You Can Only Take So Much Grief

It is hardest to talk to somebody mourning the sudden loss of a loved one. You are faced with questions that demand exact answers, but no explanation is ever enough, no course of action justified. Grief takes away all reason, leaving only an impenetrable wall of shock and anger. You are not even sure if it is appropriate to say sorry; you know that you did the best you could, and still failed.

As your patient lingered between living and dying, inasmuch as you wanted to offer family members hope, you also wanted them to understand that there is, and will always be, a limit to what you can do as a physician.

You just cannot save them all. Neither an apology nor an excuse, it’s just the way things are. In this age of gene therapy and molecular medicine, countless questions on the natural course of diseases remain unanswered by science. Why this patient? At this time? Despite everything that has been done? Death prevails, and you are reminded of the fragility of human life.

You put yourself in their shoes, to try to see things from the point of view of grief. Removing the science of increased intracranial pressure, cerebral ischemia, mechanical ventilation, inotropic support, and multi-organ dysfunction from the picture, all that is left is a patient, husband or wife, father or mother, son or daughter, brother or sister, friend or beloved, taken away with an abruptness that magnifies the pain many times over. You begin to understand, so you bear their every word, and respond with silence.

Do they realize that you are also wounded by this loss? What wakes you up each day is the hope that your patients live longer, happier, and more meaningful lives. Conversely, their suffering becomes your burden, and their death, your failure.

No doctor would want his patient to die.

You can always objectify the circumstances and shield yourself with apathy, but that would take away the essence of what it is to become a doctor. To heal is to comfort, outright impossible if you nullify all emotion.

At the end of the day, you can only take so much grief. You end up scarred, but that is the price you pay for choosing this path. You pick yourself up and move forward, otherwise you become unfair to the other patients who entrusted their lives in your hands.

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8 comments

  1. I haven’t experienced losing a patient since I haven’t had the opportunity to be on duty in the wards; although I experienced losing a loved one while I am a medical student, and had the same thoughts (Removing the science of increased intracranial pressure, cerebral ischemia, mechanical ventilation, inotropic support, and multi-organ dysfunction from the picture, all that is left is a patient, husband or wife, father or mother, son or daughter, brother or sister, friend or beloved, taken away with an abruptness that magnifies the pain many times over) at that time.

    Thank you for putting the precise and concise words into the unexpressed and suppressed emotions of a scarred doctor.

  2. Bai, this post is very timely for me, Just lost a patient this morning, the only child of two young parents, succumbed to burn wound sepsis from scald burn. Bilis lang din lahat ng pangyayari, they were prepared, but when he finally expired, they cant help but blame themselves for the accident that happened to the child. After everything, they still thanked all of us for doing our best for their son. Nakakalungkot. Pero tama ka, we do have to move on. And well, the process repeats for our next mortality. :(

    • As a phoenix rises from its ashes, every surgeon gets reborn with each patient death, bai. Pero pagdating mo naman sa private practice, malamang wala ka namang mortality sa Plastic Surgery. Sana lang! Hehe.

  3. Thanks for reminding me about the real essence of being a doctor. I feel that being in the ED has somehow taken away my ability to empathize with people… Or patients at that. Being in a fast-paced life and in situations wherein patients are brought in unstable, one’s sure way to cope up is through detachment… Being able to prognosticate without feelings… Being able to tell one’s relatives at pointblank that their relative will not make it or has already expired. Thank you for making me realize that in order to become a good doctor, one must be able to bring comfort no matter what the situation is.

    And I must also say that your articles are truly inspiring. It was only recently that I was able to read your articles when a friend posted a link on fb.

  4. My father died more than a year ago. He died of cancer after just two months of being diagnosed. It was as if a train hit us because his health deteriorated so fast. I kept thinking that it couldn’t be. His last month, the whole time he was confined to the hospital bed because he contracted pneumonia. My mother and I never left his side, except for when one of us would go home for one day just to catch up on sleep and rest. But then on his last night he let my mother go home because my sister had just given birth. I was left with him that night when his health deteriorated overnight until that morning he was gone. It was very traumatic for me, to be a nurse and to not see what was coming. I blamed myself, still do now because there must have been something I could have done to save his life. The grief and trauma of watching nurses and doctors that morning scrambling to save his life were the worst kind of pain. It changed me, scarred me, and more than a year later I still can’t believe my father is gone.

    There are no words to explain the pain when a loved one passes away. They say it gets easier everyday but they didn’t say for how long. And since that day in the hospital, I couldn’t bring myself to pursue being a nurse anymore. It used to be my passion but right now I can’t anymore.

    Spending two months in the hospital, I always wondered what the doctors were thinking of my father. I was bitter towards them because I felt that for them he was just another terminal case and they probably judged him for having lung cancer. My father wasn’t a smoker and he devoted his life to us, his family. I guess it was easier to replace anger with grief that I was feeling.

    So reading this… I guess it does affect some doctors too…to watch their patients pass away or suffer and thank you for sharing that.

    P.S. I graduated from UP Manila BA Social Science. student number 2002. :D

    All the best,

    Gail

  5. Rosalyn Donato

    I have been in both sides of the fence. I am an ophthalmologist and a cancer survivor (Endodermal Sinus Tumor of the ovary) . And truly, one becomes a better doctor after you become a patient. Maybe because you were able to empathize with them but I believe more so, that God transforms a person because of his/her sufferings. It is also called purification.
    By the way, I was also a caregiver for a time. I personally took care of my husband who passed away because of Glioblastoma multiforme, initially at the spine (T-11 to L-2) which metastasized to the brainstem. I guess you know the surgeries/treatments/complications and care for such kind of patients . Also, I am a mother of two young girls ( after my cancer and chemo) while I actively practiced ophthalmology when my husband was not in crisis. All of these really purified me to the pulp!
    My insight on all of these is that, only true healing comes from God. There are two healings – spiritual and physical. Every person brings healing graces to another even by his words,gestures & actions. And we, doctors are privileged to bring both.
    But we have to realize that we are just instruments. You will see it as you go in your practice that even if how hard you try, complications happen. While even if you thought that everything is a disaster, it will turn out fine. I found this very true because during the time I was so dead tired caring for my husband, I will do surgeries and thank God, they were all okay.
    Now, my whole attitude in my practice is that I allow myself to be used by God. To be the best possible instrument of God. I am just the delivery girl. I live by the motto like what I always teach my children, ” Do your best and God will do the rest”. And this has relieved me all of the stress that doctos’ pride bring. Because, it’s not about us, it’s about God!
    But as it has been said, God wouldn’t put you in a situation where His graces are not available. After my husband’s passing,

    • Rosalyn,

      You are such a strong person. I admire you for all that you have done for your husband, kids and patients!
      But it is true that we are lucky, as doctors, to heal the sick, not just in physical aspects but in spiritual too. I see that in my patients too. And in a way, they also help us, in one way or another. And we are instruments of God, and we just have to do what is the best for our patients! It is up to God to do the rest.
      And yeah, we will not be placed in a situation where He cannot help us. May you continue to be healed and continue to heal and touch more people.
      Will send a prayer for you!
      Godbless!

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