A Doctor's Friendship With Grief

By Christianez Dennis

At 4:00 a.m. today, I stood in the emergency room to make an important call that would change a life. In just five minutes, I was able to efficiently and detachedly go over the details of a patient with her relative. "Yes, it looks bad." "No, she probably will not make it," and "Yes, we tried our best."

The person who answered the call was the young woman's fiancé. In painfully broken sentences, he informed me that they were getting married in a month. He had recently been looking at wedding sarees for her he said incredulously, how could she die? And after a flurry of stutters, stammers and false starts, one tear-soaked word: "Please."

In my time in medicine, I have found above all else that grief is the one emotion by which people let themselves be entirely consumed. Happiness is expressed in hugs and Instagram posts, and anger is limited by the need to not make a scene. But grief? People allow grief to bring them to their knees before a stranger begging them, "Do something. Anything. Please!" They allow their despair to make them cry out to a God they probably did not believe in ten minutes ago. They allow the pain to run through their body and be so visceral that they need to double down to be able to hold it. Rarely, to even numb them to the bone to not process what they are being told. This is followed by proclamations of how they would give up their own lives in a heartbeat to not have to see this. They mention the things they wanted to do together that will now remain forever out of reach and quietly admit that they do not know if they will survive this.

The complexity of this emotion is such that it is not limited to the dead and dying. The quiet pain on a wife's face when she learns that her husband has tested HIV-positive as she looks back over the years of their marriage and tries to pinpoint what went amiss; the helplessness of a patient who knows that while there is a treatment for his disease, even part of the cost will bankrupt his family; or even the hollow eyes of someone who has just been told that his limb must be amputated if there is any hope of saving his life - this feeling seems to permeate the experience of everyone involved in caring for the sick.

As an involuntary witness to all this pain, I feel that I have learned more about being human from observation than from my own life experience. This challenge of being confronted with difficult decisions and painful emotions was dealt with during our time in medical studies, but I do not think we were ever prepared to fully embrace the idea that we would be bystanders to the shattering of other people's lives.

We were taught to be empathetic, not sympathetic; to put ourselves in their shoes and walk a mile. However, this feels like a cheap imitation compared to the lives that are now forever changed. When I say, "I understand," I mean, "How can I possibly?"

Sure, I can talk about the helplessness that comes with knowing that sometimes there's nothing that can be done, no matter how much I want to help. Or how I sometimes doubt myself because I do not feel enough, and wonder if I have become a little more hard-hearted than I'd like to be, or how I am disheartened by the lack of dignity in death - how someone's whole life can be reduced to chest compressions, beeping monitors, and adrenaline shots before it evaporates in a final breath. But that feels wrong in many ways. These are people whose known reality is being torn apart piece by piece, whose lives will never be the same. Do I, who have the privilege of forgetting all this in a day or two, dare to make it about myself?

But since life is all subjective experiences, I realise that the only thing I can address with any prospect of change is my own experience of my patients' grief. The fact is that most of these issues may not have been processed by medical professionals themselves, including their mortality, which sometimes stares them in the face in such situations. It may be easier to either close ourselves off and work at the level of biology and science or skirt around the edges of acknowledgement with a perfunctory "I understand this is difficult," or even refuse to engage to protect our feelings.

But the people for whom this pain is a lived reality, who take this position of weakness and partial understanding, deserve better. Especially from someone they believe knows the intricacies of their bodies better than they do. And only by establishing a healthy relationship with uncomfortable feelings and coming to terms with their own humanity - and yes, even the vulnerability and mortality and truly disturbing fragility of their own bodies - can a physician hope to be that person for them. Making friends with grief seems to be the best way forward. Being able to be mindfully present with the patient as we cycle through the pain, anguish, resentment, and the occasional accusing finger is important.

And until the day this comes naturally to me, the only solution I see is to consciously keep myself accountable and hope and pray that when life hands me a card that I don't know how to deal with, I will have a fellow physician by my side who will do the same for me.

And until then, I guess I am allowed to have the occasional sleepless night and the occasional day I want to just leave everything and live under a stone, and on a day like today, the occasional 4:30 am panicked phone call to my partner to say, "I don't know what I'd do if something happened to you."

By Christianez Dennis