Should doctors show their grief?

How physicians and clinicians cope with treating the terminally ill

Craig (name changed to protect confidentiality) taught me how tough physicians should grieve. They shouldn’t. Craig and I were about the same age and we also had sons who were close in age. Craig suffered from advanced lymphoma that no longer responded to chemotherapy. He knew from his shortness of breath and growing disfiguring tumors on his face and chest that he was dying. He asked me to promise, when his time came, to keep him comfortable. I promised.

Late afternoon on a “call day” his nurse paged me to his room. Call days were rough. Each intern typically “worked up” 8-10 newly admitted patients over a 36 hour period and responded to the changing needs of over 100 other patients. Upon entering his room, I knew from his gurgling, irregular breathing and faraway look that he was dying. I remembered my promise as he weakly squeezed my hand. He died a few minutes later.

Aware that I already had two new patients to evaluate, as well as a long list of other tasks, I left the room and headed for the stairs. Alone in the stairwell, I paused — surprised by a single muffled sob rising from my chest. I shook it off and headed to the next admission and, from there, to many more patients waiting to be seen that evening.

The implicit message I incorporated from those ahead of me in training was “Real doctors don’t feel sadness. You just move on.”

Is showing grief a weakness?

I did not think about Craig again until several years after my internship. I heard the book “House of God” presented a raucous and hilarious view of internship. Instead of laughing, I wept as I read the book which triggered a flood of memories and bottled up grief. I cried for Craig, and for the four year old who was crushed by a car when he darted out into the street, and for the child’s parents, to whom I had to deliver the unfathomable news. My tears felt cleansing as I recalled the many patients who died during my training.

A recent study in the Archives of Internal Medicine (Nature and Impact of Grief over Patient Loss on Oncologists Personal and Professional Lives) tracked 20 oncologists for nine months to determine if they felt grief when a patient died and how they coped with the feeling. In a New York Times article about the study, the lead researcher, Leeat Granek, writes that “not only do doctors experience grief, but the professional taboo on the emotion also has negative consequences for the doctors themselves…More than half of our participants reported feelings of failure, self-doubt, sadness and powerlessness as part of their grief experience, and a third talked about feelings of guilt, loss of sleep and crying.”

To avoid being overwhelmed, some physicians and clinicians maintain an emotional distance to cope with a career where they witness so much illness and death. Many clinicians feel they must stay strong for patients and families who are experiencing their own substantial grief. Other clinicians may be reluctant to show emotion in front of patients or their professional colleagues as they perceive this as a sign of weakness.

The study goes on to say “the theme of balancing emotional boundaries captured the tension between growing close enough to care about the patients but remaining distant enough to avoid the pain of the loss when the patient died…patient loss was a unique affective experience that had a smoke like quality. Like smoke, this grief was intangible and invisible. Nonetheless, it was pervasive, sticking to the physicians’ clothes when they went home after work and slipping under the doors between patient rooms.”

Support for grieving clincians

Here at Park Nicollet, we provide our clinicians with many resources to deal with the unique challenges of working in medicine, including professional and peer-to-peer counseling. Our other professional renewal programs include “Finding Meaning in Medicine,” a group discussion session that includes retired Park Nicollet physicians who share their experience and wisdom with younger doctors. Our off campus “Courage and Renewal for Healers Retreat” provides three days of facilitated counseling to “help physicians renew their vocational vitality and deepen their professional practice.”

We also have special meetings called “Schwarz Rounds” that are open to all team members where our clinicians share personal stories that help them address the emotional aspects of their profession.

Unfortunately, we have recently experienced our own grief at the loss of one of our Park Nicollet colleagues – ironically, the physician who led our professional renewal programs.  Judson Reaney, MD was a remarkable man and an outstanding physician who started many of our professional renewal programs and died too young at the age of 62. We have had to pause a few of our programs due to his death, but I am proud to say that Dr. Reaney’s important work will be continued by the Reaney Center for Professional Renewal, which is currently being developed.

Finally, I personally agree with a Park Nicollet doctor who wrote about physician grief in one of our internal newsletters. “The positive side of the coin,” she writes, “is in the greater understanding of the human condition that comes with the experience of loss, sorrow, and grief.  We are in a privileged position to bear witness to the naked realities of life. The brave practitioner who can use the settings of morbidity and mortality as occasion for reflection is likely to have an acute awareness of current blessings along with an understanding of the painful fragility of the world. The frequent comment from mature doctors that ‘I’ve learned more from my patients than they have from me’ is a reflection of this rich experience.”