Caroline West : 2016

How do doctors mourn?

As each person would, each doctor mourns differently. There is no course on grief in medical school, so their responses are not uniform. They do not practice their response to death with standardized patients or answer questions about it on the boards.

Perhaps the differences in grief are best illustrated by comparing mourning between physicians who experience the same tragedy. In which case, the question could be rephrased: How does each member of a family of physicians including a neurosurgeon, an otolaryngologist, an emergency medicine, a neurologist, and a medical student mourn differently?

As the medical student, I can answer this one.

My grandfather presented with symptoms of lung cancer in early September. The neurologist looked across the dinner table and asked when I last saw him, interested in whether he had the same hacking cough my brother noted earlier that morning when I did. My questioning eyes prompted him to list off the constitutional symptoms of cancer my grandfather neglected to tell me about when I visited him weeks before. Later, I cried not only because I knew my grandfather was not strong enough to endure an additional cancer, but also because I missed the signs that it was there.

The next day, I sat across from my grandfather, a resilient man who has heard the diagnosis of cancer many times before. After significant prompting, he acknowledged his difficulty breathing with physical activity, his trouble swallowing his dinner, his feeling of something stuck in his chest. In his attempt to use the medical terms he has heard throughout the years, he explained his cough, his blurry radiograph, and the need for further imaging. My grandmother, a frail, silly woman patted his arm and told him to finish his dinner. Needing more, I asked if he would allow his physicians to speak to me. Uncharacteristically, he denied me this wish.  He did not want to burden his family with his cancer.

The following weeks were filled with misinformation and continuous questions, with the gaps in knowledge filled by my family’s collective understanding of medicine. On the phone with my grandmother, I learned of a liver biopsy by the mere placement of a bandage. The cancers in my grandfather body switched location by the hour. The prognosis, according to my grandmother, was 2 years but the location of the liver biopsy said otherwise. Nothing made sense and I desperately needed everything to.

The physicians flew in on the weekends, taking call in separate rooms, exchanging knowing glances but no soothing words. The neurosurgeon spoke softly and seldom. He stood still for minutes in the middle of the room. The ENT grimaced as he reluctantly acknowledged his unfamiliarity with organs below the sternum. The EM physician, the closest in proximity but most detached from his parents, called on the phone for a few minutes of updates before abruptly ending the call. He offered little commentary, aware that this wasn’t something he could fix. The neurologist, not far out of medical school himself, called and visited frequently, answering my medical questions and confirming my randomly spurted facts yet offering no solid solutions. My little brother, the only non-medical male in the family, hugged my grandmother.

The day my grandfather died, he only called out for my little brother and me. Perhaps he feared the defense mechanisms of his sons and made this decision as his final wish: that he pass in his bed as a person and not a patient. After receiving the call from my grandmother, I grabbed all the medical supplies I could find at the CVS, while my little brother vomited in the bathroom. We arrived at my grandparent’s the same time as palliative care, and I attempted to answer their questions while my grandmother wandered absently around the property. My brother pushed my grandfather between the rooms by sitting him on the walker and holding his legs up as he moaned. I placed the nasal cannula around his thin neck and explained that the oxygen was only temporary as he hesitated. We took shifts sitting next to my grandparents as the other stepped outside to cry. The ED physician called and asked me to present his dying father as though I was on rounds. I forgot to say the vitals before the physical exam.
At the funeral, the neurosurgeon stood silently against the wall of the mausoleum, placing his gaze on something far, far away. He nodded solemnly, but shed no tears. The ENT held his mother, whose mind broke along with her heart the week before. The neurologist lowered himself onto a nearby rock and quietly watched as I read a book I wrote titled  “My Chocolate Eating Grandfather” in second grade. The ED physician arrived 5 minutes after my grandfather was buried; the stress of seeing the casket was too much for my grandmother to wait any longer.

I cannot say how all physicians mourn, but I can tell you how my family did. The neurosurgeon said few words, stood still, and when he did, he moved slowly. The ENT kept busy, asked questions, consulted us all. The neurologist remained compassionate yet safely detached, acknowledging the medicine behind the illness but aware of the shortcomings of any treatment. The ED physician internalized his emotions, as he surely has before.

And I, as the medical student accustomed to asking questions, obtaining information, then understanding, felt helpless. I craved all the knowledge about my grandfather’s illness, his labs, his vitals, and his medications. I needed a full history and a physical exam. I pleaded with my family to tell me the answers, to make a plan I can follow, or to just tell me what to do.  I felt a strong sense of guilt in not recognizing his signs of cancer in the early stages, for not telling the ED physician the vitals as if that would have changed things, for not remembering what medications my grandfather was on, for not being able to explain to my grandmother what exactly was happening. I was overly critical, reassuring myself that I would learn from these self-perceived failures.

So to answer the opening question, each physician mourns differently. They approach death with an intimate knowledge of the disease, a physiologic understanding of the last breath. The first time, they watch and learn how to respond by those around them, respond accordingly the next, and act as a model in the future. They grieve the losses of their patients as professionals, as members of a specialty who did all they could. But despite the experience they bring, when it comes to family, they also mourn as the rest of us do. They mourn as sons, daughters, spouses, and grandchildren. They mourn as the sons, daughters, spouses, and grandchildren of their patients do.

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