Family Medicine Vital Signs

By: Marlana Li, MD

I learned how best to define “grief” during my time as a hospice volunteer in college. I had wondered how to succinctly describe that “pit in your stomach,” “weight on your back”, “heaviness of heart,” etc. that people experienced after significant loss or disappointment. During my volunteer training, I became familiar with that succinct word, “grief.” Perhaps the other analogies are used because “grief” alone seems too inadequate when describing the overwhelming emotions that come when someone you love is gone. Grief is the “deep and poignant distress caused by or as if by bereavement; an unfortunate outcome, mishap, misadventure, trouble, or annoyance.” Going deeper into the meaning of grief, Elisabeth Kübler-Ross and David Kessler wrote about the “5 stages of grief.”

These stages (denial, anger, bargaining, depression, and acceptance) became more familiar with each phase of my life as a hospice volunteer, medical student, resident, and practicing physician as I helped patients and their families cope with grief. I also have had loss and life changes that required grief-work and enabled me to be more compassionate and empathetic towards my patients. My grandmother, who helped my mother raise me, died during my intern year, and it took several months to feel “normal” again. I still think of her every Thanksgiving (the anniversary of when she died) and I cry at times when I make her German pancakes. I sometimes get tearful when my patients grieve their loved ones dying since I can understand to some degree the depth of their sorrow. I can be strong and keep professional boundaries, but I also know crying is not a sign of weakness. “Grief is the healing process that ultimately brings us comfort in our pain.” ¹

People respond to loss or change in different ways, and sometimes go through the various 5 stages at different times, and may repeat a stage several times. Also, grief: 1) is a highly individual, nonlinear process, 2) is a healing process, 3) can be an isolating process, and 4) can be a transformative process.¹ And, “the only way out is through.” As a physician, I have to watch for “complicated grief,” which is a diagnosis for people who grieve longer than the typical amount of time (6-12months) that people need to recover. ² We often have pressure from society, peers, and employers to get over our grief quickly. But how long is normal to grieve for a young lady shot on campus, a child who dies of cancer, an elderly parent who has dementia? Again, the grief process is highly individual, and I think is best treated with the support of family, friends, community, counselor, and/or a primary care physician.

Grief’s definition is broader in that it can be the emotional changes that can occur with any life change, not just the death of a loved one. Even good changes can cause grief. For example, when I moved to Chicago for medical school, I felt sad. Yes, my dream was coming true, but I was also leaving behind everything familiar and had new responsibilities. Indeed, grief is a complicated issue and one in which we are all too familiar. But that is not the end of the story. Grief can be good. C.S. Lewis, said, “The pain now is part of the happiness then. That’s the deal.” We cannot fully live, love, and enjoy the precious things of this life unless we allow ourselves to fully be present in each moment. Yes, it hurts terribly when loved ones die, people get divorced, family members fight, we get sick, friendships end, close neighbors move away, jobs are lost, or countless other griefs/ tragedies occur, but it also can be very healing to know we will overcome. The good things/people of the past shaped us into who we are today, and we can bring happy memories forward, instead of being stuck in “what if” or “it should be different.” We can have new relationships and adventures, and we can come to accept our losses and disappointments. We can choose happiness. Through the grieving process, we can learn new things about ourselves, put things into perspective, and come out stronger, kinder, and gentler. Grief is a painful process, but we emerge with wisdom and compassion that can positively change the world.

I am grateful that I serendipitously was trained in helping others cope with grief as a hospice volunteer since this skill has been most useful throughout my medical career. I sometimes feel helpless as I sit with a patient who has a problem (physical, financial, emotional, etc.) that I cannot fix, but then I realize that just listening is often enough. I can help them cope; sometimes just understanding what grief is, and knowing “you are not alone” is all we humans need to survive and thrive. We physicians cannot fix everything, but we can help fix broken hearts by getting the resources and support needed.

Some quick ways to cope with grief:

• Be good to yourself.
• Exercise, eat healthy, and get plenty of rest.
• Ask for help; you are not burdening others. Let others feel good they are doing something purposeful.
• Uplift your spirit; connect with your religious leader/ church, meditate, pray, etc.
• Keep a gratitude journal (I wrote about the power of an “attitude of gratitude” in a prior blog).
• Focus on happy memories.
• Get into counseling.

References

1. “Finally! A Grief Definition That Makes Sense”: https://www.loveliveson.com/thank-you-a-grief-definition-that-gets-it/
2. Fields S, Johnson WM, Mears J. “How to Treat Complicated Grief.” The Journal of Family Practice. Vol. 67, No 10. October 2018.

Marlana Li, MD, is an Assistant Professor (Clinical) in the Division of Family Medicine which is housed in the Department of Family and Preventive Medicine at the University of Utah. Dr. Li delivers pediatric, maternity, and adult care, with special interests in chronic disease management, preventive medicine, and patient education.