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Sharing the experience of grief from a doctor’s perspective

Sharing the experience of grief from a doctor's perspective - Featured Image

The blog docgrief.wordpress.com has recently been started by Dr Alison Edwards as a resource for reflection and sharing of stories about health professionals’ experience of grief and bereavement from a personal perspective. Follow her on twitter.

I am a GP in South Australia having lived and worked in my small rural community now for over 20 years. Twelve years ago I hooked up with my soul mate after spending most of my 38 years to that point mostly on my own. Ten years ago in the lounge room at home he had an unexpected, inexplicable, random cardiac arrest. He died. I know he had good CPR because I did it, but out-of-hospital cardiac arrests, particularly in small rural communities, do not have much of a survival rate. It is not an experience I would recommend to anyone.

Grief is a lonely space, and one we discuss little as a community generally. As a result there are few pointers about how people have faced it well or otherwise. There is little in the way of narrative about what are normal healthy thoughts and emotions and as a result, little to reassure the griever that they are doing it OK. Everything about grief feels wrong, particularly sudden loss. In all honesty there are no rules about how to grieve – what feels right and works for the individual is their right way to do it. Unfortunately this doesn’t stop others from opining that it should somehow be done differently.

When in the depths of my grieving, I yearned for a story with similar threads to my own to somehow reassure me I wasn’t all alone in my thinking. The themes I sought were loss after a short time together; dying young; sudden death; grieving as a somewhat public figure in a small town; supporting kids as a bereaved pseudo-step-parent; how doctors engage with death. This last point turned up very few links in 2005.

Doctors learn early on how to sanitise their emotional engagement with dying. From Pauline Chen’s 2007 “Final Exam- A Surgeon’s Reflections on Mortality” … “I learned from many of my teachers and colleagues to suspend or suppress any shared human feelings for my dying patients, as if doing so would make me a better doctor. These lessons in denial and depersonalization began as early as my first encounter with death in the gross anatomy dissection lab and were reinforced during the chaos of residency training and practice.”

While I think there is a need for distance in our clinical practice, I think this has the potential to leave us more vulnerable when grieving personally. We think we know death, but the dispassionate professional connection is not a useful introduction to it as a personal acquaintance.

I recognise that doctors understand death better than the average punter. We know the limits of modern medicine and harbour fewer illusions about its capacity to fix everything. We know that the inexplicable does happen without thinking everything is explainable or even understandable. I guess in a way this is helpful in the grieving process in that there may be less questioning of how, but doesn’t lessen the greater existential cry of why!

How about loss of control as an aspect of grieving? Doctors love control. Like many “high achievers” we have had to keep control in various stressful environments, we try to control our consults to not run too far overtime, we try to control our patients’ BGL/BP/Chol/BMI, we keep our professional distance and control our emotional response to others’ tragedies. Personal grieving turns all this on its head and I think presents an extra challenge to doctors in their grieving.

Small town issues are another aspect in losing a partner as a rural GP. My mate was the local footy legend, and had been the butcher with cheeky twinkle in his eye and a friendly word for everyone. Small communities are very connected and have a strong sense of ownership of “their” doctor and “their” footy legend/butcher. Strict “professional boundaries” are a very nuanced thing in country towns. I drop into the pub on a Friday night, I played netball in my day, I have friends who are patients and patients who are friends. There is no capacity for anonymity and sharing a grief with an entire town was both supportive and challenging. Returning to work and having most patients unable to hold back their desire to acknowledge my loss was a challenge. Grief counselling takes on a whole new depth when the recipient knows the lived experience of the counsellor. Choosing whether or not to reveal this is generally not an available option in a small town, but is also a powerful giver of credentials that has become easier to bear as the years have gone by.

Learning how to manage flashbacks and avoiding triggers when possible, like choosing not to be involved in the annual CPR update for the hospital, are other rarely discussed facets of doctor grief. Halting the video rerun of the resus attempt took about a year to control- most of the time -with some earlier helpful chats from our visiting psychologist about previous patients and finding the power to switch thinking to pleasant memories.

All these themes and more will eventually find their way onto my blog by way of my own personal reflections as well as links to others’ writing, submitted stories or interviews, book reviews and other useful articles. I welcome input from others reflecting on personal loss with similar or completely different themes as the more stories collected will increase the capacity to offer someone else one day seeking reassurance they are not alone.

Dr Alison Edwards is a rural GP from South Australia and set up docgrief.wordpress.com. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

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