How Do We Grieve?

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FICTION

This short essay examines loss and grief as experienced by a trainee physician—me. The essay explores the personhood behind the clinician and how the complexities behind “who” the clinician really is can be unmasked through the experience of loss and grief. Although the essay itself has a somber tone, its main takeaway is that, unsurprisingly, experiencing a wholly human emotion like grief or loss helps decrease the distance between clinicians and patients.

For grief! The irony! It’s lamentable that the experience of loss can be pathologized. Consult our revered manual, that aubergine purple with the bold white, and you will find that the differential is wide. Thusly, it has been decreed, your experience of loss (surely, of someone meaningful to you) can almost certainly be described as existing somewhere along a spectrum. Somewhere between normal grief and a complex bereavement disorder there exists a “STOP!” But I digress, or maybe I am perseverating on someone lost.

If you can pardon the absurd introduction, I would like to share. Sometime approximately past the halfway mark of intern year, something peculiar began to happen. I can’t be sure if it was the context of COVID or an artifact of the practice of medicine. It was almost as if I were inoculated against, or immune to, emotions I previously experienced when a fellow human ceased to exist.

While I wouldn’t have been able to articulate it at the time, it was as if I were on another planet. The gravity of loss and mortality didn’t ground me as much as it did before. I realize now, in many ways, this was likely protective. Detachment is a salve against the human condition of suffering. Being South Asian, the dharmic pantheon’s interpretation of human life, attachment, and suffering has been impressed upon me. In my specific circumstance of intern practice, the novel context of interacting with an impressive volume of suffering (patient mortality and morbidity) likely led to a subconscious desensitization.

And then, in predictable circadian fashion, the truism of mortality and loss knocked at my cognizance. I beheld, at the threshold, my grandmother with a stapled scalp writhing under the confusion of delirium. Mummyji, with whatever symptoms Glioblastoma presents with, lay with a shawl over her head in a hospital bed. And I could not cry. The guidelines, the textbooks, questions of radiation and concern for mass effect, palliation and hospice, artifacts of medicine kept that door tightly shut. Like those esoteric prayers she taught me as a child, the empiricism of medicine—the most potent analgesia I know—numbed me to listlessness. Yes, I could not cry. I could not grieve. My cheeks were dry. My vision clear, I continued linearly from one disposition to another.

Mummyji, or my maternal grandma, was 93 when she passed away. She was my connection to a religion I had disavowed, a language I hold dear yet rarely speak, a culture that I inherited, a land that I am no longer a national of, food that I rarely consume anymore, laughter and humor that I could only share with her, the wispy white hair blanketing a furrowed forehead that I will never kiss again.

She was the living embodiment of centuries of North Indian history. A Sikh who grew up in colonial India, she migrated to east Punjab at the dawn of freedom. She was a victim of partition, witness to ethnoreligious pogroms and massive sociocultural, economic, and political upheaval. In a time and place where women were disincentivized from pursuing an education, she was an educationalist with a graduate education in economics. Notably, she would instruct me in the law of diminishing returns whenever she saw me gorge myself on candy. I do not mean to eulogize or elegize. But, to quantify meaning, she was everything to me.

How does one grieve? I was never taught. Sadly, given the context of medical training, I can only recall myself opining on what is appropriate and what isn’t. As I write, I am still trying to coax tears, exhort my being to a meaningful cry. I have tried the following so far: (a) listening to mournful music in the language I spoke with my grandmother, (b) making awkward conversation about the loss of my grandmother with passing acquaintances, and (c) relating amusing memories that I shared with her to my wife and cats.

It has been a few months since my grandmother passed, and I am not certain if I have grieved, let alone enough. I must admit, a tear or few, or a small spurt may have leaked through the dike. But the cement and mortar, the endless pursuit of knowledge and multitude of patient cases, make barriers robust. We are always at risk of being submerged, but fearful or know better than to let it happen. It may be that my subconscious has taken it upon itself to keep me from hosting a full emotional catharsis. And for this I can only thank, or resent, my self-chosen pursuit of medicine.

In clinic the other day, I sat with a middle-aged man, troubled by an unrelenting low depressed mood. I saw another young lady who had recently relapsed into substance use. Another elderly gentleman, I assessed in the ED, for thoughts of suicide. The commonality amongst them: They had all lost a loved one in the not-too-distant past. Other than my expert opinion and offer of forms of treatment, I had not much else to offer them. But I sat with each of them for an extended moment, and with great honesty, I shared, “I am sorry for your loss. I can’t imagine what it feels like. I want you to know, it’s okay to cry.”

Dr Kaleka is a PGY-2 Internal Medicine-Psychiatry (dual program) resident at the University of Kentucky. Dr Kaleka has also previously had the opportunity to provide direct patient care as a registered nurse.