“She is not yours to grieve.”
That statement, from another physician, hours after Ava died and as pent up tears rolled down my face, left me embarrassed and ashamed.
The message: She was my patient, not my child.
Never mind the amount of time and tenderness I had poured into her care during the month she spent in the pediatric ICU. I had no right to mourn her death. I am a doctor.
As a resident physician, I often spend long hours with patients and their families. I am the first face they see at dawn during pre-rounds and the last face at night during evening rounds. I am the first person the nurse calls when he is worried, and I am the last one left at the bedside once things have stabilized enough for the attending to get a few minutes of sleep and the nurse to check on his other patients. During these long and often arduous hours, I am able to form a unique bond with these families.
Because of this powerful connection, I play an important role in helping families begin the grieving process when a child dies. Literature, guidelines, and curricula are available to help navigate these devastating situations. There is a seemingly endless stream of advice regarding what to say and what not to say to a grieving family.
In stark contrast, however, is the lack of direction when it comes to coping with our own grief associated with the loss of a patient.
Instead, the hidden curriculum of medicine teaches us to distance ourselves and create protective boundaries. Feeling and displaying too much emotion is not only regarded as unprofessional; it is a sign of weakness.
This attitude is unrealistic and harmful. Literature that explores physicians’ responses to the death of a patient is limited, but the work that exists is alarming. Physicians often experience feelings of guilt, powerlessness, self-doubt, isolation, failure, worthlessness, and despair after the death of a patient. Left unaddressed, these feelings can lead to increased distraction, medical errors and burnout.
When Ava died, I experienced these paralyzing feelings. Initially, I tried to ignore them; but this was not sustainable. I felt isolated and detached. I was unable to expose my heart to the patients who still needed and deserved my empathy and care.
Institutions across the country, beginning to acknowledge and better understand the grief we experience, are developing remarkable and innovative ways to focus on physician wellness and healthy coping skills. Through resources such as support groups, access to mental health professionals, and remembrance ceremonies, medical culture is changing.
I was fortunate enough to participate in some of these therapeutic avenues and reflect on Ava’s life and her death. I began to fully appreciate how much she had changed me as a person, and as a physician, during the month I spent as her doctor. Eventually, I was able to conclude that, while I was “only” her doctor, Ava was mine to grieve.
By giving myself permission to mourn without fear that doing so meant that I was unprofessional or weak, I was able to work through the feelings of failure and guilt in healthy ways. By addressing my grief instead of trying to hide it, I will be able to continue to open my heart to patients and their families without burning out. This is not only beneficial personally, but my responsibility professionally, in order to take the best care of my patients.
This lesson, that as a physician, not only am I allowed to mourn but that I am obligated to grieve, is not something I ever found in a textbook or heard in a medical school lecture. It may, however, be the most important thing I have learned about medicine thus far.
Lauren Gambill is a pediatric chief resident. She can be reached on Twitter @renkate.
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