By Anthony Galanos, MD
I Realized…Grief Needs Recognition
“Give sorrow words; the grief that does not speak knits up the over-wrought heart and bids it break.”
Shakespeare, Macbeth, act 4, scene 3
The first time that I missed it, and it mattered, was as an intern on call in 1987. I was admitting a delightful woman to the hospital for a non-life-threatening illness and was wearing something with “Duke” on it, as I did every call night, for good luck. She quickly pointed it out to me, and we began a conversation about Duke. She shared that her son had gone to Duke and had died shortly after graduation in Vietnam.
Later, she mailed to me Letters from Sandy, a collection of letters Lieutenant Marion Lee Kempner had sent his family. It impressed upon me how much his parents were grieving twenty years later: “…Sandy will always live in the memory of his bruised and grieving family, and…his having been was perhaps its own reward and the only recompense for our loss.”
As a teacher of communication to medical students and residents, I learned about and taught about the value of “empathic communication”—when a doctor hears something important from the patient or family and either responds to that empathic opportunity or simply skips over it. In palliative care, we pride ourselves on knowing how to conduct a family meeting and how not to miss opportunities and respond with empathy. With the current pandemic, all of us, not just health-care practitioners, might be missing the opportunity to acknowledge the staggering grief that results when some 1,000 Americans die each day from this virus. In this COVID era, we all are “essential,” and we all can enhance and promote the necessary grieving of others.
Grieving is now complicated by families not being able to visit the hospital, and the patient being isolated in an ICU surrounded by personnel in space suits. Recently, I was part of two family meetings that took place over the screen on an iPad. When the chaplain showed the packed room of family members on the other end, their loved one in her ICU room on the ventilator, they simply asked, “Is there a Bible in Spanish in her room? …Is there music, doctor, because she loves music!” What simple and caring sentiments to their mother or grandmother in the most complex of surroundings. I remembered my earlier patient: Instead of talking about the too-familiar theme of Duke basketball, I could simply have said, “Tell me about your son.”
When my adult son, Nick, died, my grief broke me in pieces too numerous to count. I turned to the literature, like a good academician, and found too many terms and not enough understanding: “anticipatory grief,” “complicated grief,” “prolonged grief disorder.” So, I made up a word that made sense: “gruilt.” I was feeling both profound grief (80 percent) and some guilt, too (gruilt). And with a better understanding now of grief, I have learned that while it changes, it does not dampen or end.
And so it is with the pandemic. We learn more and more about it and human social behavior, yet fail to identify the grieving process that is a consequence. I propose we legitimize our grief, name it, and say something like: “I am sorry you are going through this, and I acknowledge your sadness.” Let’s not miss the chance to be empathetic. Let’s see and hear what is important to others, be it the loss of a family member, the loss of a job, or the loss of confidence in tomorrow, and acknowledge what they are going through.
Anthony Galanos, MD Is professor of medicine at Duke Health specializing in palliative care.