Recently, we touched upon some of the emotions that may affect physicians and other healers when a patient has an unexpected, adverse outcome. Of course, all of these feelings are often heightened if the patient’s outcome results in a medical malpractice lawsuit. That combination creates burnout in physicians, and can lead to anxiety, depression, and even physician suicide. Those, too, are important, unfortunate, adverse outcomes.
As I mentioned in my blog post “Inside the Whirlwind,” these experiences affect people in diverse ways. Today we’ll explore the roots of one of the most universal feelings in the injured healer -- grief -- sometimes so pronounced as to rise to the level of bereavement.
3 Reasons Why Physicians Grieve After Adverse Outcomes
1) Grief Born from Love
According to Roxanne Dryden-Edwards, MD, “Grief is the normal ... feeling one experiences in reaction to a loss... usually... the loss of a loved one through death.”
It might feel foreign to imagine ourselves actually grieving our patients’ unexpected losses. Nonetheless, research on the experience of the second victim demonstrates that we do. This is purely a consequence of our real commitment to our patients’ welfare. The more committed we are, the more joy we have to gain in our work, and also the more we have at stake.
The practice of medicine produces a constant tension between distance from patients and closeness to them. Invasive procedures require us to create the mental space to focus on mechanics and equipment. Delivering bad news or exploring complex treatment options demands empathic support. When it comes to this tension, we are like Goldilocks, constantly in search of “just right.”
Since all of us are in this profession by choice, it’s worth asking ourselves, why would we choose to embrace this particular set of constant challenges? At the end of the day, I believe we do it out of love. “(Loving) with our minds,” Dr. Rachel Naomi Remen poignantly calls it, “studying for years in order to be there with the knowledge to help strangers.”
When you love your patients enough to pour in all that effort, you care enough to grieve. It matters not that your patient is not one of your inner circle. They are part of your human family, and you have taken an oath to care for all comers. It’s as simple as that.
2) Grief Brought on by Trauma
The word “trauma” frequently refers to a troubling internal response to a disturbing event, particularly one perceived as distressing or life-threatening. While confusion and fear are obvious reactions to threatening events, psychological trauma may also encompass a feeling of grief.
Unexpected patient outcomes frequently provoke the sort of response psychologists call trauma in healers. And although it is normal for a traumatic event to provoke an emotional reaction, to the individual going through it, that response may feel anything but normal.
It may make sense to you that a patient would experience trauma in response to their unexpected, negative outcome. But, you may wonder, why should we? After all, we are not the one whose life or safety was directly threatened. My best guess is this: given that our mirror neurons are constantly engaged with work preserving the lives of others, events which threaten the lives of those others may impinge upon that neurocircuitry to evoke a trauma response in us, too.
Although witnessing illness and injury is part of a life in medicine, there seems to be something different about the bad outcome which comes out of the blue, and leaves us wondering whether we contributed to it or somehow could have prevented it. When things surprise us in that way, we have no opportunity to mentally prepare, to brace ourselves.
Some of us experience the grief associated with that sort of event as overwhelming. If left unaddressed, it can result in persistently negative feeling-states which impinge upon our capacity to live well.
If I could give one piece of advice to those going through this grief, it would be that a problem addressed early is often more effectively addressed as well. In many instances, traumatic grief ignored is like a wound that has not been properly attended to. It drags on, complicating your life on every level. Consider finding a trustworthy source of support to process it early, whether that be a coach such as I am, or a psychologist or spiritual counselor.
3) Grief For a Lost Part of Ourselves
The work of a physician, nurse, psychologist, or other healer is often so intense that many of us see our work not simply as our profession, but as a fundamental element of our identity. In other words, it goes beyond what we do, it’s who we are. Or, to quote an old Army ad, “It’s not just a job. It’s an adventure!” And with exceedingly rare exception, those of us licensed to heal intend to help, not to harm. In our hearts and minds, we are healers.
When my own patient had a devastating, unforeseen outcome, one of the central components of my grief circled around questions regarding whether I am fit as a healer, whether I am intelligent enough, attentive enough, insightful enough, and so on. All of the other factors which complicated the situation and all of the other tens of thousand patients I had seen previously drifted into the background when compared with this one patient’s outcome. I grieved at some level for the loss of who I thought I was and wanted to be. And it took time and significant effort for me to find my center once again.
After talking with many physicians, I have learned that this form of grief is commonplace among us. I do the work of Thrive in part because so many physicians express a need for a place to safely talk about that abrupt shift in their self-understanding and a need for tools for sorting through it all.
If you find yourself immersed in that kind of grief, I encourage you to take heart. Keep an open mind to the notion that the gifts you bring to the world are greater than this one traumatic event might suggest. Healing can come, and your own healing will equip you better to be of service to others and yourself.
If you find that these thoughts speak to your experience, I’d love to hear your story. Reach out to me here if you’re open to sharing it with me. And if you find that some support is needed as you progress through your own challenges with a difficult patient outcome, reach out and we’ll schedule a brief consultation free of charge to brainstorm around your options and explore what might be useful to you.