Oncology Times

Journal Logo

View From the Other Side of the Stethoscope

As an internist and cancer survivor, Wendy S. Harpham, MD, FACP, offers a unique perspective on oncology practices.

Thursday, October 27, 2022

Surviving Loss & Grief

Wendy Harpham image.jpgFor professionals in oncology, loss and grief weave through every workday. During your precious off-duty time, why choose to go to a sad space for even five seconds, let alone read a whole book on Loss and Grief: Personal Stories of Doctors and Other Healthcare Professionals?

Why? Because loss and grief weave through every workday. Given your shared background with the contributors, their insights about surviving loss may change how you show compassion for patients and colleagues experiencing loss. Extraordinarily candid stories may help you grieve after you lose patients and when—not if—you suffer personal loss.

The introduction by Marshall Forstein, one of the book's three editors, asserts that how we grieve over time impacts whether we move forward after loss or get stuck. The contributors, whose work involves relieving patients' suffering, offer actionable “insights into some of the very failures of how we educate and train healthcare professionals." The collective hope of the editors and contributors is to mitigate suffering on both sides of the stethoscope. As the title of the epilogue cries out: “We can do better."

Chapter One sets the stage with oncologist Lidia Schapira's reflection on “Loss and the Culture of Medicine." Her conclusions are informed by her years of efforts to foster in trainees the human side of cancer care and by the loss of her “soul mate" father. As a medical resident at the height of the AIDS epidemic, she aspired to be a compassionate physician for every one of her patients, a goal that underestimated “the toll of cumulative losses and constant exposure to the suffering of others." Back then, the oncology community sounded the alarm about pervasive burnout among clinicians. Yet throughout the decades since, most discussions have focused on the role of time pressures, administrative overload, and loss of autonomy. Misguided strategies to mitigate burnout have neglected to address the burden of loss.

To round out the book's stage-setting, I had the honor of writing Chapter 2, “On 'Doing' Loss." After defining and expanding on what “loss" is, I make the case that assessing losses facilitates healing responses. Is yours an insignificant or significant loss? If significant, have you lost something, someone, part of your body or mind, or are we talking about losing your life? Vignettes from 32 years of survivorship, as well as my sister's final illness, illustrate my approach to “doing" loss, a method designed to help manage expectations and promote healing through honoring grief and finding hope.

Then comes the heart of the book: intimate descriptions of a range of personal losses, including loss of: a childhood to abuse; two disabled children (ages 4 and 10 years old); a 33-year-old son to mental illness; a 49-year-old mother to painful cancer; a middle-aged mother due to sequential heart attacks; a friend killed in Viet Nam; a wife to divorce after 45 years of marriage; a husband to cancer after 38 years as a gay couple; a husband who'd collapsed due to a fatal heart attack; a joined-at-the-hip younger brother due to cancer; years of health and happiness due to cancer complicated by depression. The final story paints a picture of loss of agency and sense of self-worth due to medical training in the early 1980s.

For this review, the challenge of further explaining what readers can expect reminds me of the art of discussing intensive therapies with patients. How can I best prepare you for potential difficulties without frightening you away from an intervention expected to help make life with loss the best it can be? Keeping the long-term benefits in mind, here goes:

The contributing authors drop the masks of their professions. They courageously describe suffering caused by the hand of fate and exacerbated by insensitive comments, hurtful actions, and neglect by some people, including some in the healing professions. Their lucid, evocative writing elicited my empathy while a sense of “there but for grace go I" thrummed in the background. Pain resonated, especially when they wrote about their fears, loneliness, shame, anger, and unhelpful thoughts and actions shaped by professional training.

Any discomfort you experience while reading will likely be less than mine unless you are skirting burnout or grieving personal loss. For me, still adjusting to my latest diagnosis, I periodically stopped reading to wipe away tears and take calming breaths. A fog of melancholy descended after finishing the book as I processed the wisdom offered through stories and discussions.

The short-term sadness was well worth it. I've appreciated a noticeably heightened awareness of loss in its various forms. Whether comforting myself or someone else, my increased confidence in responding compassionately with nuanced language will serve me well for the rest of my life.

Wanting to give you a taste of the book's specific offerings, I selected from a list of over 40 ideas:

  • Efforts to maintain a professional persona may hinder healing grief. For healthcare professionals in the role of patient or loved-one's caregiver, letting go of responsibility for outcomes and seeking support and/or counseling (the earlier the better) help minimize common added burdens, such as feeling undue responsibility, self-blame, shame, and loss of control.
  • People's memories and interpretation of immutable losses evolve continually over time. As clinicians, choose words and actions with the understanding that you are co-editing patients' stories. After personal loss, craft narratives that help you accept, adjust to, and embrace your changed reality with hope.
  • Small acts of kindness matter. Take a few seconds to sit quietly, listen intently, or gaze with compassion into the eyes of people suffering loss. It will help them…and you.

We must do better to preserve compassion in medicine. May the messages of Loss and Grief shine light in the darkness and transform perceived weakness into strength, helping you be the healer you've always aspired to be.​

Cover art by Scott David Farrell-Forstein​