Abstract
Dear Editor:
Grieving is part of life for those left behind. Being bereft is part of the human condition. Those entrusted to teach future health care providers have a responsibility to teach our palliative care and hospice learners about “grief and bereavement,” just as we do with other topics such as pain management and how to run a family meeting. If we stop and ask ourselves where palliative care clinicians learn about grief, we might have to grudgingly admit that it is mostly “on the job experience.” We humbly ask our teachers of all health care disciplines and clinical and program leaders to start to teach about grief and bereavement—both personal and professional grief—even if only at a most basic level: “Grief 101.”
Data suggest that trainees as early as medical school carry a certain amount of personal grief and that it affects their ability to learn. 1 So, if trainees in medical school and other professional schools come with some personal loss, it is important to consider the impact of taking care of those with serious illness, some of who die during a longitudinal relationship. The literature does not yet inform us around the question of the impact of “cumulative grief” on practicing palliative care clinicians over time. Although a self-selected group that has chosen a profession filled with serious illness and end-of-life care, how should we prepare ourselves to succeed during this noble adventure? We would submit that we must acknowledge grief and start to account for its effects in our self-care and surveys about burnout. It makes sense that the most basic of human experiences and emotions, grief, will apply to those who are repeatedly exposed to this phase of life.
We also know that both clinicians and patient families experience “gruilt,” which is theoretically 80% grief mixed with roughly 20% guilt. 2 Gruilt is a functional term: it applies to families who say “if only I had gotten my husband to you sooner” and it equally applies to the clinician who worries that they missed something or that they could have done something more. Gruilt can keep you any of us up at night or make it hard to finish dinner. Gruilt is very human.
It is important to recognize that this professional grief interacts with personal grief as we age. The longer we live, our personal lives sometimes can begin to mirror our professional lives. 3 In essays on physician grief, the common denominator is the need for time and space to process grief, to just stop long enough to acknowledge that a sad event happened and that we grieve that loss. 4 An intervention can be as short as one minute. After a code or after we learn that someone we cared for in our clinic has died, we can all “pause” for one moment just to memorialize the event. 5 It has been written that the only real medicine for grief is “acknowledgement.” 6
So we make a call to action. A call for senior clinicians such as ourselves to be available to their younger colleagues and trainees. We leaders should build in time for palliative care clinicians to acknowledge how hard the work can be; to mentor them on building that internal architecture, that scaffolding, that is required to be there to process the sad events in our work lives. And we must provide leadership when sad events happen in our personal lives or within our work organizations. 7
We need to be more aware. 8 We need to create a culture of not just providing exquisite end-of-life care, but also to continue to care for the families of the patients we serve after their loved one has died. 9 That way we can continue to be available, in a robust and meaningful way, for not just the next patient and family but also for ourselves and our colleagues.