Expressing grief through the power of story [PODCAST]

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes

“Now the room is silent as if nothing at all occurred. I stand watching the red stain forming on the pristine white sheet, mocking me in my failure. I trained at excellent institutions, survived residency, and served in combat. Now, here at a Level 1 trauma center, I could not save this life with every possible medical tool at my disposal. This injury, this particular injury, always has, and forever will, haunt my dreams. The hubris to think that I could be the difference, that I am better than those who came before me, was answered tonight, as it has been before, by this deserved slap in the face.

I absorb the charged silence; my mind wanders back to my third year of medical school. I was doing well, a moderate prodigy of the medical department. I was ready for every conference, every patient, well-read and well prepared, until that fateful day.”

Richard Morand is a trauma surgeon. Melissa Fournier is a social worker. They are, respectively, contribute and co-editor, The Healer’s Burden: Stories and Poems of Professional Grief.

They share their stories and discuss the KevinMD article, “I could not save this life with every possible medical tool at my disposal.”

Did you enjoy today’s episode?

Please click here to leave a review for The Podcast by KevinMD. Subscribe on your favorite podcast app to get notified when a new episode comes out!

Do you know someone who might enjoy this episode? Share this episode to anyone who wants to hear health care stories filled with information, insight, and inspiration.

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Richard Morand and Melissa Fournier. Melissa is a social worker, and she’s the co-editor of the book The Healer’s Burden: Stories and Poems of Professional Grief, and Richard is the surgeon who contributed one of the stories of the book. There’s an excerpt on KevinMD, and it’s titled “I could not save this life with every possible medical tool at my disposal.” Melissa and Richard, welcome to the show.

Melissa Fournier: Hi, Kevin, thanks for having us.

Richard Morand: Yes, thank you for having me.

Kevin Pho: All right, I’m going to ask each of you to share your stories and your journeys to where you are today. Richard, why don’t you go first?

Richard Morand: I graduated from the University of Rochester School of Medicine and went on to do a surgical residency at the Naval Hospital San Diego, which led to a career in naval surgery, and ultimately I was a trauma surgeon, or combat surgeon, for the Second Marine Division during the first Desert Storm war, which of course seems like forever ago now. After that, I left the Navy and became a trauma surgeon at Mercy Hospital in San Diego, where I was a staff trauma surgeon for eight years.

I probably would still be there today, except I had my son, who is our only child, and my wife and I are both from the East Coast, so we decided to move back to the East Coast so that he could be close to family. Actually, one of my junior residents and I formed a group in Maine. I spent the rest of my career in Central Maine, working first in private practice. Then, with a change in insurance policies and the like, and I think many people experienced this, we were pushed into pretty much becoming employees of the hospital we worked at. We did that for a while, and I didn’t find it really enjoyable.

So for the last five years of my career, four of us who were partners then, we all left and went to the VA hospital locally, and it was a nice conclusion to my career, because I started off taking care of military folks, and I ended it taking care of military folks. And so it was a good journey.

Kevin Pho: Wonderful. And Melissa, can you share your story, your journey to where you are today?

Melissa Fournier: Sure. One of the things I find fascinating about life is that our moments right now are a culmination of everything, right, that we endure and experience. I studied psychology at Wayne State University in my undergraduate years and went on to get a master’s in social work from the University of Michigan. I had a tremendous interest in mental health and worked in hospital social work and private practice in that arena, took a few years to raise my kids, and then experienced the death of my daughter in her infancy, at birth, actually. And that led me into some healing work, work in hospice, palliative care, and grief and bereavement.

My life has been sort of a culmination of these experiences. I lost my father to cancer when I was 13. Around that time, I actually wanted to be a surgeon, you know, thought about medical school and that kind of thing, but veered into psychology and really just wondered so much about what makes people think and act the way that they do, and took that route.

So the long and short of it is that I have a passion for writing and poetry and combined my interest in story with my career in social work and the life care, bereavement. I was also raised by an ICU nurse and saw the impact of her work on her. So all of this came together with this sort of question: How are we taking care of our health care workers? And what are their stories, and how do we make space for them and their grief?

When I worked in hospice, I knew what it was like to experience the grief at the loss of a patient and how that was handled. I worked in a very supportive, great hospice environment, but even with the notion of being deeply in touch with our own feelings, there’s sort of a sense of, you know, you have to watch how much you connect and keep that balance. So all of that became really interesting to me.

And the experience I had with my mom, just watching her through the years as I grew up, watching her come home from work exhausted and then continuing her care of five children. At the time of my father’s death, she went to work the next day and wasn’t able to tell us personally that he had died. And I can only imagine the pressure she was under to be present at work, to do what she had to do, and to honor that commitment.

But as I did my work in hospice, I started to see my mom through a different lens and wondered: How did she carry all that? How did she carry the constant exposure to death? Did that in fact impact her ability, or the barrier, in terms of her being there and present for me and my siblings when our father died? So it offered a clarity, and I wanted to do something with this.

So I also studied narrative medicine at the program at Columbia and was just fascinated by this idea that we connect with people’s stories, we have an urge to tell our story, we need to hear stories, and it’s what we bring together, two stories and how we interpret them, that can deepen our capacity for listening and understanding others, for being better in terms of our patient care, and that it can create affiliation among us in which we can support each other differently and better.

Kevin Pho: Wonderful. And Melissa, you are already co-editor of the book The Healer’s Burden: Stories and Poems of Professional Grief. Now, Richard, you contributed one of the stories to this book, and I was wondering, how did this come together? And did you share the story that you contributed to the book and excerpted on KevinMD?

Richard Morand: I journal a lot, and it’s a way of, that was one of my ways of kind of getting through all the things that happened day to day. And when I retired, my thought was to pull a lot of that together in the form of a memoir, which I’m actually working on now.

I was looking at the Examined Life Conference information with the thought of going there, before all of COVID happened and everything, and ran across a message from Gina and Melissa asking for contributions to be submitted. I got to thinking that one of the parts that I’d written about would be especially relevant to this kind of work. And I sent it in, not really expecting too much, and lo and behold, I got a call back: They were actually interested in it. So it went on from there.

The title of the story is “Tough Hand,” and it’s the story of my brother, my youngest brother, who was 21 years old and was stabbed in the chest multiple times by an angry ex-husband of his girlfriend. He went to a local hospital in central Massachusetts, which was, you know, limited in its capabilities, and he ultimately died on the operating room table. The cause was thought to be an air embolism, but, long and short of it, he didn’t survive.

At that time, I was finishing medical school with the idea of going into internal medicine, because that was my strongest suit. When my brother had this happen to him, it made me angry. It made me think: Why, with all the technology we have, do people have to die from injuries that should be salvageable? And so I immediately changed my focus and, as fast as I could get my paperwork together, applied for a surgery residency instead, thinking in the back of my mind, “It can be done better. I’m going to do it better.”

I did. You go on to do surgery, you know. Combat surgery in Iraq taught me that people die. Trauma surgery in San Diego taught me that people die. And over the years, I became much more empathetic to the plight of that surgeon who took care of my brother in the middle of Massachusetts with very little available, and I felt guilty about the way that I looked upon him for many years. And then, being in a major Level 1 trauma center in San Diego with everything possible at my disposal, and having a very similar patient to my brother die under my hands, made me fully aware that he had a really difficult time, and that I held him in low esteem unjustly for many years.

Kevin Pho: So, Richard, you mentioned you’re writing a memoir. You obviously contributed this very poignant story to the book. Tell me more about that intersection between your writing and your medical career.

Richard Morand: Writing has always been a way for me to kind of express myself. It’s difficult, even with, you know, certainly you can’t share with your children, but even with a spouse, to kind of go through what it feels like. The successes are easy. But when things go badly, I found it a way to kind of digest it and come to an understanding, and to be OK with the things that happened, by journaling through it. And once I started to do it, I just continued to do it for many years.

I found that it’s really difficult. You have your morbidity and mortality conferences every month, of course, and you talk about the cases that went badly, the deaths, the bad outcomes. But it’s very sterile. And the underlying vibe is usually that somebody did something wrong or something went badly: How are we going to fix it so that it doesn’t happen again? And that’s all good. You need that objective input. But what we never talked about was, how do you feel about the fact that in spite of your best efforts, this person died or this person had a terrible outcome?

In all the years that I was a surgeon, I never had that come up. In the last month, at the very last mortality conference of my career, there was a difficult death, and I did speak up and ask, and it was as if I had come from the planet Mars or something. It wasn’t easily accepted, and even the person that I offered the sympathy to seemed more embarrassed than thankful. So we’re not good at experiencing or sharing the grief among each other. We try to be tough, and surgeons are probably the worst of the bunch, but we’re people, and we become better surgeons and better doctors when we acknowledge failure as being part of the job.

Kevin Pho: And Melissa, can you share some of the themes and messages that you want the audience to come away with after reading your book?

Melissa Fournier: So, you know, interestingly, in The Healer’s Burden, we started this project before the pandemic, and we were really pleased with, when I say we, I’m talking about my co-editor, Gina Priba, who is an instructor in medical ethics and teaches creative writing herself. So she was the perfect co-editor, and we actually met at the Examined Life Conference that Richard had mentioned.

And so what we saw evolve, we were looking for stories in which the writer took risks in conveying their story. And that certainly was apparent to us in the very first paragraph of Richard’s story, “Tough Hand.” But what we noticed happening thematically as we took in these stories and made selections was that people feel very much alone in this idea of mourning a patient or grieving a patient. The idea that it’s not OK to show the feelings around it; if you’re emotional, you’re somehow too attached and perhaps less competent. That people hid what they were experiencing, or if they couldn’t or didn’t hide it well enough, felt a sense of shame about that.

And so, this notion that we need the space to grieve, that those in health care, pandemic or not, and those working in high-loss environments are dealing with death consistently, and that that is personal. It takes a toll. And the notion that we can dissociate and not connect with those emotions and make space for that is harmful to people. I think it harms our relationships outside of work. It certainly can. If we’re having to be so distant in our work, we take that into our private spaces and have a harder time connecting.

The idea that we need community, we need one another, we need a space to mourn together, that it’s not the length of our relationship with a patient, that these are intense connections, and that when people die, we have feelings about it. And that needs to be safe, OK, and talked about.

And one of the things that surprised Gina and me as we did this work is the gratitude that people had, whether or not their story was selected. Every submission came with “Thank you for doing this project. My goodness, this is long overdue. We have needed this.”

And so people want this space, and I believe organizations want to do better by their health care workers and struggle to know how to do this, with all the demands and everything that’s happening. So the book itself was created in such a way as to not only be an anthology of stories and poems, but it’s also founded in some of the principles of narrative medicine. We pose discussion questions, and we created this for use in small groups or even larger groups with a facilitator’s guide.

And the idea is that the book itself is not necessarily meant to be read and sit on a shelf, but it’s a tool that can be used in medical schools, hospitals, nursing homes, you know, wherever there are patients and wherever there are people doing this work. People can come together and create a space for discussion. And when we can enter the discussion through the stories of others, it’s a little bit less risky at first. We can use their story to get the conversation going and then connect it to ourselves, our own lives.

Kevin Pho: Now, we have so many stories in health care that we want to share. However, not every clinician is a wonderful writer, but their stories are no less important. So, Melissa, do you have any tips for health care professionals who may not be writers on how they can share their story?

Melissa Fournier: Absolutely. One, just write it, and write it with a mind to doing something for yourself, and have a trusted listener or reader. Something happens when we tell a story. Something happens internally for us with that story, and something happens for the listener. And we each bring our life experiences to that story and to the interpretation of the story.

So lots of people say, “I’m not a writer,” and then when they write, well, there’s a story here, and it’s meaningful. And there are people there to help if you want to do something with that story, like publish it. There are people to help make that happen. On our website, healersburden.com, we continue to take stories from people, stories and poems, and publish one a month, with the idea that whether someone is just interested in writing, or is an emerging writer, or just isn’t a writer per se but wants to tell the story, we’re interested in reading that. Gina and I are interested in posting those stories and making those available to people so that the conversation continues.

Kevin Pho: We’re talking to Richard Morand and Melissa Fournier. Melissa is co-editor of The Healer’s Burden: Stories and Poems of Professional Grief, and Richard is a contributor to that book. Now, I’m going to ask each of you for your take-home messages that you want to leave with the KevinMD audience. Richard, why don’t we start with you?

Richard Morand: Well, I think the take-home would be that grief is real. Sharing it with your colleagues is not a sign of weakness, but of strength. And it’s every bit as important to explore that as it is to explore the objective findings when something goes poorly. It makes you a better physician or a better health care worker, whatever your specialty.

And I think everyone is a writer. Writing is something that we share universally. We all have experiences, and we run them around in our head, and we think we understand them, but the little effort of putting pen to paper brings these things into focus. And it doesn’t need to be published. It’s for yourself. If you decide to publish it at some point, great. But it will for sure help you to kind of crystallize what’s going on and make it understandable for yourself. And in the long run, you may help someone else as well.

Kevin Pho: And Melissa, what is your take-home message that you want to leave with the KevinMD audience?

Melissa Fournier: The take-home message would be that there are communities of people within health care interested in supporting one another. There is a tool to do it. It’s The Healer’s Burden. And that we can’t ignore it. It doesn’t work to suppress it. It finds its way out, and we need to be tending one another in this grief.

Kevin Pho: Melissa and Richard, thank you so much for sharing your time and insight, and thank you both for being on the show.

Melissa Fournier: Thanks for having us, Kevin.

Richard Morand: Thank you, Kevin.

Listen and followApple PodcastsSpotifyYouTubeMore apps · Browse all episodes