After he dies, I take tests for my family doctor. The first one measures how much my grief affects my life. I score 74.4%.
That’s really high, my doctor says.
See, I want to say, it really is this bad (Lin 7).
Recently, I attended an intensive board review course to prepare for my first hospice and palliative medicine certification exam. At the beginning of the three-day course, I learned that three percent of the exam will cover grief, loss, and bereavement. Three percent. At the end of each day, glued to a chair in a large hotel conference room, I returned to my room to read Here After, a memoir from Amy Lin, whose partner, Kurtis, died unexpectedly while running in the woods during the first few months after the COVID-19 lockdown. In short spare chapters she unspools her grief and describes the tests her doctor provides her:
The words swim on the page. I put my finger beside each one and try to focus.
Panic is common, my doctor says. So is anxiety, sadness, yearning, difficulty concentrating, and confusion about what happens next.
I pause.
What does happen next? I ask (Lin 15).
Panic, anxiety, sadness, difficulty concentrating, and “confusion about what happens next” could just as easily describe what a clinician might experience when faced with a grieving patient. Consider that if the board exam for a hospice and palliative care physician—who continually counsels and cares for seriously ill and dying patients—has so little content devoted to grief, how often do trainees in other fields know how to accompany a patient like Lin, whose “chronic discord, the push-me-pull-me of my sadness” (Lin 124) pummels her for weeks and months as she contemplates the crater-sized loss of Kurtis?
The answer is likely not very often. For something as ubiquitous and challenging as grief, it is nearly non-existent in medical education. A scoping review conducted by Sikstrom and colleagues (4), identified 37 articles over a 40-year period that described grief training interventions within the fields of pediatrics, psychiatry, and family medicine. Most articles pertained to grief training in medical school, and most described single, voluntary workshops, electives consisting of a one or two-day seminar, or short modules. In every article, grief referred to the loss of a loved one, eschewing other grief-filled settings: infertility, the initiation of chemotherapy, the sequelae of substance abuse, self-harm, and any number of other tender scenarios within healthcare work.
“Is it not astonishing,” I frequently ask my students and trainees, “that while we all get lectures on things we might never do—like deliver babies or manage advanced heart failure—that we do not get comprehensive training in something one hundred percent of us will experience in our work and in our lives?” This is the absolute that I will add to the adage that the only certainties in life are “death and taxes.” In the “test taking tips” section of my board review, we are reminded that we can eliminate any answer with an absolute, like “never” or “always,” but when it comes to grief, I stand firm—none of us on the patient side of healthcare will escape grief’s grip.
In other words, while grief is common, Lin’s doctor asking her about it seems pretty extraordinary. If medical education is a barometer for grief training throughout healthcare education, then healthcare professionals are frequently left to flounder amid the fallout of caring for a grief-saturated patient population. And even if a healthcare worker has been trained to ask about grief, it doesn’t mean they know how to process that patient’s grief and continue the work day. “Where do you put the pain?” a colleague bombarded with a particularly gut-wrenching streak of sick patients once asked palliative care physician Amy-Lee Bredlau. For Bredlau, who works with dying children, she deliberately makes house calls—allows the car commute to help diffuse the stories and soothe her aching limbic system (Bredlau 983).
For me, after-hours reading requires some degree of thoughtful titration, especially if I’m spending my days reviewing the ways to attenuate the suffering of seriously ill patients in physical and psychosocial realms. No doubt memoirs on grief bring humility to my work—“How can grief be so universal and yet still so widely misunderstood?” Lin chides (152). I may soften the edges of such laments and my fear of inadequacy as a healer with hope-filled rom-coms, let the works of authors such as Emily Henry, Katherine Center, and Lyssa Kay Adams bring in some levity. Of course, when I look a little closer, even these “lighter works” contain a fair amount of gritty backstories of grief and loss. Oh, the ubiquity of grief! And yet the arts and humanities can help with all of that if we are receptive—inform and comfort, prod us along in our journey as healers-in-training or teachers in need of healing—perhaps even one hundred percent of the time.
Works Cited
Bredlau, Amy-Lee. “A Piece of My Mind. Where Do You Put the Pain?.” JAMA vol. 315, no. 10, 2016, p. 983. doi:10.1001/jama.2015.17474
Lin, Amy. Here After: A Memoir. Zibby Books, 2024.
Sikstrom, Laura et al. “Being There: A Scoping Review of Grief Support Training in Medical Education.” PloS One vol. 14,11 e0224325. 27 Nov. 2019, pp. 1-16. doi:10.1371/journal.pone.0224325
