By: Emma Herrington, c2018, Hamilton Campus
My father took his own life five months into my training as a medical student. His death was public; photos of the scene were shared on twitter before I even knew. On the morning of his death, I was working at my family medicine placement in Burlington. At the time, my main concerns were trying to remember the order of palpation and percussion as part of the abdominal exam and learning how to complete SOAP notes. My brother called me as I was walking into room 6 to take a history. During a trauma, heightened senses result in transposing those negative emotions to environments that are visually similar. I strongly associate the uniform design of family clinic examination rooms with loss.
My father’s work colleague gathered me from the clinic; I carried nothing but my white coat, stethoscope and McMaster clipboard into my hometown. The last note I had scrawled into my clipboard before I found out that my father killed himself was, “adrenal insufficiency.” A part of me, the young woman who was just starting to learn about Addison’s disease, died with my father that day. Only five months after his death, I’m unable to specify which part—I just know that I am no longer the same person.
Society’s response to suicide is one of self-fulfilling curiosity, awkwardness, and fear. I initially thought that these visceral reactions would not translate to the medical student world. In this world, I told myself, we are learning about mental health and self-care; in this world, I told myself, we are learning how to comfort patients and break bad news.
Yet, when I returned to school after missing only 10 days of classes, I entered a dismal maze of ostracism. It is a maze I have still not managed to exit. The walls of this maze were built not only by the same curiosity, awkwardness, and fear that I experienced outside of McMaster, but also by myself.
If you are a medical student and you know someone who is grieving, I offer some insight on how to create a safe space:
1) Acknowledge how hospitals can be triggers
Following my father’s death, I spent a great deal of time around hospitals supporting family members as their bodies responded to the shock. For those who are grieving, hospitals may not be associated with just classes.
2) Acknowledge how a simple history taking can be a trigger
Whether it’s breaking bad news or asking about self-harm, these discussions are difficult and exhausting when grieving following a suicide. Keep in mind that these histories can include those taken from standardized patients or with clinical skills preceptors—this means that grieving students are routinely placed in environments directly related to their own negative life experiences.
3) Consider how their life at home has changed
As we know, outside of medical school we all have our own personal relationships. For a grieving medical student, the transition from home to school is exceedingly difficult. I would compare it to entering different dimensions that require completely unique versions of my personality. Simply inviting another student to share the challenges they face when transitioning between dimensions is a true demonstration of thoughtfulness.
4) Do not take a history of the dead individual
We, as medical students, are trained to dig deeper and explore health issues. Curiosity is of paramount importance in medicine. However, remember that the person sharing their grief with you is not a patient seeking formal assessment and treatment. Provide them with the space to share details when they are ready. When it comes to suicide specifically, asking about potentially missed signs instills a sense of guilt in the loved ones who are left behind.
5) Be sensitive when it comes to their social anxiety
Because of the public nature of my father’s suicide and how people responded, I developed extreme social anxiety. I could no longer attend large groups sessions/lectures. I was fearful of what people would say to me, how people would look at me, and what topics would be mentioned during lecture. Recognize that the grieving individual’s comfort with social interaction may or may not have changed. Ask them how to offer support in social settings. Check in with them weekly to gauge if their level of comfort is changing. Socializing outside of class when grieving is uncomfortable and awkward. The emotions that are synonymous with grief do not always allow someone to socialize in large groups with alcohol. Acknowledge that this may limit their ability to share their story and ask how you can accommodate. Furthermore, there are periods throughout the grieving process when social interaction is not possible. If someone who is grieving appears to have lost all interest in your usual activities, be patient and accepting.
6) Do not attach any timeline to their grief
While the stages of grief do exist, I would argue that they do not happen sequentially and are not required to exist separate from one another. Grieving is an individual process. Do not get frustrated with where they are in the process of grieving.
7) Encourage them to engage in self-care activities
Ask them what activities make them feel more balanced, rather than happy. It could be as simple as hitting the weights together, making a healthy meal, or going for a hike.
8) Create a safe space to discuss feelings of self-harm
These are difficult conversations to have. But the truth is that self-harm is a real concern after the death of a loved one. If you are not comfortable having those discussions, then ensure that they are aware of services they could utilize in times of need.
9) When you don’t know what to say, say exactly that!
Rather than anxiously uttering some sort of platitude that could be interpreted as insensitive, offensive, or both, simply admit when you do not know what to say. This honesty is appreciated. If words fail completely, offering a hug is not unreasonable. Before you speak, consider your motivations. If you are simply trying to get information, understand that your interaction with the grieving individual should be centered around their needs, not yours.
10) Be willing to learn
There may be times when you do or say something that is interpreted as insensitive, even when you had the best intentions. Take this as an opportunity to ask why it was insensitive and explain what you meant by your action or comment—communication is key.
Ultimately, grief is a deeply personal journey that becomes even more difficult to traverse while in medical school. Keeping these 10 things in mind may provide you with the opportunity to form a rewarding connection with a grieving medical learner. By applying a trauma-informed approach to your interactions, you may rescue a colleague from a maze they feel unable and too fatigued to navigate. For those reading who are grieving while in medical school, I comfort you with psychologist Carl Jung’s concept of a wounded healer: one day, your own hurt will allow you to better serve a patient; in fact, the depth of your pain may be a measure of your power to heal and connect.