When longtime Georgetown resident Sherie Winston fractured her arm a year and a half ago, the four-year breast cancer survivor feared her past treatment might have weakened her bones. So she chose orthopedic oncologist Allan Aaron, based in Chevy Chase, to take care of her. "He reassured me that my fracture wasn't related to my cancer," says Winston, 48. "I remember joking in his office during a follow-up appointment."
Two days after that last visit, while reading a local paper, she saw an obituary for an Allan Aaron. She didn't think it could be the same person. But it was. Her "trim, fit caregiver" who, at 44, was younger than she was -- had died of a heart attack.
To many patients the white coat a physician wears, the color of an angel's wings and rescuing knights, seems to confer invincibility. Even in these days of managed care and 15-minute office visits, doctors are healers, trained to convey strength and instill confidence. So when a doctor dies suddenly or leaves a practice prematurely because of an illness, patients -- especially those who are seriously ill -- can feel that something inviolable's been breached.
"The patient feels rage at the doctor for abandoning him, then guilty about feeling that way," says Carol Kleinman, assistant clinical professor of psychiatry at George Washington University School of Medicine. "It helps to know that it's normal to feel this way, in the midst of grief."
"Your physician is the one who is going to cure you, so when that's taken away, it's terrifying," says Julia Rowland, director of the office of cancer survivorship at the National Cancer Institute in Bethesda. "You were counting on a future because of this person."
While it is, fortunately, a rare occurrence, it's worth remembering that doctors do get sick and die, just like the rest of us. But for patients who are in this position, it's also good to know there are ways to make the transition smoother.
"I never thought I'd outlive her," Gina Shaw, 38, says of her breast surgeon, Jeanne Petrek. Petrek, a nationally known physician based at Memorial Sloan-Kettering Cancer Center in New York City, died in April at age 57 after she was hit by a van while crossing the street. She left behind hundreds of current and former patients, each of whom was called by her office staff.
Shaw, a freelance medical writer who lived in the District for 16 years before moving recently to New Jersey, was diagnosed with invasive breast cancer two years ago. When she heard why her next appointment would be with a replacement doctor, she broke down and sobbed for hours. Petrek "seemed invulnerable," she says. "I'm still in shock."
"For most people, a serious illness has a tremendous influence on their psyche and triggers all sorts of responses as they try to cope with the fear," says Richard Goldberg, a psychiatrist who is the medical director at Georgetown University Hospital. In a solid doctor-patient relationship, Goldberg says, "the doctor helps to buffer the patient from the stresses of the disease, as well as delivering hope about the outcome."
Patients who feel stripped of that protection, says Kleinman, need to remind themselves that they've already developed good coping skills by dealing with their illness, and that their doctor left them in good hands.
Idealizing the deceased caretaker, says Goldberg, makes it difficult, if not impossible, to settle into a secure relationship with the doctor who takes over. Sometimes a sick patient who is on a complicated schedule of medicines will stop taking them.
One way to start building a solid, trusting relationship with the new doctor is to be open with your feelings. "Tell him what you liked about the deceased physician, and about your sadness that he is gone. You may want to say, 'I hope that I can develop the same kind of relationship with you,' " says Kleinman.
And that need to reach out will probably extend beyond the new physician. The death "affects the milieu in which you are treated, because the staff is also mourning the loss of the physician. With a diagnosis that involves team care, such as cancer, the loss echoes throughout the entire environment," says the National Cancer Institute's Rowland.
"Patients need to be sensitive, aware and empathetic to the doctor's staff. Everyone is rattled by the death," Rowland says. "You may want to acknowledge the loss by sending a condolence card to the office." Kleinman suggests that, in order to "help them with the grieving process, which will take time," patients also attend the physician's funeral, if possible. When the deceased doctor is a general practitioner or a specialist who's been at the nexus of a patient's health care for many years, the loss is especially profound.
Sometimes the doctor has time to prepare patients for his or her death. This was the case with Larry Sheinhorn, an eye surgeon who died of esophageal cancer in May of this year, at 52. "He told me during my last office visit that his cancer had spread to his liver and that he wasn't going to make it," says Marjorie Parker, 82, of Derwood, who had been a patient for 11 years. "I felt terrible. He was a wonderful doctor."
Experts say that losing a physician can be similar to losing a friend or a family member. "Remind yourself that you were lucky to have had this person as your doctor for many years, and that it will take time to get over the loss," says Kleinman.
While dealing with the emotional challenges of the death, there are some practical steps you can take to make the transition easier. If you don't already have copies of your medical records, make sure to get them. Prescriptions from your doctor become void after his death; to get refills of medications when you are between doctors, take a copy of the doctor's obituary notice to your pharmacist. And since the deceased doctor's office will be chaotic for a while, with support staff wondering if they will lose their jobs, it helps to be patient and understanding.