A grip on grief

DOA, HAMA, IVF. These are some of the medically acceptable acronyms easily recognized by any health-care professional. As a student, the one that stood out was DABDA. Death and dying are subjects that one is never prepared to discuss, and we have to thank Elisabeth Kubler-Ross, a Swiss-American psychiatrist, for introducing us to her theory. Spelling it out, it stands for denial, anger, bargaining, depression, and acceptance, better known as the five stages of grief. While traditionally taught to refer to the range of emotions that comes from the loss of a loved one, it has crossed over to define any situation most often unexpected, that disrupts normalcy.

Just last week, I was asked by a friend if I have personally witnessed anyone dying from grief. Her question caught me off-balance but I knew where she was coming from, for how often have we seen it depicted in movies? I was quick to say no, but also mentioned the possibility, of having heard of the broken-hearted syndrome which is a condition that may mimic myocardial infarction, as a result of cardiovascular dysfunction induced by physical or emotional stress. Her question also brought back recent and past memories of interactions with patients and their families and their ability to cope upon receipt of a diagnosis that would either entail chronic or palliative care. To my knowledge, for the families that have been affected or left behind by a loved one, from random messages and conversations with their attending physicians, they have managed to move on with their lives.

I don’t recall the first time that I was made to deliver sad news or was there any algorithm that was available back then that would help one navigate. Trained primarily to acquire both scientific and technical expertise, early in practice, I constantly struggled with how to explain the disease in a manner that could be easily understood. To compound matters, I was more intent on delivery rather than providing them with what they needed most in those crucial moments of intense grief: empathy and a listening ear.

If adults are more capable of expressing their grief, have you ever wondered if children go through the same stages as well? I am no psychiatrist and have scant knowledge on this, save for a story shared by the mom of Shobe, the same little girl that I had mentioned in my column two weeks ago, that made me think that they, too, go through the process, in their own fashion.

She was in relapse from her leukemia and asked her mom why did God allow such a thing to happen. Her mom tried her best to explain and wondered if it was enough. The very next day, Shobe was visited by a priest who had become a regular visitor and her good friend. Leaving the two alone to spend some quiet time together, her mom was a little bothered that she had chosen to disappear under her blanket rather than sit up to engage in a conversation. Checking up on them a few minutes later, she saw her child’s hand slowly inching its way out of the blanket to clasp the hand of the priest. When asked about her initial reaction, she said that this was because she was so embarrassed to have even questioned God about her condition. Shobe was also known to spend so much time in prayer and eventually, they found out that this was because she would be very specific about the people she prayed for. She was barely seven years old.

Everyone will have their own way of coping especially when faced with one’s mortality. Interestingly, the stages do not come in a chronological manner and there is no time limit despite experts telling us otherwise. One can even drift from one stage to the other or remain stuck before realizing that the only way to move on is to accept that there are things that cannot be changed and beginnings will have eventual endings. If you have been given an opportunity to assist in such a situation or are going through it yourself, one helpful advice is to allow enough time to grieve.

One may think that doctors are used to dealing with issues of death or dying and, worse, that we remain unscathed from constantly being exposed to and witnessing grief. One friend had even gone as far as saying “We must get used to it.“ I was quick to contradict, as a doctor or not, that any feeling human being is not exempt from such an emotion.

We may have mastered the art of giving you that stoic and bland look that often is mistakenly thought of as having a lack of compassion or the capacity to empathize. But let me reassure you that we feel you.

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