Not Superheroes: Holding Space for Physicians to Grieve

You remember, all too vividly,
The beep-beep made by machines as she takes her last breath,
The cacophony of wailing sounds by relatives after you call his time of death,
As you drive home in silence, you finally give in to the torrent of tears,
Asking for the umpteenth time:
"Why couldn't I save them?"

The first time a patient in my care died, I was a medical intern in my home country. I still remember how distraught I was, as my heart shattered into several pieces. It didn't stop me from working, though—instead of processing my grief, I worked even harder, bereft of the skills required to navigate how I was feeling before moving on to the next patient like nothing earth-shattering had happened. Even if I had the time to grieve, I didn't know how.

Grief as a concept is so intertwined with our lived experiences as physicians that there's no escaping it. Yet, the fast-paced nature of medical care pressures us into "putting our emotions together"—sometimes within a time frame as short as 15 minutes after the loss of a patient. Considering the depth of critical decision making involved in patient care, we compartmentalize our grief, maintaining our presence as the strongest figures in the room. Notwithstanding, the emotional burden of consistently caring for patients eventually takes a toll on even the strongest of us, as grief-related stress has been correlated with increased rates of anxiety, depression, and burnout among physicians (1).

I have often wondered how to appropriately grieve as physicians while carrying out our day-to-day tasks effectively. To navigate our sad reality of prescribing how to process grief while barely processing ours, is it feasible to recommend going through the nonlinear grief process using the Kübler-Ross stages of denial, anger, bargaining, depression, and acceptance? Dr. Kittleson, in an Annals of Internal Medicine essay entitled “The Privilege of Grief,” talks about the trajectory of a doctor's grief and recommends that the physician ask such questions as "Was it my fault?" and "Could I have predicted this?" followed by the startling recognition that control is only an illusion (2). It isn't uncommon for the physician to ponder over every detail of patient care, wondering what else could have been done to save a patient from the brink of death. Many times, the answer is "nothing," and while difficult, it is beneficial to accept that sometimes our best medical efforts fail patients.

How can we hold space for physicians to grieve? At the institutional level, physicians need to be supported in handling the relentless faceoff with death by the development of curricula that provide grief management as a survival skill. On a personal level, you and I must give ourselves the permission to feel grief by detaching our superhero capes, and letting go of the fear that grief makes us ineffective or unprofessional. We are humans after all, not superheroes, and the ability to feel grief is a core part of our humanity. Dear physician, yes, it's okay to sit still and just grieve.

References

1. Sansone RA, Sansone LA. Physician grief with patient death. Innov Clin Neurosci. 2012;9:22-6. [PMID: 22666638]
2. Kittleson MM. The privilege of grief. Ann Intern Med. 2018;169:729-730. [PMID: 30452577] doi:10.7326/M18-2049

Oyepeju Abioye, MD, MSc

Dr. Oyepeju Abioye is an aspiring internist and oncologist who is passionate about advancing equitable health care. Originally from Nigeria, she is pursuing U.S. medical residency and has recently completed a master's degree in epidemiology and biostatistics from the University of Witwatersrand in South Africa. Her major clinical and research interests include survivorship among marginalized populations, as well as diversity and inclusion in clinical trials. Dr. Abioye hopes to contribute meaningfully to these spaces through clinical practice and evidence-based research and is currently a research assistant at the Florez Laboratory of Dana Farber Cancer Institute.

Omotomilola Fadipe, MD

Dr. Omotomilola Fadipe, originally from Nigeria, holds a bachelor’s degree in biochemistry and obtained her MD degree from Ryazan State Medical University in Russia. Her journey in medicine has been characterized by unwavering dedication, a relentless pursuit of knowledge, and a deep sense of empathy. Driven by her profound passion for improving health care standards, she has volunteered with several NGOs, demonstrating a strong commitment to providing medical care in marginalized communities. Dr. Fadipe firmly believes that primary care is the cornerstone of medicine and is determined to make a meaningful impact on the global health care landscape.