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Mindful Practice

Learning to mourn my patients

Kraus, Sara MMS, PA-C

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Journal of the American Academy of Physician Assistants: October 2020 - Volume 33 - Issue 10 - p 1
doi: 10.1097/01.JAA.0000697280.65583.fb
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My grandmother died yesterday. She had been suffering from dementia and failure to thrive. She was loved and well-cared-for—there is no question. As a family, we welcome the peace we hope she finds in death after months of confusion and pain. We have come together as a family to mourn her. We have a group text we have used to share memories and photos of her when she was more herself. A sad peace has settled over our family as we remember her from our different corners of the country. She was our cherished matriarch.

I work in an ED. Death is common in our department. I am certainly familiar with death, but I do not understand death. I fight it and I fear it, but I never face it. I doubt, as we all do, my ability to manage the medicine, the family members, and the emotions that come through the door with the emergency medical technicians. In the face of this doubt, I steel myself against all emotions. I do not let the fear, regret, insecurity through. Nor do I let the sadness through. It is through this hardening that I have stopped mourning my patients.

Somehow, professionalism and emotion seem mutually exclusive. My professional self yearns for the freedom to feel. I am isolated, living in a world of rationality and boundaries. What would happen if we looked death straight in the eye? What is keeping us from breaking down just one of the walls we have built so we can mourn the lives that slipped from our grasp? The fear of letting go of too much. The fear of admitting inadequacy. The fear of displaying weakness.

I started to ask myself if I was burnt out when I noticed that these fears were outranking my hopes. The hope to connect. The hope to embrace my entire self as a provider. The hope to love my job. The chasm between my professional self and my personal self was growing. Less and less I contemplated my patients' perspectives. Seldom did I stop to think about the families of the deceased. More and more I found myself eager to remove myself from those difficult situations.

I have been bridging the gap lately. I am nurturing a professional self who, for so long, has been floating alone in RVU limbo. I am focusing on the moments during my training that highlighted the joy of medicine, such as the small kindness of taking a scared stranger's hand or sharing a smile with a patient. As I celebrate these moments, my joy at work becomes amplified and my insecurities become muted.

Honesty with myself and my coworkers has allowed me to embrace my entire self as a provider. I regularly identify the gaps in my knowledge. I say things like, “Let me see what I can find out” and “Thank you for that perspective; I hadn't thought of that.” I emphasize shared decision-making. I laugh at myself with my patients more. This transparency is not eroding the façade of a competent, impenetrable PA that I thought I had been forming. It is building my reputation as an honest and trustworthy colleague and provider. And it is in building my confidence that, in the face of the unknown, I can still find answers for my patients.

And in the face of the greatest unknown, death, I am learning that the strength I gain from embracing my insecurities is what allows me to honor, celebrate, and—ultimately—to mourn my patients.

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