There's Much to Learn in How We Say Goodbye

February 12, 2003

My husband, Dale, has lots of sayings he's known for, some of which I can even repeat. One is, "Your hair is too long if you can't comb it with a washrag" (convenient for a man who essentially is bald). But there is another I have always liked, not because it is funny, but because it is true: "You can tell more about people by the way they say goodbye than by the way they say hello." 
Believe it. Our goodbyes reveal much more about our character than our hellos. It's easy to make a good first impression, but it's the leaving that lingers. It's at the end when you'll see what a person really is made of, whether it's as simple as thanking the hostess as you leave the party or a bigger goodbye such as moving to a new city. It also applies to how we die and how we behave around others who get sick and old and die. 
I have a clear memory from my medical school days in Houston. We are sitting in the auditorium, only a few of us, waiting for a lecture on Alzheimer's dementia. The speaker is a geriatrician, a specialist in the care of the elderly, and he begins by telling how he and his wife care for a dear relative in their own home who cannot feed or clothe herself. She cannot walk or talk or bathe herself. She is in diapers. He tells us how much they treasure this loved one, what delight they take in caring for her, how special she is and what a privilege it is for them to care for her. And then he reveals that this relative is not an elderly parent but their infant daughter. 
I never have forgotten his point about how gladly we care for our babies -- how tenderly and lovingly and with what joy and hope. But the same care required by our elders, we give grudgingly, with pity or dread and with a sense of futility, tragedy and grief. He challenged us to approach the care of the elderly, whether as physicians or family members, with more hope, more optimism, more joy and more of a sense of privilege -- to say goodbye as well as we say hello. 
As a physician, I take care of some very, very sick people, many of them elderly, many from nursing homes. I admit, it is a fearful thing to see a human being shrunken and inert, to look into the eyes of someone who stares through you vacantly. But it matters how I care for them. It matters how often and how long I visit. It matters how I treat these people as they are leaving life as we know it. 
There is hope and help in doing this from a passage in The Bridge of San Luis Rey by Thornton Wilder: "Even memory is not necessary for love. There is a land of the living and a land of the dead and the bridge is love, the only survival, the only meaning." 
I remember a woman named Ruth I took care of many years ago. She was 82 and dying from emphysema. One day on rounds, I found a nurse's aide named Iris at Ruth's bedside, painting Ruth's fingernails. Iris had put lipstick and green eye shadow on "Ms. Ruth," perfect shades to complement her red hair, now carefully brushed. She had dressed the patient in a clean, new nightgown -- one with little pink roses and a ribbon at the collar. Iris had Ms. Ruth so fixed up, I had to spend extra time examining her just to make sure she was as sick as I believed she was. She was.
Maybe Ruth wasn't aware of any of that. And maybe both Iris and I will be forgetful one day and won't remember any of it, either. The memory of this parting may be lost, but the love and kindness with which it was done will stand forever, an eternal image of Wilder's words: "the bridge is love, the only survival, the only meaning." 

Barron, BA '88, MD '92 (University of Texas Health Science Center-Houston), has been an assistant professor of family medicine at UT Southwestern Clinical Faculty and more recently at Family Practice Center in Waco for 10 years. She now is in private practice in Waco. She and husband, Dale, BA '87, have two sons: Luke, 5, and Samuel, 21 months.