Andrew Griffin, OMS-III
Kansas City University of Medicine and Biosciences

A couple of weeks into my surgery rotation, I came home from an extended shift when I checked my phone to read dozens of condolences on one of my friend’s Facebook walls alluding to that something severe had happened. Not wanting to jump to conclusions, I reached out to mutual friends. As I learned that the worst had been true, that he had committed suicide, I received a call from my attending to return to the hospital. We had an emergent surgery. I scarfed food down and attempted to box in the emotions I was feeling as I ran back out the door.

Unfortunately, I am not a stranger to this. As an American combat veteran, I have lost more of my friends to suicide than as combat casualties. It is a current epidemic that afflicts our culture (as I’m sure anyone reading this has seen float through their social media). It does, however, not dull the pain of it. Every time hurts just as bad, the pain feels just as sharp, and the mourning just as difficult. Unfortunately, in medical education, we are rarely afforded the opportunity to actually mourn.

Before entering medical school, I got a master’s degree at my medical school to aid me in actually getting into medical school. During that year, I had a person I served with commit suicide and I was fortunate enough to be able to attend the funeral. Even though the program was intensive, it still wasn’t medical school. I felt comfortable taking the time to mourn and attend the funeral.

During our orientation, our Phase 1 director told us that we would sacrifice a lot, and that our friends and family would not understand. During my first semester of medical school, those words ended up resonating with me more than I could have possibly imagined. I had a close friend, who also served, lose his battle with PTSD; my grandfather a month after that died; and finally, the last week of our 1^st semester, my mentor and the man who was essentially my adopted father and who pushed me to be where I am in life, died unexpectedly.

Unlike my master’s experience, there was simply not time to make it to all but the final funeral. My mentor was laid to rest the day after my final exam of the semester, and I drove home immediately after taking the test (the school allowed me to take it early to make this possible) and attended the funeral. One out of three that semester. There didn’t feel like there was time to mourn, time to take the 8-hour drive back home to be there for any of the other funerals.

Our Phase 1 director’s words echoed in my head. I felt guilt creep into my heart as I wondered how people perceived my absence from these important people in my life. I wondered if people blamed me for not being at the funerals. Self-consciousness creeped its way into the back of my head, adding stress. Guilt that I couldn’t be there, couldn’t support, or show my support. The truth is how could anyone understand who had not been through medical education to understand how demanding it was? There’s no way for them to empathize or even to communicate what is required of us. While my school would have given me the time, could I have truly kept up with the pace if I took the time?

On top of the guilt and insecurity about extrinsic views regarding my absence, the act of burying a loved one is important to the grieving process. It’s fairly ubiquitous in cultures across the world that funeral rites are conducted. This exists, outside of religious viewpoints, to give us the opportunity to say goodbye to that loved one. To have closure.

So, the question is, the question that I’ve wrestled so much with myself, is how do I effectively mourn while pursuing a medical degree? How do I continue to perform in school and progress my goals while effectively mourning? Staying busy is nice and keeps you distracted but it doesn’t allow you to mourn in a way that is effective. How do I cope with these insecurities of people judging me or blaming me? How do I wrestle with the guilt of being away? The guilt of possibly not being around when one of the friends I lost may have needed me?

The truth is, I’m not sure I have the secret. I think this is the kind of situation that is always going to be difficult. Medical school is insanely difficult. Losing loved ones can be insanely difficult. When you combine them together, I don’t think there are words in the English language to describe how difficult it really is.

I think, for me, the first step was validating myself. Internalizing the fact that these things were going to happen was the first step, whether I was in the same state as them or in a separate one for medical school; realizing that and choosing to believe it. As easy as these words sound, it’s hard. It’s hard to truly internalize it. It’s hard to validate yourself in this way. For many of us this is a dream that we have been pursuing for many, many years. When we lose people who were close to us, it’s hard because it feels selfish that we are gone pursuing that dream.

When my grandfather died, one of the conversations I had with my mom was the fact that my grandfather sincerely wanted the best for me. He would have actually been upset if I missed school to come to his funeral. Those that leave us want the best for us and knowing that has helped ease some of the pain of being away ‘selfishly’ pursuing my dream.

Being away from my support system further impacted that level of insecurity. The adage that you choose your own family is one that is true. Medical school forges some unbreakable bonds. I found myself self-conscious about ‘burdening’ my colleagues with these things. The truth is though part of the nature those bonds are the support network that comes with them. Those people can empathize with you in ways that your support system back home can’t. There are times they can truly give you support that no one else can. Finding time to talk to them, making time, can be one of the best ways to cope with the constant turmoil of emotions you are feeling during these periods. These are the people who are going to be some of your closest friends long term. They want what’s best for you and will support you through some of the roughest times. As will you them. Let them be there for you, because you would be there for them.

Our intensive coursework in medical school, either during clinical rotations or during the first two years, does require a certain degree compartmentalization; it does not however require you to ignore your feelings. As we were called into that surgery, I pushed those feelings down and forced the compartmentalization, knowing I’d let myself feel the emotions later. As I came back home once the surgery was over I let myself grieve and let myself feel the pain of losing my friend that way.

If you completely repress your emotions, you’ll never truly mourn (I did this with my friend who lost his battle with PTSD). It’s almost impossible to get over it. I literally scheduled times to feel. As funny as that sounds, it was very cathartic. I let myself breakdown when the next fire was out. When I finished the next test, I would decompress with emotion and let myself mourn that loved one. I let it be regimented and that let me both compartmentalize and to perform.

Even though your loved ones may not be able to empathize with you all of the time, they do want the best for you. Losing people who are close to you is so tough. You have to compartmentalize, but you have to afford yourself the opportunity to mourn. You have to allow yourself. We will lose loved ones in the future. Especially in the EM setting, we will lose patients. Learning how to compartmentalize and handle those emotions now will serve us in the future so that we may better cope with lost loved ones and still deliver our best care. Losing patients and still coming home loving our families the same way.

Pain helps us grow sometimes and it’s important to allow it to. It’s important to take the time for yourself and mourn, grow from the experience. Doing so will only allow us to deliver better care to our patients in the long term.