Honorable Mention, Doctor's Writing Contest

Now I understand grief

The author thought she knew how to talk to suffering patients. She was wrong.

By Marybeth Lambe, MD
Family Physician/Redmond, WA

Danny died at 5 months. I found him in his crib one rainy summer morning in 1990.

When Danny hadn't awakened that morning, I crept quietly into his room. As I touched his still, cold form, I knew immediately that he had died of SIDS. With strange calm, I turned to our two other children, who had followed me into Danny's room. I pulled them into my arms, and gave them the type of news I've had to impart to so many others in the ER where I worked: "Your brother is dead."

Schooled in artificial calm through years of doctoring, I shed no tears. I called the police and the ambulance, my actions as stiff and frozen as my little boy who lay upstairs.

In the months that followed, I maintained a surface calm, but felt angry with anyone who hadn't lost a child. Others' happiness wounded me. Why were they so lucky? Why couldn't I have died instead? I was angry with my husband. Why didn't he act more heartsick? Didn't he care? I was angry with my other children. How could they expect me to be kind to them when I was a maelstrom of agony inside? I was angry with the idiots who said things like, "Danny is with God now" or "You can have another child."

When you hold your dead child in your arms, you learn a lesson you would travel through hell to avoid. Before death touched me, I had thought I understood grief. When patients experienced a tragedy, I believed that my words of comfort and support helped ease their pain. I was patient and kind, and I thought that was enough.

Many pediatric patients came through the emergency room where I worked. Colds and broken bones were punctuated by the occasional horror of a child critically injured or already dead—brought in by a frantic parent or an ambulance team vainly attempting CPR. After such an event, the nurses, other doctors, and I would bow our heads in sorrow and thank God our own children were safe at home. Sometimes, I'd sit outside the ICU and hold hands with grieving family members.

When patients' bodies betrayed them, I'd rush to smooth over their sadness. "The side effects aren't bad," I'd say. "It's just one more medicine." Or "You won't even notice the brace in a few weeks."

When a patient's loss was serious, I would ask how he or she was coping. But I'd fill most of our time together with talk about prescriptions, counseling recommendations, and platitudes.

What drivel had I been spouting to patients all those years? I'd had no idea of how grief turns one to stone and later releases a torrent of tears and screams. As doctors, we are taught to ignore our small losses: a missed diagnosis, a botched surgery, a failure to act quickly enough in an emergency. Few of us speak to our fellow physicians about such small griefs. Is it any wonder we aren't more adept at handling a family's grief? To support them in their sorrow, we must first let go of our own grief that we could not save the patient.

Danny's death taught me that it takes courage to grieve. Our patients, suffering through injury or illness, are showing us their bravery. Now I take the time to appreciate their struggles. I've learned that grieving takes time. A person dealing with loss is on no timetable but his own. Whether the healing takes weeks, months, or years is personal. Our impatience with grieving individuals, our desire for them to "get over it," has no place in the work they are doing. We need to master our impatience and reach out to these individuals, rather than push them away in frustration.

One patient I saw after my son died was a woman I'll call Mrs. Wilcox. She'd been independent all her life. However, two strokes and advancing macular degeneration meant that at age 87, she finally had to move into an assisted-living facility. Mrs. Wilcox was irritable whenever I broached the topic, and her family was annoyed by her reluctance to accept her limitations; they hadn't considered the move a tragedy for their mother. "She's moving to a wonderful place," said her daughter, Barbara. "They serve meals and she won't be alone."

In a conference with her family, I asked her daughters: "What losses is your mother facing with this move? What is she grieving?" These questions turned the discussion around and made the daughters realize what this move represented for their mother. Perhaps they even allowed themselves to mourn the loss of the strong, competent person she'd been.

"She used to hang laundry in the backyard at 5 in the morning," said Barbara. She and her sister Betty looked stricken. "She won't be doing her own laundry anymore. She won't be in charge of herself, either," Betty said.

It is painful to acknowledge another's grief, far easier to rush in and cover it up with soothing words. When Betty and Barbara stopped telling their mother she shouldn't be sad about the move, that everything would be "wonderful," they accepted their mother's right to grieve. That, in itself, was healing.

Danny's death taught me to take a moment with patients to add, "It's hard, isn't it?" Or "Are you scared?" Or "How does this make you feel?" We might talk about the courage to grieve. Or about how long and lonely the road ahead could be.

The hardest grief for me as a doctor is missing the patients who became like part of my family. When Mrs. Wilcox began to die at age 92, I had trouble telling her the truth. She broke it to me.

Her kidneys were failing; her heart was barely pumping. We sat in her apartment at the assisted-living facility and listened to the silence. She finally said: "My knees aren't getting any better, and my back pains me something awful."

"I wish there were more I could do for you," I said.

"No, I'm done," she said. "I know we're not doing that dialysis, but I don't want those pills, either. I realize that you could keep me going. But I'm not too old to know when I'm dying."

That is when I learned the last lesson about grief. People pass from this life and sometimes there's not a damn thing we can do about it. All we can do is love them while they're here.

Now, when I'm talking with grieving patients, I'm content to follow wherever they want the discussion to go—or to hold their hand in silence while they weep. I guess supporting someone in mourning takes courage, too.

 

Marybeth Lambe. Now I understand grief. Medical Economics 2001;10:76.