Many doctors are taking it upon themselves to explore the issue independently. You said reading Remen's Kitchen Table Wisdom: Stories That Heal helped her develop some insights, and she now incorporates writing prompts and "moments of humanity" into her work with medical students and residents to help them address the emotional aspects of medicine.
Mendiratta launched a book club at his hospital. The group recently read When Breath Becomes Air, neurosurgeon Paul Kalanithi's memoir about his battle with terminal cancer, and used it as a springboard to discuss their own experiences. So far, he laments, "Only the nurses have come. They get connected to these patients. A nurse came up to me and said it was really helpful. I think the physicians would benefit too, if they could take off their armor."
Finding Their Way
Despite the emergence of formal programs, many doctors say the most valuable lessons they've learned have been informally from the people around them.
"I gravitated toward oncology because I saw really wonderful attendings at the bedside who showed patients so much compassion at death," recalls Mendiratta. "I would lean on them and ask, 'What do you do at night? How do you cope?'"
Over a cup of coffee one attending said simply to Mendiratta, "I sit down and cry. This is human." Another told him, "You go home and you hug your kids, and you put your life into perspective." A third said he would go into a quiet room, turn off the lights and reflect on one positive interaction he had had with the patient or the family. "Don't ever shortcut that moment," he advised.
Mendiratta says that guidance, professional counseling, exercise, and attention to self-care have all helped him process his grief. However, the most important lesson came just a few months into his medical career when he was reminded that true care isn't necessarily curative.
"I was talking to a patient's daughter about additional chemotherapy and clinical trials and she asked, 'Doctor, have you ever talked to my 84-year-old dad about what he really wants?'" Mendiratta was shocked to realize he hadn't. "I sat down with the man and asked him what he wanted most so that I could try to help him achieve his goal. He said, 'I love to fish. My granddaughter is getting old enough. I want to make it to summer so I can fish with her.' If I'd have given him more chemo, he would have been too weak to take his granddaughter fishing."
Vital conversations lay the groundwork for patients to set their personal goals, which is essential to patient autonomy, according to Mendiratta. Yet it also provides succor for the living. Helping patients achieve what is most important to them enables caregivers to celebrate victories rather than endure defeats.
"The care of the patient doesn't end when we can no longer 'do something' for them," says You, who attended the funeral of the baby girl who died in the NICU and cared for the mother years later when she gave birth to a healthy baby boy. "We need to do for them not as a patient but as a person. It's a privilege to walk with families in the midst of bad outcomes."
Inhabiting that privileged space is hard, she notes, and grief is a natural, unavoidable part of it. Even for the doctor.
"Some people may feel guilty—that it's not their grief to hold—but you need to feel what you feel," she says.
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Cite this: Shelly Reese. Why Doctors Need to Mourn - Medscape - Jul 17, 2019.