A classmate of mine committed suicide a few weeks ago. Though I’ve heard the harrowing statistics about physician and trainee suicide rates, to be honest, I never expected to personally encounter such a tragedy. The small classes at my medical school allow for a strong sense of community in which we all know each other, celebrate important life milestones, and happily reconnect when we’re together after clinical rotations scatter us throughout the hospital.
In some ways, I can’t help but wonder if the inevitable dispersion during rotations played a role in his distress. We spend much of our preclinical time leaning on our classmates as we collectively attempt to master the intricacies of medicine; oftentimes, they are the first to offer words of encouragement after exams don’t go our way, kindly explain concepts that weren’t clear the first time around, or simply provide companionship over an afternoon cup of coffee. However, during rotations, the medical school experience becomes much more isolating — joining teams often as the lone medical student, left to your own devices to navigate not only clinical challenges, but also the awkward and complicated hierarchies universally found in medical training. When considering the additional isolation that comes with social distancing due to the current pandemic, I can only begin to imagine the suffering my classmate must have been experiencing.
In the weeks since his passing, I’ve found it challenging to grieve. No tears have been shed, nor have I been able to reminisce over the warm memories of his kindness and joviality as we tackled cadaver dissection together. Instead, I’ve found myself wondering about the medical minutiae of his “case” — a word that, despite its omnipresence in our medical lexicon, takes on a cold, reductionist tone as it attempts to distill the life of a friend down to a history of present illness, physical exam, set of lab values, and assessment and plan. How long did it take for someone to find him? Was recovery even a possibility? Were his organs eligible for donation? Did his care team know he was one of their own?
When my thoughts of medicine abate, I’m left with more troubling questions about myself. Why can’t I ignore the medicine and simply grieve his loss? Has my ability to grieve morphed into a numb, medicalized replacement? Is this how I’ll “grieve” the losses of my family or other friends too?
In retrospect, these feelings shouldn’t come as a surprise. In medicine, we’re unconsciously taught to medicalize losses of all kinds as we care for patients. In the trauma bay, for example, I observed “a traumatic aortic injury with unsuccessful repair,” as opposed to a tragic car accident leaving behind a young widow with small children. The octogenarian I met on hospital service was no longer known as the life of the party at Bridge Club; instead, she was the frail elderly woman admitted for a change in mental status who would require skilled nursing placement at discharge and would have to miss her granddaughter’s birthday party. The disheveled gentleman I met in the acute care psychiatric unit wasn’t seen as the neighbor who shoveled snow off everyone else’s driveway, but rather the man with decompensated schizophrenia admitted under civil commitment for stabilization and medication optimization. In none of these instances was the impact of loss a component of the conversation; instead, we focused on the medicine.
To be clear, it is necessary that we view our patients through the lens of medicine; it is our job to address the medical issues that bring them to our doorsteps. However, when we overly medicalize our patients as they experience loss, we create an unnecessary distance, shielding ourselves from some of their grief. Based on my experience, I suspect we suffer from that distance as much as they do. I personally felt out of touch with grief because despite the losses occurring around me throughout my rotations, we seldom took time to acknowledge the elephant in the room. Grief is a normal human emotion, so why are we trying so hard to avoid it? What might hospital rounds or office visits look like if we took the time to discuss the losses our patients experience, not just with them but with each other too? How might that change the learning environment, or, more importantly, patient care?
Perhaps my feelings — or lack thereof — are simply a product of my training level that will fade as I become more comfortable with my clinical skills. Instead of worrying about interpreting lab data or performing physical exam maneuvers correctly, I hope someday to work through the medical aspects of care more efficiently, allowing me more time to sit with my patients, experience the weight of their sadness, walk through the pros and cons of difficult choices with them, and extend my condolences to loved ones. In the meantime, I can challenge myself to bring to light the grief experienced by the patients we encounter on rounds or in our outpatient clinics and encourage my peers and preceptors to pause in reverence of this emotion.
I hope as I encounter future losses, my fears about medicalizing grief are never realized, but I suspect that if I continue to acknowledge the presence of grief around me, I can safeguard myself from future hard-heartedness. I hope the same for others too.