Do doctors grieve differently?

Doug Hendrie

15/01/2020 3:36:27 PM

After Dr Alison Edwards lost her soulmate, grief took hold. Who else, she wondered, knew what this was like?

Dr Alison Edwards and partner Mick
Dr Alison Edwards set up the website, Doc Grief, following the death of her partner Mick 15 years ago.

‘We really need to talk more about death … it is an inevitable part of life, and yet we shroud it in euphemism, hushed secrecy, and denial. We often grieve alone with little sense of shared understanding as we sanitise our emotions and somehow carry on.’
That is how South Australian GP Dr Alison Edwards began a talk she gave to her local palliative care team. And it is why she set up a website, Doc Grief, dedicated to supporting doctors who have lost loved ones.
That is what she wished existed when she lost her ‘soulmate’ Mick to a sudden cardiac arrest 15 years ago.
Dr Edwards’ own path of grief has shown her that doctors often grieve differently – and that the professional distance necessary to deal with death at work simply does not cope with personal grief.
‘I felt the need to know others had walked a similar path and survived, and to maybe find some tips about how best to achieve this,’ she told newsGP.
‘I wanted to read a story that was a close match to mine, but found very little in print about doctors grieving. So some years later I felt drawn to create such a site for others.’
Writing on her site, Dr Edwards tells the story of her loss:
Mick was the local footy legend, the cheeky butcher with a sparkle in his eyes. After 38 years of thinking life for me was destined not to be one of a long-term couple, it was really nice to have someone to love and be loved by and even see myself growing old with. 
Mick had spent the afternoon out with the kids and had had a couple of beers down the pub while I was in at work. He was in one of his favourite positions – lying on the lounge channel-surfing. And then Mick had a cardiac arrest and died. No warning. No clues. Just chatting with me one minute about the perfume the kids had given me for Christmas and next minute making funny breathing noises as if he didn’t like the perfume.
Mick died, and the world as I knew it crashed down around me.
Mick was just 37.
In the immediate aftermath, Dr Edwards’ small community – Port Broughton on SA’s Yorke Peninsula – reached out. That, she found, was supportive and challenging.
‘It meant having to share my grief with the town. There was no opportunity to return to work and not have everyone wanting to express condolences,’ she said. ‘I couldn’t turn around without finding more scones, lasagnes and soup.
‘People want to do something physical, which is beautiful, but you also can’t be anonymous. In an urban practice, you could sneak back and your patients would necessarily know. Here, everyone knew.’
Dr Edwards took several months off following Mick’s death. When she returned to work, she printed little cards for her patients to read ahead of consultations.
The cards stated that Dr Edwards was doing okay and asked patients to treat it as a normal professional consultation.
‘No one could stick to it. I gave up,’ she explained. ‘Patients felt rude not to express their condolences.
‘The first time you see everyone, they feel the need to go through it. It made things a little bit harder.’
Since she set up the site, many GPs have told Dr Edwards that it has been helpful. Some have written to her seeking support. Others have contributed their own stories of grieving.
‘Reaching out to those with lived experience can be very supportive,’ she said.
‘I’ve had people write saying thank you so much for setting this up. Just knowing that someone else had lived the experience while having a broader understanding of the health system [is helpful].
‘Doctors do get the idea that random stuff happens. In the community, there’s often the expectation that we can fix everything, but doctors understand that things are unpredictable.
‘People do randomly have cardiac arrests and die.’
Dr Edwards believes doctors grieve differently, due to their familiarity with death and learned ability to maintain professional distance.
‘Knowing death so intimately may falsely lead us to think we are acquainted with grief, but when it comes to losing a loved one all bets are off,’ she wrote in a KevinMD article.
Dr Edwards believes that the stereotypical doctor personality traits – high achievers able to hide their emotions and focused on control – can pose particular challenges, as grief and loss are entirely uncontrollable.               
‘Doctors spend most of their time observing … [but] unless we have loved in a dispassionate, dissociated way, we do not give our grief a fair chance if we do not live it,’ she wrote.
Dr Edwards’ grief was ‘very raw’ for the first few years. Over time, it gradually changed.
‘I went from feeling it with every breath and as if it was sitting right in front of me, to a place of living with it rather than living for it,’ she told newsGP.
But she still misses the shared life that could have been, writing:
I still love him and what he gave me. And I miss the future we didn’t get to share … I think I have a more profound sense of living life to my fullest capacity and valuing what I do have.
I have coped by taking one day at a time, allowing time to soften the impact and create new memories.’
There are no shortcuts and no way of bypassing the process of healing after a broken heart.
There are no right ways of grieving. Whatever you find works for you is probably the best for you. This is unlikely to be booze, drugs or running away but you may need to try this for yourself for a while before you believe it. There is no standard timeline. You do not get over it, you do not move on as if it could be left behind. But you do learn to live with it rather than be consumed by it.
Increasingly, Dr Edwards finds people grieving in her long-time community are seeking her out.
‘It has changed how I practise,’ she said.' ‘You’re taught not to bring too much of yourself into the consultation, to keep your distance, be professional, as it’s not about you.
‘In a little community, it’s almost impossible to do that. Patients want that sense of connection – especially when they already know your story and you can’t duck away from it.’
Dr Edwards will share parts of her grief with patients to help normalise their own experiences.
‘You almost need to do this in smaller communities, but it might not be appropriate in an urban setting,’ she said. ‘There is power in a shared understanding.
‘Often people want to talk because they know I have that lived experience. Not to acknowledge that would be counterproductive.  
‘We’re humans, we like to know we’re not alone. We can be reassuring, to let patients they’re not going mad – that this is a normal response.
‘It can be powerful to hear that from someone who lived it.’
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Dr David   16/01/2020 9:42:57 AM

One of the hardest things about grieving as a doctor, as I assume it is in nursing, psychology, social work.... is to be faced with other people’s complaints and problems. I have found it fascinating how these consultations filled me with anger at first. I would want to shout at people and tell them they were feeling nothing compared to me and I’m still working! Now as my grief ages and is part of me more than something surrounding me I find myself much more able to help people with their everyday challenges and their experiences of grief. I would give anything to have not gone through it but my grief has given me the gift of being a much better doctor.

Thanks so much for the article and the website.

Dr Maryellen Margaret Yencken   16/01/2020 12:53:35 PM

This article has provoked me to wonder if it starts earlier and is part of the personality that is attracted to medicine and is able to cope and survive the rigours of studying and performing medicine. I lost my absolute loved best girl friend at 19 who I considered my soul mate and someone who was going to experience and share with me all the future adventures that were still to unfold in life.
Those stereotypical doctor personality traits described by Dr Edwards – "high achievers able to hide their emotions and focused on control "– were what came to the fore.It makes for a very lonely grief. I always thought it was because at 19 most other's haven't yet experienced grief in that intensity and why should they? Intense personalised grief isn't something easy to share, but perhaps our early training and personalities may set us up from the start not to feel "permission" to express openly intense grief and a safe place to do so, on top of already set societal constraints.

Dr Cho Oo Maung   16/01/2020 3:22:08 PM

We do mindfulness to reach the level of accepting the law of nature to resilient the loss.
We talk it out in the computer writing as a biography or an Australian story. This is a kind of letting out our sad unconscious mind abscess. We practice acceptance of the Nature.

Dr Peter James Strickland   16/01/2020 6:51:03 PM

Doctors grieve the same as everyone else. Grief reactions are related to our experience, our beliefs and our personalities, and we grieve for different reasons that are sometimes hard to understand. With deaths of close relatives and friends we really grieve for ourselves, and not for the person, and especially if one believes in a happy and stimulating afterlife.

A.Prof Christopher David Hogan   18/01/2020 8:54:20 AM

We grieve as all people grieve. The skills of having a poker face & the two edged sword of equanimity so beloved of Sir William Osler are designed to help our patients talk to us without impediment - they are not designed to assist us.
However, over time our patients see thru our masks & accept us for whom we are. After a long time in Medicine I remember the times when I was suffering . Instead of supporting my patients, they supported me. It really helped.