The True Cause of Death

“I had met him at the Over 60 Health Center, a clinic founded by and created for the Gray Panthers, to serve the aging Black Panthers and others in the community. And now a short decade later, he is gone. A self-described lifelong revolutionary, a Black Panther and member of the Black August organizing committee, Roy’s life was filled with stories, and those stories culminating into his immediate cause of death—metastatic cancer. His other underlying medical issues: hepatitis C and a rare spinal cord condition that contributed to unrelenting functional decline. Thinking about his life and what led to this death, I reflected on the day he came to establish care with me. I remember learning of the years of fragmented care, the years of struggle finding safe and affordable housing, and I remember him adjusting to a progressive disability. Life took on twisty turns, and his care again became disrupted after my departure from the community health center, my own father’s death, the birth of my daughter, and then a global pandemic.

The expansion of telehealth allowed me to see him again a year ago, only to find out that he had been diagnosed with hepatocellular carcinoma, despite timely cancer screening and successful treatment for hepatitis C with new direct-acting antivirals. But as I lay awake thinking of events that occurred to him during the last decade that I knew him, and over the 7 decades that he lived, I realized that something glaring was missing from his cause of death at age 71. His stories and his revolutionary steadfastness made it clear. Systemic racism. It affected his ability to be housed safely, obtain medications, navigate his health care, receive appropriate care, and ultimately did contribute to his death.

Like many of my peers, I was never formally taught to write a death certificate.¹ Instead, years ago, completing the death certificate worksheet was just one of many tasks given to me as an internal medicine resident. These ‘to-do’ items handed to interns and residents, at best came with formal teaching and training, and at worst came merely as a checklist of what to do when someone dies; pronounce the patient, call the family, call the medical examiner, call the organ donation network, fill out the worksheet. Check. Done. Next task.”

Read more on The True Cause of Death via JAMA.