I sat in the exam room with a pleasant elderly 80 year old woman. She listened carefully as her diagnosis of myelodysplastic syndrome was explained. She listened even more closely as the treatment plan was outlined. It was then that she asked me for my opinion. But this woman is not another patient. This woman is my mother and I feel the internal struggle between my physician persona and my mother’s daughter begin.
This was not something that I ever spent much time thinking about. Maybe subconsciously I assumed that my being a physician would keep my loved ones from ever dealing with any serious health issue. Logically I know my mom is not going to be with me forever, but this was the first time that I have had to face the reality that my mom will die and probably within 10 years.
As Family Physicians, we face grief regularly. Over time we learn to deal with loss, frustration and grief. We have to learn to be comfortable with end of life issues so that when our patients are faced with death, we can help guide them and their families through the stages of death and dying. When our patients die, we have learned to set grief aside. We have to be able to leave grief on the sideline. But are we really able to do that or are we fooling ourselves and those around us?
What is grief? On the surface grief is a natural reaction to a loss of any kind. We usually define this loss as the death of a loved one. But we can experience grief with a diagnosis of a terminal illness, loss of a job, the end of a relationship or the loss of anything that is important to us.
Grief can be described as a punch to the gut and it is painful, both mentally and physically. When we do not acknowledge and deal with grief it begins to take an emotional and physical toll that can cause us to be less effective physicians. We can become cynical and less empathetic. We can start to pay less attention to our patients and mistakes become more likely.
It is important that we face our own feelings of grief. We need to look to others (our loved ones or our colleagues) for support but it is not easy for us to admit that we need help. We are the strong ones that others look to. But being ‘strong’ eventually exacts a toll as evidenced by fatigue, decreasing energy reserves, onset of depression and physical illness.
I know that I am not the only physician son or daughter to deal with a parent’s illness or death. I have watched several colleagues deal with these very issues. But I am struck by my own tendency to fall back into my white coat persona which makes it easier to put up a barrier to the grief I know I will face.
I hear my doctor voice as I explain what is happening with my mom to my brothers and sisters. I start to feel that slight detachment that I have felt when I talk with the family of a patient that is nearing the end of their life. This is how we as physicians have learned to deal with death.
I feel conflicted, but it is somehow easier to deal with the facts and statistics of my mother’s illness than the emotions of the situation. I suspect this is how many of us deal with the deaths of our own loved ones. Maybe it’s time to start a new conversation and develop new skills to get through this very human emotion.
Chris Jeffrey, MD,FAAFP