“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.