“The wound is the place where the light enters you.”–Rumi
Recently I walked into the hospital for an overnight shift and instead of the constant buzz and hum of an Emergency Department, I felt a somber air. The disturbing quietness that always follows a tragic outcome.
Earlier that evening a baby had arrived via ambulance coming from the field, medical condition unknown. The baby’s pulse was lost en-route, CPR was started in the ambulance and continued after arrival. Every attempt was made to revive the baby, but all were ultimately unsuccessful. Time of death 1745.
Emergency Department, it’s right in the name. In my job, emergency is the norm and tragedy is common. As an attending physician in the ED, one must figure out a way to manage all of the hurt and despair that comes through the hospital doors daily.
Hospitals are healing centers, but they also inflict their own brand of pain. Anyone walking in an ED is having a pretty rough day – from crying kids, traffic, stress, long wait times to the inevitable high costs of treatment. Parents are often terrified, which contributes to already high levels of anxiety – whether that is because of an injury (such as a broken bone) or inexplicable symptoms (abdominal pain, chest pain, headaches, etc).
Regardless of the reason for the ED visit, there are two common themes: a) people have scared the crap out of themselves by trying to diagnose via Google and b) they have incredibly high expectations of me to instantaneously diagnose/treat whatever the issue is (no matter how complex).
I learned very quickly how to compartmentalize my emotions to survive the pressure. I worried that if I didn’t stuff my emotions down, the toll of the tragic/unbelievably sad stories would overwhelm me and possibly affect my ability to do my job.
Emergency Medicine is conducive to this flawed coping mechanism due to its brief and transitory nature. We take the ill, do our best to improve their urgent medical condition, then admit them to the hospital or discharge them. Some days it is easy to stuff the emotions down, other days it is much harder. Those are the days when I have to deliver a new cancer diagnosis or when patients are actively being resuscitated or when we see any form of child abuse.
This particular day, when I realized I was walking into a department that just lost a baby, my heart sank. I am a mother of an almost 2-year old beautiful boy. Before we had this rainbow baby, I had a miscarriage, and then another one. If you would have asked me what grief was before I experienced personal loss, I’m not sure I could have answered. Losing my unborn babies (one after another) sent me to a place where my normal coping mechanisms failed. For the first time in my life I was not able to compartmentalize and move on as if everything was normal.
When my husband and I had our first miscarriage the amount of agony and loss I experienced took my breath away. We went to our first doctor appointment with butterflies in our stomachs super excited to see this beautiful addition to our family on ultrasound. We had told our families we were pregnant and were eager to see for ourselves what we had created. When the ultrasound first located the baby we were rapt with anticipation, but just like the ED on a bad day … there was a somber, quietness to the air.
There was no heartbeat. The doctor just kept saying “I am so sorry.” Over and over. I felt like I had been punched in the gut. I couldn’t put this emotion anywhere; it was way too big. Way too heavy. My sadness was like a freight train at full speed, fast moving and unstoppable. It was frightening. Unfortunately, just when I thought I had regained control of ‘the train,’ we had a second miscarriage.
Despite all the pain from the first failed pregnancy, we were very excited to be pregnant again. We thought, ‘this time it will be different.’ I intentionally delayed scheduling my first pregnancy appointment because (unless things went well) we were going to be reliving a nightmare. Finally, I made the appointment. That very same day, out of nowhere, I started bleeding. The bleeding was heavy and felt like it would never end. Soon, we discovered that this pregnancy was also not viable.
But this time my emotions were fiercer, darker, and seemingly bottomless.
There was no compartmentalizing. It was all consuming. It was like I had fallen into a deep dark pit, that I had no idea how I stumbled into in the first place. I didn’t know where the ground was, and I was alone. I wanted desperately for someone to turn on a light, to show me the way out. To be back in control and just … be ok again. But no one knew how to help, least of all, me.
Not a day went by without someone telling me ‘everything will be ok’ or ‘you are still young’ or that ‘you have so much to be thankful for’ or instructing me to ‘don’t be so sad, God is good.’ The comments were meant to be helpful, but instead dismissed my pain, which made it hurt even worse.
It was like they were telling me in my darkness, ‘just turn on the light, it is so easy.’ No one knew how to help, and I didn’t know what I needed or what to ask for. Grief for me was like a blindness that I didn’t know how to cure and a fear that the darkness I was feeling would never go away. I wasn’t sure I would ever see light again.
It was the most isolating thing I have ever experienced. So I fell further into the pit. Time was lost, I walked through life with muted emotions, not really able to be happy about anything. I functioned, but it was like I was on auto-pilot.
But then, after what felt like a very long time—countless hours of counseling (some because my husband dragged me), conversations with other couples who had similar experiences, and buckets of tears, I felt a little better.
Stillness arrived and I no longer had the feeling of air rushing through my ears, and there was quiet. There was calm, and I realized I didn’t feel like I was falling anymore. It was like I finally saw a light, one that was really faint and in the distance at first, but slowly got brighter and brighter. Before I knew it, things felt a little more like they used to. But then they didn’t. Because now I knew. I had traveled through the darkness that was grief, and I will always know that it exists, what it felt like, and how grateful I am to have it be over.
It is weird, because the arrival of light and calmness seemed to happen suddenly. I realize now that my moving through grief back to normalcy was a process of time and pain. Acknowledging the presence of darkness was necessary as was sitting in it and feeling. It hurt, and it was scary, and I hated it. But it eventually got better.
Having been on this arduous journey of grief, I am no longer able to compartmentalize. I handle tragedy that shows up to the ED in a very different manner. This particular evening, sitting there, talking with my colleague (the one who was there when the baby came in) about this horrific situation, I slowly walked back to the edge of grief, to the edge of the pit and looked down.
I could feel in my bones what grief feels like, and together we grieved for this family. For the mom who would never get to hold her baby again, and for all the hopes and possibilities that had been imagined for this baby and family. And we honored those things, because that is how I have now managed to maintain an ability to really care about my patients.
It felt strangely beautiful to be able to take a moment of silent reflection, honoring the family, bearing witness to the grief that will permeate these people that I never even met.
We sat there and cared about them in a way they will never even know, and silently prayed that they travel through this bumpy ride with as little darkness as possible. Yet knowing that unforeseeable depths of pain and absolute darkness of days are inevitable for anyone dealing with loss. To know that, and make space for it instead of saying dismissive comments like, “at least you have the rest of your family, or “it will get better,” is the only way to truly honor it.
And I realized, that I am thankful for my experiences, my grief, because I have a far greater capacity for compassion, thoughtfulness and caring, and empathy. In the end, if we are trying to heal the ill and help those in need, we have to make room for the pain, and make room for the grief if we expect to make room for healing.
How about you? How do you manage the tragedies you see? Do you have a grief story?
As a side note, my husband and I were directed to this video done by Brene Brown that describes the difference between empathy and sympathy. It was incredibly helpful when trying to explain to people how we couldn’t explain what we needed and that what one really wants and needs is empathy. So if you need some tips, this is a great start.
Powerful piece. As physicians we see the best and worst of the human condition. We see and treat so many intense things. And you are right, compartmentalizing is necessary to do our job. I’m Peds and I’ve seen everything you’ve mentioned above and more. Oh the stories I can share…
For me, journalling is very cathartic. Having supportive family and friends also helps. As physicians, I think being able to share our intense experiences and be human is so important
Thanks Nadia–all so true. I think sometimes we forget how important our support system are as we do this job of ours. I have only recently found writing, but I am finding it to be hugely helpful in articulating my feelings.:)
Dear Annie, I am so sorry to hear your story. I think I understand it, or some of it. My second pregnancy ended up in a miscarriage. The doctor who did the ultrasound said, why do you cry, you have already a child… then the one doing the D&C wouldn’t tell me the sex of the baby, which is OK, I guess… Then I had two other kids. They all know that they had a sister or brother and that they are 4 not 3 siblings. At that time we were told “this is life”, no counselling, no support. I went home after the D&C and scrubbed the whole house, down to the smallest detail. It is a coping mechanism I still use sometime. My friends told me I looked very pale…
Now, as a biochemical geneticist, I see families, couples who have severely affected pregnancies, losses, stillborns. Sometimes, I used to think, that they are better off then the ones who carry full term and the baby has a terrible neurodegenerative disease. Then, I watch the mothers who take care of their severely affected babies, toddlers, children, then adolescents. We know each other for many years, they grow up with me. Their mothers push the heavy wheelchairs, they wipe the drools off their teenage son’s face, and they laugh… and I no longer grieve for them, I am carried away along with their little joyful moments, and I admire the human resilience, or is it a gift from God that comes with the child in a wheelchair? I will never know, but these women are angels, and they have a place already in Heaven. This is when I realized that whatever I have LOST, it is incomparable with what they HAVE. Maybe I have empathy because of personal loss? I am also an orphan, lost my parents at relatively early age. I don’t know, but I think that we become better doctors when we can “feel” our patient’s grief and “feel” their happy moments. The other day one of these moms told me, that she would give anything to just be in her Johnny’s place for just a couple of hours, to see how is that like… Be you Annie, this is something they don’t teach in medical school.
Wow, Gabriella! It sounds like you have experienced immense personal loss as well. And it is tragic to me how dismissed you were with your miscarriage. All those things I felt so intensely….
As far as your observation with the moms–I am sure they experience their own grief–loss of that “which could have been.” But maybe it is transformed, they are able to be this sort of ‘angel’ that you describe.
I DEFINITELY think we are better doctors when we feel.
Thank you again for your support, and your stories that have done and excellent job of complimenting my own. 🙂
Over five years ago now, I also worked in the ER. (Sometimes with you, Annie). One of the occasions that has stayed with me most was an overnight shift I worked on Thanksgiving. I believe I started the night before and finished up early on Thanksgiving morning. Anyway, at some point that night, a van pulled up out front and several people hopped out and started quickly unloading boxes and equipment. Very efficiently. They were an organ harvest team. Which meant that someone’s child passed away at the holiday where we pause and reflect on what we are most greatful for. That family made an incredibly brave and generous decision in their grief, to share their child’s organs with others in need. I have no idea what organs were donated or where they went, of course. But at least one family had a special Thanksgiving that year – they got a call that an organ was available for their loved one.
I still think of all of these families now and then and maybe say a little prayer for them. I hope the family that lost their child has found the sharpest edges of their grief smoothed away a bit by time, memories of their child and that some part of them lives on. I hope the donor recipients have recovered and are healthy. That their families appreciate the gift of extra time with their loved one. That the organ teams can continue to do their work and save families while away from their own.
Some stories just stick with you.
Finally, I’m so sorry for the loss of your babies. Too many friends and family members go through this. Thank you for sharing with us.
Thanks for sharing Laurel! I think this is a great example of the amazing things that occur in the midst of the tragedies we see. Sometimes I find the work that we do is really amazing.
Hi Annie. Thanks for sharing. Only what is brought into the light can be healed. And we as physicians have to remember, that we are human beings like anybody else. Form my long experience the more I have been able to be me/to show my vulnerability/my stories the better and more heartfelt the conversations has become.
My story is based in a toxic divorce 14 y ago. It opened my heart and I had to live with the fact that I could not be together with my beloved daughters every day (only 9 out of 14 days). That is another kind of grief and sorrows than you have experienced with miscarriges. But it also had to be healed over a long time. Thankfully they have grown up to two fantastic young women.
I also use the video from Brené Brown when I teach Communication in Healthcare at our hospital. She is my favorite.
We have to open our hearts to the patients and their families. But first to our self <3
#medicalsisterhood
Love Lilli, MD
Thanks for your insight, Lilli! I definitely agree that the more vulnerability we display, the more heartfelt our relationships and conversations can be. Thank you for sharing your story as well!
#MDsisterhood!
Beautiful Anne. I’m so sorry for your loss, for the dark journey that you and Jim have had to navigate. Thank you for generously sharing this perspective. 💛💛
Thank you again Michelle for not only reading but also being such a supporter in the background. I think you must totally know how hard this writing journey can be……:) So thank you so much.
Annie, This is beautifully written. Two points that really struck me:
“The comments were meant to be helpful, but instead dismissed my pain, which made it hurt even worse.” Yes. This exactly. I empathize with people who truly do not know what to say when faced with another person’s grief. It’s a terrible feeling to feel helpless and stutter out some lame response that you immediately wish to retract. But, oh, how painful it is to be on the receiving end of these kind of comments. Any and all of those “At least…” comments should just be banned from the English language.
and
“Before I knew it, things felt a little more like they used to. But then they didn’t. Because now I knew. I had traveled through the darkness that was grief, and I will always know that it exists, what it felt like, and how grateful I am to have it be over.”
This point really resonated with me. Once you know what it’s like to walk through that darkness, you are really never the same. The blinders are off. You can no longer bumble along happily oblivious to anything bad ever happening to you.
Thank you for sharing your story.
Thank you so much Leah for your comments and insight. I totally agree that the ‘at least..’ statements be banned!! Thank you for reading.