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Clean Sorrow

Glaser, Johanna S.

doi: 10.1097/ACM.0000000000002667
Teaching and Learning Moments
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J.S. Glaser is a fourth-year medical student, University of California, San Francisco School of Medicine, and predoctoral fellow, University of California, San Francisco Osher Center for Integrative Medicine, San Francisco, California; email: johanna.glaser@ucsf.edu.

An Academic Medicine Podcast episode featuring this article is available wherever you get your podcasts.

It was nearly 4:00 AM, and I was on my bicycle. I turned a corner, and the hospital came into view. The windows glowed yellow against the sky, hundreds of patient rooms illuminated.

I had just begun my third-year clerkships, and I was on a surgery rotation. For two years, my classmates and I had systematically studied the human body and disease. Before that, I couldn’t have imagined the complex beauty of the body’s cells and organs quietly working in sync or the intricate balance of the processes underlying a single moment of life. Nor could I have imagined how nearly all of these processes can go wrong.

Now, as a third-year student, I was witnessing daily these surprise betrayals by the body. In the operating room, I peered into abdomens and limbs, placing careful sutures into flesh. Patients described a vast array of suffering. Each day I wanted to kiss my body all over for everything going right inside of it.

In the hospital, I was not the only one realizing how much I take my health for granted. Patients told me about the things they wished they had done while they still had their health and described newfound clarity about what mattered most to them. Now, on my morning bike ride, each yellow window told a story—the story of a patient and his or her loved ones coming to terms with illness and decline.

As the year progressed, I found myself drawn to patients nearing the end of life. In this context, people’s values seemed to come into particularly sharp focus. The superfluous things fell away. In these rooms, I simultaneously witnessed loss, regret, acceptance, humor, joy, despair, love, unfairness, and profound tenderness. Life’s most poignant emotions and connections magnified.

One memorable moment took place during a palliative care visit with a woman who had just lost her husband to cancer. She had worked closely with the physician and her husband to make complex decisions for him over the last few years. As treatment options dwindled, the three of them explored her husband’s values, fears, and hopes to best support him in the dying process.

At this visit, his now-widow described the weekend routine she and her husband had shared for over two decades. “I went to the farmers market like we always had. I went to each of our favorite stalls.” Her eyes filled with tears. “And he just … wasn’t there.”

The physician paused for a few moments of silence. “You’re describing what I think of as ‘clean sorrow,’” he said. “With the thoughtful work you and your husband did to prepare for his last months, you gave him the best possible landing. Instead of frustration or regret, it sounds like you’re feeling a very pure sorrow.” He paused. “And your sorrow is beautiful, because it’s completely tied up in your love for him.”

The woman’s face brightened as she took a notebook from her purse. She carefully wrote down the words “clean sorrow.” Something inside of me latched onto the idea too. I wondered what kind of work I needed to do in my life, in my practice of medicine and in my personal relationships, to experience such clean emotions in the face of adversity. How could I live in such a way that love would be the prominent, simultaneous component of future experiences of loss?

As physicians and as people, have we prioritized the things we value most? If our bodies were to suddenly betray us, would our experiences be muddied with regrets? Or could we focus cleanly on the beauty of our work and our relationships thus far?

What story will our glowing yellow windows tell against the 4:00 AM sky?

© 2019 by the Association of American Medical Colleges