Disenfranchised Grief

A few months ago one of my most beloved patients died. I know we aren't supposed to have "favorites" but I think it's fair to say that we all do.

Your favorite patient may resemble your father or have a sense of humor like your best friend. Whatever the situation may be, that person somehow sneaks their way into your heart. This particular patient (we will call her Sally) did just that. She was spirited and courageous. She had a dry sense of humor and always had a twinkle in her eye.

I met Sally on her first day of chemotherapy less than a year ago. She was anxiously sitting in a recliner as a nurse started her treatment. My first meeting with Sally lasted almost two hours. We discussed her grim diagnosis, her support system, and practical matters like income and insurance. But it wasn't long before the conversation wandered from oncology to the outdoors. Sally detailed her love for animals and her desire to hike the Appalachian Trail.

We met every week for a little less than a year. Our conversations would vary in seriousness. One day we did a role-play in an attempt to predict the questions her young children might ask when she explained cancer to them. The next week we joked about a recent Seth Rogen comedy we had both seen. Sally's health declined rapidly and I watched as her courageous spirit began to grow tired. When the doctor told her there were no other treatment options available, I worked diligently to set up hospice care.

A month went by before I was informed that Sally died. The news somehow caught me by surprise and an unwelcomed tear rolled down my cheek. My usually guarded demeanor was momentarily washed away and I allowed myself to grieve the loss of Sally.

I have connected to a countless number of patients since I began working in oncology but this was the first time I truly allowed myself the space to grieve. I believe that healthcare professionals experience disenfranchised grief. Disenfranchised grief equates to your loss not being recognized and the relationship you had with the patient not being acknowledged. Most importantly, the griever (YOU!) is not recognized.

How often does a patient die on your unit and you are expected to continue your day as if nothing happened? Do you discuss these losses with co-workers or bottle them up? Rachel Remen, MD and author of Kitchen Table Wisdom: Stories that Heal, proclaims, "We burn out not because we don't care but because we don't grieve... because we have allowed our hearts to become so filled with loss that we have no room left to care."

As healthcare professionals, we must find a way to process these losses so we do not experience bereavement overload. Focus on participating in restorative activites to help yourself cope instead of becoming a profesional escapist:

Restorative activites:


• Taking a vacation
• Doing yoga
• Exercising
• Journaling

Escapist activites:


• Drinking
• Eating
• Spending money

How do you cope? Do you have a favorite restorative activity or do you find it easier to escape? Does your job offer a safe space for open discussion about grief?