that person should have lived. Some other quirk of thinking causes people to look for the villain that accounts for the death of a loved one.
They are, I think, part of a larger group who are inclined to blame someone whenever anything bad happens. If something goes wrong, it has to be someone’s fault:
“If you hadn’t stopped to put your makeup on, we wouldn’t be stuck in traffic now.”
“If you hadn’t upset me, I would not have driven through that stop sign.”
“If you had not put that glass there, I would not have knocked it over.”
“If he hadn’t coughed all over everybody, I wouldn’t be sick now.”
“If someone else is to blame, then I am not to blame. If that person who died from lung cancer smoked, then, if I don’t smoke, I am safe.” (Unfortunately, not true. It is possible to develop lung cancer with no history of smoking, or doing anything else wrong.) There are things we do, or have done to us, that can heighten out risks for getting sick and dying, but in the end illness is unavoidable. People get sick with or without someone coughing all over them. The search for the guilty party (“I got Uncle George’s cold,”) is pointless and likely to reach the wrong conclusion. Illness and life, in general--and death-- are capricious.
Those who suffer from obsessive-compulsive disorder are especially inclined to this way of thinking because they have the idea that they can control extraneous events by their own behavior. It is called magical thinking.
“If I wear the right clothes, nothing bad will happen to anyone in my family.”
“If I check the door many times, I can protect myself from intruders.”
“If I wash over and over again, I will not catch any infectious diseases.”
“If I say the right words in my head, nothing bad will happen.”
It is as if the world could be made orderly and controllable by effort alone. So, it is reasonable to think that there must be some way of preventing death, even in a 93 year old woman with brain cancer. And if she dies, after all, it must surely be someone’s fault.(c) Fredric Neuman Follow Drl Neuman's blog at fredricneumanmd.com/blog