Learning and Unlearning

A few years ago, on the advice of a colleague and mentor, I went to see a therapist. My father had just died after a sudden but agonizing illness and I found myself not knowing what to do with this behemoth called grief. There were times I was so distraught, I couldn’t breathe. It was as if I was repeatedly being pulled underwater, submerged under the density of my sadness, no matter how ferociously I swam to reach the surface to catch my breath. 

“What will happen if you let the sadness come? What if you didn’t resist it?” my therapist asked me when I told him I couldn’t sleep, memories of my dad’s last weeks being so intrusive.
“Well, then I’ll keep thinking about him.”
“And then what?”
“I’ll feel miserable. And then I won’t stop crying for hours — feeling angry that I can’t talk to him anymore.”
“And then what?”
“I don’t know then what?”

This was getting irritating.

“Then,” he said knowingly, “You’ll stop crying and feeling miserable and angry.”

I remember just staring at him and thinking, for this I’m coming here once a week? He noticed my puzzlement.

“Shelly, the hardest thing to do is not think about something. Let it come, don’t avoid it. You’ll be okay.” 

So, I did. I let the grief come and sat with it, through it, in it. It was indescribably painful and upsetting. But, eventually, it was illuminating, interesting and revealing. I emerged from that time with a deeper understanding of how fortunate I was to have the father I did. I don’t think I would have landed there without the misery, the desolation, the despairing loss. My therapist was right; in the end, I was okay.

When I think back to March, when all our lives came to a halting stop, I was fine at first. It felt like being in some sort of strange experiment, the quirks of which I could tolerate, as long as I could be assured this would soon end and my normal life would resume. When it became clearer that “normal” was being redefined on a 24-hour cycle and was far removed from anything I could recognize or feel comfortable with, I was hit with an unpleasantly familiar sensation: I couldn’t breathe. It was as if everything I held as certain and true and reliable had turned to sand and I could no longer hold onto to it. The harder I squeezed, the quicker it slipped through my fingers. It was, literally and figuratively, out of my hands.

I used to be so proud of this one piece of advice I would give families whose loved ones were admitted to the ICU. “You’ve got to live in a new reality, where your time is reduced to 12- and 24-hour intervals. It’s so difficult to predict what will happen beyond those timeframes so it’s best to set your expectations within those shorter periods.”

I truly believed this was helpful. That is, until I had to take my own advice.

As it turns out, it’s agonizing to be compelled to reset your definition of the future to short bursts of time. Particularly for people like us, ones who have built their careers around what is coming next — the next exam, interview, application, grant, promotion, meeting, patient.

Needless to say, uncertainty in my day-to-day existence felt like an entirely different animal than the scientific uncertainty we contend with in medicine.This, I was not good at. I was frustrated, impatient and upset with everyone. It was a short trip from that to anxious, hopeless and demotivated. It was an even quicker journey to guilt. And then shame.

What kind of monster am I? 

When so many have lost so much and face losing even more, how could I not be awash in gratitude for the health of my family or the security of a stable job or access to all I needed to get through each day? How dare I feel anything other than lucky? And yet, all my attempts to snap myself out of my abyss and into a more graceful place of appreciation were fruitless. It was a switch I couldn’t flip; I was in a hole I couldn’t pull myself out of and so ashamed that I was stuck there. 

Sitting in our discomfort is something we physicians don’t do well with. It runs contrary to how we were trained to see ourselves; we are doers, finishers, fixers, diagnosers, testers, examiners, thinkers, solvers, achievers. We keep moving, and we take our unresolved and unexplored losses with us, trying desperately hard not to think about them. We’ve learned how to succeed, not how to suffer. And now, during what is arguably one of the most difficult experiences any of us could have imagined, it’s no wonder so many of us are struggling with navigating the difficulty. We know how to manage a crisis, we just don’t know how to feel about it. 

We’ve learned how to succeed, not how to suffer. And now, during what is arguably one of the most difficult experiences any of us could have imagined, it’s no wonder so many of us are struggling with navigating the difficulty. We know how to manage a crisis, we just don’t know how to feel about it.

I had to remember the lesson from my days in therapy — that pain and acceptance are inextricably linked — to finally emerge from the paralysis that had overtaken me. I had to allow for my own grief and anger to surface so that I could confront it, understand it, appreciate it and then move forward. More importantly, however, was the lesson that I had to unlearn, one that we’re all better off unlearning: comparing our wounds serves no purpose other than to render true suffering unworthy of compassion. We do this on the regular in our world; when we utter the classic Things were so much worse when I was training, what are we doing other than nullifying the painful experiences of another? Interestingly, today, it is all of us who are nullifying our own suffering, deeming it unworthy of compassion by willing it away with guilt or shame.

It is undeniable that we have all lost something in this moment.

Grieving our losses, mourning what we once had before it was taken from us, in no way diminishes our ability to feel compassion for others who have been hit more harshly and cruelly and irrevocably. In fact, if we were to finally put into practice what good evidence and common sense has shown us, and have compassion for ourselves, our ability to provide compassionate care will grow. Like fear, grief and anger are the overt manifestations of something deeper, something worthy of more exploration and understanding. And, like the practice of medicine itself, our most painful experiences are difficult and also amazing. The reward for sitting with the pain and discomfort of our own private grief is the revelation of the amazing, all those things I wanted to feel gratitude for but couldn’t until I first reckoned with the difficult.

To quote a wise person I used to see on a weekly basis, “Let it come. Don’t avoid it. You’ll be okay.”