Mourning In Medicine

Today marks one month since my dearest and sweetest step-mom passed away from breast cancer at the age of 52. I feel like I’ve finally had enough time to reflect on the grieving process, which is a unique experience for those whose job requires that we discuss death and dying on a daily basis.  

Leading up to her death, knowing it was impending given the extent of her metastasis (shortly before we found out it had spread to her brain), I had this flash of clarity thinking that maybe grieving would be easy. After all, I tell patients bad news all the time and usually don’t feel anything.  I’ve gotten so good at objectively approaching morbidity that I thought maybe the sadness would be brief and painless.

I could have not been more wrong.  From the time I knew she was on BIPAP for respiratory support, to hearing hospice was consulted, to getting the message from my dad saying “Call Me” and just knowing she was gone, to having to pick out a casket, to seeing her lifeless body, to being at the gravesite, the pain was incredibly real and deep.  Even with a medical degree, all logic, all statistics, all the understanding that “death is inevitable” and “cancer can happen to anyone due to random genetic mutations” was thrown out the window.  How could this happen to Diane, who has never smoked, never drank, grew up in the fresh-aired country side, worked hard every day of her life, was full of joy and good vibes? WHY did this happen? I was sad and angry and devastated. To watch my dad have to bury the love of his life, and wife of 22 years was almost unbearable.   

But everything I felt and still feel is incredibly normal, and in hindsight, I was relieved to still have these emotions.  In a career that can make you feel like a human robot burying the natural reactions to bad news, these cathartic feelings were a reminder that I am ok. They were an indication that I truly and wholeheartedly loved her.  How many people can say that about a step-parent? Relationships can be tumultuous, and as a little kid I hesitated to love her and know her. She didn’t want kids of her own, and being a step-mom didn’t come naturally. But as I grew up, we grew together.  She inspired me, working full time not because she had to but because she wanted to contribute to the world and she loved her co-workers (even when she found out she’d need whole brain radiation her first question was, “but when can i go back to work?”) She could fix a flat tire and use a chainsaw and drive a tractor and can a vegetable without hesitation. Growing up in a small rural town where racism and homophobia are the norm, she chose to rise above this (without any direction) and love absolutely EVERYONE. 

Her death has taught me so many things, but the most important lesson was bringing me back to the bedside with a patient’s family, really understanding what it’s like to be in their shoes.  That dying person in the bed is someone’s hero, someone’s true love, someone’s best friend, mother, son, whatever it may be. And those relationships are important and deserve the kindest interactions.  We get education from Gift of Life, and they often remind us that families who find out their loved one is dead or close to dying, are operating at a fifth grade level. I finally understand this feeling. I finally know how to talk to these families. Just this week I had to share the following news: “your lung cancer has spread to your spine”; “your father’s kidneys are failing, and he’s unlikely to respond to any more chemotherapy”; “it’s very likely that your only chance of living is a bone marrow transplant.” But this time around on oncology service, I pulled up a chair and sat for these conversations. 

Diane, I wish every day you were still here. But I thank you for bringing me back down to earth when you are up there, reminding me that I’m not a robot delivering bad news. I’m a human that happens to be a doctor that is not immune to the heartbreak of life ending too soon. 

Love Always,

Shanny D.O