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veryone, even those in the medical profession, experiences the loss of someone close to them at some point in their lives. Some doctors may be lucky and have colleagues who willingly take on the burden of additional work or shifts to give them time off with family and friends. Others, such as single-handed GPs or doctors in smaller hospitals, may have to return to work almost immediately due to lack of cover, however heartbroken and distressed they may be. Doctors who have moved abroad to pursue their careers may not even get home to ‘say goodbye’ and isolation from family and friends may make a loss even harder.
Grief affects the brain. It can cause concentration difficulties, forgetfulness, inability to make decisions, and general ‘absent-mindedness’, yet doctors may go immediately back to an environment where they make important decisions daily. What safeguards are in place when we are ‘distracted by grief’? Do we tell colleagues to ‘double check’ what we do? How easy is it for us to limit our hours or take an extra day when we need it? As a group, we are already at risk of alcohol and substance abuse and it is easy to see how that extra glass of wine or self-prescribed sleeping tablet could become a crutch to suppress emotions and aid sleep to get through yet another, busy, stressful day or weekend on-call. Working in a smaller community may mean that patients know and may wish to express their condolences either at the beginning or end of the consultation. It can be difficult to keep emotions in check, concentrate and keep to time, adding to the pressure and length of an already exhausting day.
It is not just personal loss doctors have to face; they lose their patients too. Some are complete strangers, others good friends. The death of a patient can produce a range of emotions. Providing good end-of-life care can be hugely fulfilling, but also emotionally draining, particularly when a younger person is involved. If the death was unexpected or due to an undetected problem there may be ‘what ifs’ and justifiable or misdirected anger from distressed relatives. Medicine is not an exact science, despite what we would wish and sometimes with the benefit of hindsight; there are times when things might have been done differently had we only known. There may be self-examination, self-doubt and even on occasion, uncertainty about career choice. It goes with the territory, but it doesn’t make it any easier to deal with when it happens and it isn’t something they prepare you for in medical school.
We are sometimes encouraged by others to distance ourselves in order to maintain protective boundaries. Feeling and displaying too much emotion can be regarded as unprofessional. Sometimes we intellectualise or medicalise our grief. We can appear ‘unaffected’ or ‘hard’ in contrast to the more demonstrable displays of grief of those around us. We may park our own grief as, to quote a friend, “by the nature of our profession, we become the go to rock of strength for everyone else”.
Colleagues may tell you “it gets easier” or “you get used to it”. I’m not sure either is true and am not convinced that it is the answer. Caring and empathy are part of our art and their loss can lead to dehumanisation of patients and burn-out in doctors.
The image of a young US doctor crying outside a hospital after losing a young patient recently went viral on social media. It gave the public at large a small insight into our world.
Perhaps, in the future, it will be recognised that doctors grieve too, even if they get good at hiding it. Death is part of life and part of medicine. When patients experience loss of loved ones, we are there for them. We listen and give them sick certs until they can cope with going back to work and we advise bereavement counselling. We tell them to avoid making important decisions for a year. We tell them to look after themselves, to spend time with family and friends, to exercise, to listen to music, to practice mindfulness and do anything else that helps. Are we as kind to ourselves?
Perhaps in the future, within our health service we will develop a culture of caring for staff as well as patients; sadly, I think it is lacking at present. In the meantime, we need to continue to look out for each other. Waves of grief can hit often when least expected. It can take days, weeks or months for their impact to lessen. A phone call, a text, an email or a listening ear over a cup of coffee from a colleague can make all the difference because sometimes they are the only ones who know what’s going on behind that façade of ‘I’m fine’.
A healer’s heart is pure and strong, who heals the healer when the strength is gone?