When you hold your own dead child in your arms, you learn a lesson you would travel through hell to avoid. Oh I had thought I was wise, that I understood grief. When patients went through some tragedy, I believed my words of comfort and support. I was patient, I was kind and I thought that was enough.
Danny died at five months. I found him in his crib one rainy Seattle summer morning.
So many pediatric patients came through in the Emergency Room I had worked in. Mild colds, prolonged rashes, severe coughs, or broken bones were punctuated by the occasional terror of a critically injured child or worse. A child already dead--brought in by a frantic parent or an ambulance team attempting CPR in vain. After such a horrible event, the staff would have trouble recovering. For the rest of that shift the nurses and the doctors would bow our heads in sorrow and thank God our own children were safe in bed. Or so we thought.
I had seen many such tragic cases and wondered, each time, how does a parent survive? "I would jump off a cliff." I would tell the nurse working beside me. She would nod her head. "Impossible." She would agree. "I would have to die too."
When Danny did not wake up that morning, I crept quietly into his room. As I touched his still, cold form, I knew immediately he had died of SIDS sometime during the night. Medical training can be a blessing. With strange calm I turned to our other children, pulled them into my arms, and gave them the news I have had to impart to so many others before. "Your brother is dead."
Schooled to artificial calm through so many years of doctoring, I could not force tears even at this nightmare beyond words. I attended my children's grief, took them up to see, with their own wet eyes, their brother laying still and rigid in his little crib. I called the police and the ambulance, my actions as stiff and frozen as my little boy, Danny, who lay upstairs.
What drivel had I been spouting to patients all those years? I had no idea of how grief turned one to stone. Or how, in the space of a quick, quiet step into a room, my life could be altered forever. Did I say stone? A rock where one's heart used to lay. To become, later, a torrent of tears and screams and violence.
What had I known of loss? When I held a family member's hand as we sat quietly just outside the ICU, how kind was the grieving husband, daughter, brother, or friend. They held their suffering inside. They did not pull away from my incompetence at compassion to ask: "Have you never suffered? My wife, my mother, my brother, my dearest one is dying! My beloved has died! Save me from this grief! I am alone and alone and alone."
Maybe I even shed a few tears with them but they must have known. I, clearly, had never stepped through the fire of loss myself. "Your wife's heart stopped and there was nothing we could do." Calmly, gently, I imparted the news. "Your daughter did not make it through surgery." I sat with them, gave them my full attention, held their shocked gaze.
Sometimes, family would even apologize for crying. "I'm sorry," They would tell me. "I don't mean to make a scene." Can you imagine? My demeanor so calm and quiet they felt their grief was rude and intrusive and they were "Sorry, I can't seem to stop crying."
What did I learn in those terrible days after Danny's death? What am I still struggling to comprehend? How could my own shattering experience help a patient or another doctor?
I had not understood, before, how grief is a thread that runs through so many aspects of our lives. How tragedy can leave us so alone, so destroyed, so disabled.
But I learned something else from my son's death as well. Loss has touched each of us, all of us, in some way. Perhaps not in the catastrophic discovery of a dead child, but in so many smaller scenes. Each of us have suffered, been alone with a grief, been afraid. Who among us have not had the grief of lost love or been wounded by humiliation, or stupidity, or shame? A friendship broken or faded, a marriage sliding into coldness or anger, personal illness, dreams never realized. Sorrow has touched all of us. And, if we can examine those feelings, we are better able to help our patients through their own bewilderment and despair. Perhaps it might even make our own lives sweeter. Surviving loss makes that which remains, so much more precious.
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. We hold these professional 'defeats' in our hearts, brooding on them privately, if at all. Is it any wonder we are not more adept at handling a family's grief? When our patient dies, it feels like failure. To support the remaining family members in their sorrow, we must first let go of our own grief-our grief we could not save that patient.
Danny taught me much about heartbreak. Here is the first lesson I learned.
It takes courage to grieve. Immense courage simply to endure and travel through loss. Our patients, suffering though injury or despair, are showing us their bravery. Now, I take the time to appreciate their valiant struggle. Mrs. Wilcox was eighty seven years old. She had been independent all her life but two strokes and advancing macular degeneration meant she finally had to move into assisted living. Her family was impatient with her, annoyed because she seemed so reluctant to accept her age induced limitations. Mrs. Wilcox was irritable whenever the topic was broached and she found a myriad of reasons to delay her move to the senior apartment. In a conference with her family, I asked her two daughters a few simple questions. "What losses is your mother facing with this move? What is she grieving?"
These questions turned the whole discussion around. The family had not considered this move as a tragedy for their mother. "She's moving to a wonderful place! They serve meals and she won't be alone and someone will even help her keep track of her medicines!"
But now, they were silent, thinking of what this move represented for their mother. Perhaps they even allowed themselves to grieve for the strong competent mother she had been. "She used to be out there at five in the morning." One of her daughters, Barbara, told me with a smile. "She would be in the back yard hanging sheets in the winter cold; told me it was the best time of the day." Barbara turned to her sister Betty. "Remember how Mom scoffed when we bought her that dryer? ' Wouldn't have the smell of the wind and sky in it with that damn machine' she told us, remember?"
Betty sniffed and they both looked stricken. "She won't be doing her own laundry anymore, will she? She won't be in charge of herself either."
It is painful to acknowledge another's grief. Far easier to rush in and cover it up with soothing words and reassurances. 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.
Tennessee Williams wrote: "I don't ask for your pity, but your understanding-no, not even that-no. Just for your recognition of me in you..."
How many times have I rushed to smooth over my patients grief? Ignored their sadness when their body betrayed them?
"The side effects aren't bad, it's just one more medicine."
"You won't even notice the brace in a few weeks."
"There's a spot on the X-ray."
"Get your husband to do the vacuuming, your back is getting worse."
"I agree with your son You shouldn't be driving at your age."
"Your sugars are still too high."
"The Pap smear was abnormal."
Danny's death taught me to take a moment longer to add. "It's hard, isn't it?" or "Are you scared?" or, more often: "How does all this make you feel?"
When a patient's loss was more serious, it used to make me nervous. Oh yes, I would carefully inquire as to how a widow was coping and sleeping and eating. But I would fill the time with sleep prescriptions and counseling recommendations and platitudes. Now we might talk about the courage to grieve. Or how long and lonely the road ahead. How hard it is to put one foot in front of another on that road. Or how to keep moving from one endlessly long moment to another. That it is normal to resent others whose lives are still intact, or how it is perfectly fine to talk to one's dead spouse. I am now content to follow wherever my patient wants to travel in this discussion. I am content to also hold their hand in silence while they weep. I guess supporting someone in grief takes courage too.
"Life begins on the other side of despair." -Jean-Paul Sartre
I have learned grief is ugly. One who has suffered a loss is irritable, unreasonable, and, at times, impossible. Going through grief takes such enormous sums of energy, there is nothing left over. Grieving patients may yell at me, they may curse and shout. Anger is a large part of loss.
'How dare my mother die while I still needed her', 'How could my brother be so stupid to drink and drive', 'Why didn't my husband take better care of his health?'
When Danny died, I was angry at anyone who had not lost a child. Others' intact happiness was a wound to 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 openly 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 silly things. 'Danny is with God now.' Or "You can have another child.' Or 'You really need to get hold of yourself.'
Grieving takes time. A person suffering through loss is on no timetable but their own. We do not decide how long a woman may grieve after a miscarriage; it is her loss, not ours. Grieving is hard work and it is done when the job is finished and not before. Whether that means weeks, or months, or years, is private and personal. Our impatience with the grieving individual, our desire for them to 'get over it already', has no place in the work they are doing. Far worse is the grief pushed away before it is dealt with, before some resolution is achieved. It is difficult to deal with the patient who seems to make no progress in their grief. We need to master our impatience and reach out to such individuals rather than pushing them away in frustration.
What is the hardest grief for me as a doctor? I miss the patients who became part of my family. When Mrs. Wilcox, at age ninety two, began to die, it was difficult for me to tell her the truth. As Elie Wiesel writes: "It is easier to kill a man than to break the news that he is going to die."
Poor Mrs. Wilcox, she had to break it to me.
Her kidneys were failing; her heart was barely pumping. We sat in her apartment and listened to the silence. Finally, she spoke.
"Mrs. Gunderson died last week. You remember she was in Apartment 2 C? Mrs. Taylor went into the hospital on Thursday. Mavis Foster says she won't be coming out of the hospital alive."
Mrs. Wilcox pushed the tin of nuts toward me, vaguely because her vision was almost gone. She coughed, cleared her throat, and swiped at her mouth with a tissue. "My knees aren't getting any better and my back pains me something awful."
I nodded, then remembered she couldn't see my gesture. "I know, I know. I wish there was something more I could do for you."
She chuckled, a low sound that turned into a coughing fit. "No," she said. " I'm done."
"What do you mean?" I asked, ever slow.
"I'm just telling you I'm finished, I'm tired." She turned her rheumy eyes toward me. "I know we're not doing any of that dialysis but I don't want those pills neither."
"But--" I began.
"-I'm not saying you couldn't keep me going; you're a good doctor, no offense. But I'm done. I'm not too old to know when I'm dying. " Mrs. Wilcox sat back, her hand on her chest, a bit breathless.
And that is when I learned the last lesson about grief. People pass from this life and there's not a damn thing we can do about it. We can at least love them while they're here.
