Not Superheroes: Holding Space for Physicians to Grieve - Annals of Internal Medicine: Fresh Look Blog


Wednesday, April 17, 2024

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.


  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

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