Learning to See
Without acknowledgement, grief becomes suppressed, and its ability to heal becomes constricted, constrained and concealed.
I had been on call overnight in the hospital so was easily the first to arrive on the ward for morning rounds. I was also the last to gather in our huddle. I was withdrawn and quiet, and Dr. Wairua noticed immediately.
"Dawn, did something happen? You don't look okay."
Had I been facing any other attending I might have attempted a brave face, one that brushed off the ache in my chest. Dr. Wairua's demonstration of empathy demanded a different response.
"I just learned that my dog ... my dog was hit by a car last night."
Given that Dr. Wairua was likely anticipating hearing that something horrible had happened to one of our patients, the intensity of her response surprised me.
"Oh, Dawn! Oh no! That is so awful. I am so, so sorry." She put her arms around me just like I had seen her do for so many others, granting me permission to cry.
"What's her name?" she softly asked.
I so appreciated that she used the present tense.
"Kaya," I said.
"What type of dog is she?"
"Husky," I said.
She hugged me more tightly at this response. "I've had huskies. They are such amazing dogs." Then she let go of our embrace and instead positioned her hands on my shoulders with her arms straightened so she could look at my face.
"Dawn, you should go. You need to go. You need time. Give yourself some time."
Dr. Wairua could see what I had yet to understand: bearing witness to grief is what gives its healing powers permission to emerge. Without acknowledgement, grief becomes suppressed, and its ability to heal becomes constricted, constrained and concealed.
As much as I personally benefited from Dr. Wairua's attention to grief, her approach was unique. When under the tutelage of other attendings, my ability to support the grief of others remained constricted, constrained and all-too-often completely concealed.
****
Marvin never wavers in his conviction that his cancer is going to be cured even though he has been in a hospital isolation room for over two months. He is 45 years old, and Kayla, his wife of 20 years, and their 14-year-old daughter, Cynthia, constantly bring him new photos of his beloved Doberman pincher, Peabody.
"Doc," Marvin says, "I know they're going to be clear this time. I'm certain of it."
I just performed a bone marrow biopsy on Marvin., his seventh since coming into the hospital. Each of his previous ones were done at specific intervals, looking for evidence of remission, meaning only healthy cells were returning after chemotherapy had a chance to wipe everything else away.
Marvin has completed his third round of chemotherapy made up of an entirely new cocktail of medications two weeks ago. I was not present for any of his previous biopsy results. I have no idea what he was told each time the cancer cells returned. I am afraid that he believes he can just keep getting more chemotherapy. No big deal. I know that with each round of chemotherapy, not only is it becoming less and less likely that his cancer will ever go away, but also it is increasingly likely he will develop a complication that will send him to the ICU and prevent him from ever seeing home again.
"I'm going to take these samples down to the lab. As soon as we have looked under the microscope, I will be back to talk with you," I say.
Sitting around the multi-headed microscope in the pathology lab with my attending, Dr. Palum, I watch as he taps a few drops of immersion oil from a small glass pipette onto the slide. The delicate clinking sounded sweet, like a prelude to a wedding toast. Dr. Palum removes his reading glasses and begins rotating the dials on the head of the scope, eventually asking, "Dawn, what do you see?"
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