To Cry or Not To Cry

“One of the most common experiences in the practice of medicine is the experience of loss and disappointment…from the small nudge of a lab test revealing a medication is not effective, to the blow of a patient dying. It is a great deal for any caring person to handle. Yet most of this loss remains unacknowledged and ungrieved…The expectation that we can be immersed in suffering and loss daily and not be touched by it is as realistic as expecting to be able to walk through water without getting wet. The way we deal with loss shapes our capacity to be present to life more than anything else. The way we protect ourselves from loss may be the way in which we distance ourselves from life. Protecting ourselves from loss rather than grieving and healing our losses is one of the major causes of burnout.”
- Rachel Naomi Remen, M.D. "Kitchen Table Wisdom"

My second to last call night on MICU was an emotional one. I learned a very important lesson that night. For the first time in my medical career, I gave myself permission to grieve, to acknowledge the pain of losing a patient. The situation involved a family discussion with a dedicated wife and her adult children. Her husband/their father had walked into the hospital 1 week ago with fatigue. On his 2nd day, he seized, breathed his stomach contents into his lungs, and developed a dreadful case of aspiration pneumonia. He had gotten so sick that his heart stopped. The code to bring him back lasted over an hour. The lack of blood flow to his brain during this time left him with irreparable brain damage. On this call day, we broke the news to his family. Mr. R would never be coming back. In fact, he was in the slow process of dying. His family was devastated. The room was filled with tears. His wife was inconsolable. “How can this be? He walked into this hospital last week!” she sobbed, tearing apart a used piece of tissue in her hand. After several minutes, she looked up, her eyes filled with tears and memories of love. “He was so healthy. You know we purposely did not get the paper delivered to our house each day? It was how we got our exercise. Every day, we would walk to get the paper. It didn’t matter if it was raining or not. Then we would come home and read it together.” It was this moment, the description of a small, every day event that got me. It reminded me that this patient was more than a body in a hospital gown. When I walked out of that emotionally-charged room, time stopped for an instant. As I walked out, I literally saw two paths in front of me. I could shrug this off and rejoin my co-residents, finish my work, and move on to dealing with other patients. Or I could choose to stop and allow myself to feel the gravity of this moment. For the first time in my career, I chose the latter. I walked into the bathroom. I burst into tears. As I sobbed, I couldn’t figure out why I was so upset. This wasn’t my family. It wasn’t my loss. In retrospect, I guess it was the picture of a man who was once very much alive and the very real love he shared with his wife. It was about the injustice of loss. It was about the feeling failure when, as a practitioner of healing, you have nothing else to offer a patient. Allowing myself to feel that sadness, albeit in the midst of a hospital bathroom, reminded me that I was human too. That I am not a robot in a white coat. That I myself am very much alive.