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Medicine and the Arts

Commentary on “The Five Stages of Grief”

Sweeney, Alexis (Roldan) MD

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doi: 10.1097/01.ACM.0000520957.13661.43
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Although our meeting lasted just 15 minutes, my conversation with a patient who had experienced medical complications traced—like Linda Pastan’s poem—all five stages of grief, and in the end, expressed the continued process of learning to endure in a new reality.

Her name was Star, like the flickers of light that set our nights aglow. But for this woman, after a surgical accident during a minor procedure, her light had diminished.

I sat across from Star in her room as she told me the details of the day before the incident. For a few weeks, she had complained of minor abdominal pain to her doctor, and he directed her to have an endoscopic retrograde cholangiopancreatography, a routine surgical imaging procedure. The day before the procedure, Star went to work and told her boss: “I will be back in two days. They won’t keep me overnight.” She had no concerns. Her doctor assured her that she would be asleep for only 45 minutes and that the pain would be minimal. Yet when Star woke up, her doctor decided, “You will stay overnight.” Immediately, she knew: There had been a mistake.

Overnight became two nights. Then three nights. Then one week. Then two weeks. Then eventually one month. Then two. Upon our meeting, Star had been there for three months.

There had been numerous complications. She developed a hemorrhage. The hemorrhage became infected with vancomycin-resistant enterococci. Eventually, an abscess formed. Complication after complication extended her stay, and ultimately, Star still woke to nurses checking on her, the moans of a neighboring patient, and the clatter of rolling carts and footsteps outside her door.

Star’s story echoes “The Five Stages of Grief” by Linda Pastan. The piece is narrated by a speaker who walks through denial, anger, bargaining, depression, and acceptance after a beloved’s death. The poem comprises a series of metaphors that exemplify the pain the speaker feels and the iterative, revolving nature of grief. While Pastan’s speaker loses a person, Star has lost vital aspects of her own personhood: her freedom, her independence, her ability to live outside the confines of a hospital. During our interaction, through subtle movements and shifts in tone, I felt us climb what Pastan describes as Grief’s “circular staircase.”

The first landing was Denial. Within the first few seconds of my entrance, I noted Star’s demeanor. She sat up, straightened her back, and looked me directly in the eyes. She appeared, for a moment, almost stalwart as if nothing were wrong. Nonetheless, I wondered how much of this was to compensate for the burdens of her long-term stay. Was she denying her sadness? Acting tough as if unfettered by the frustration, exhaustion, and constant tedium of being in this prison-like state?

We took some time to get to know each other. Little by little, she relaxed. We discussed family, friends, her job at the bank, back massages, and Korean dramas. Eventually, Star recounted the story of the doctor who told her the procedure would be quick and easy. The retelling brought on an expected feeling: Anger. As she spoke, her fingers tightened around the bedsheet. She looked away, and the lines near her lips sharpened to a thin scowl.

Still looking away, Star described: “They told me that I would be discharged on August 13. I told them that I.… And they would do this, but then.… It’s been so much longer. Why did this happen to me? What did I do?” She was Bargaining, or at least trying to. Would any cost validate her loss? “October 27th will be the four-month deadline. That’s all I want. I won’t stay longer. I won’t … I won’t cry. I won’t.”

We still didn’t make eye contact. But I knew that Depression had “come puffing up.” Her gaze shifted to the ceiling, as if praying to make her forget a secret burden. “I won’t,” she repeated, “I won’t.” Despite the pleas that Star recited, it wasn’t long before tears flooded her eyes. They were so red. I wanted to offer “bandages for the eyes and bottles of sleep.” I handed her a tissue instead, and she explained that the hardest part was that the events came without warning. For months, they told her that she would be discharged “soon,” but here she sat, three months later, still existing in a hospital. “This,” she explained as she wiped a tear away, “this is not living. This is not my life.”

After a long pause, Star took a deep breath and with a wave of the hand, she recomposed herself. She straightened herself back up, and as Acceptance lit up across her face, her eyes regained a glimmer of confidence. “Well, there’s nothing I can do. The doctors won’t know when I’ll leave, so I don’t know. Everyone here is nice, so it’s not a problem.” Despite the silence, I felt her climbing. “Hope was her signpost” as she reached for Acceptance.

Regardless, Star’s fingers still trembled and she never fully regained eye contact. In time, politely, she asked if it would be all right if she could rest. She and I both knew that Grief’s “circular staircase” would rise again. I nodded and reassured her that those few moments of her time were plenty. She smiled gratefully, then lay back and pulled the bedsheet up to her chin.

In just 15 minutes, I saw a woman experience the five stages of grief. We walked together up that circular staircase of denial, anger, bargaining, depression, and acceptance, and I helped alleviate the burdens where I could. Although seemingly feeble, this is the responsibility of good physicians: to recognize our patients’ struggles and walk beside them through all stages of disease, of grief, of life.

Copyright © 2017 by the Association of American Medical Colleges