A common question I get as an oncologist is this: "How do you deal with the sadness of your work? How do you cope when your patients die? How can I remain a caring clinician and protect my health?"
First, I hope you know that there is a lot of joy in medicine across all fields, including oncology.
More often than not, my patients find ways to tell jokes and make others laugh, even in the face of serious illness. My patients often have a perspective that others do not. They know how to live. Time is precious to them. They have an incredible ability to find joy amidst hardship.
I also experience loss and grief in my work. As a gastrointestinal oncologist, I care for patients with some of the most severe illnesses, like pancreatic, liver, stomach, and colon cancer.
Some of my patients are very young when they die. Some of them have young children.
Early in my career, I received some advice recommending compartmentalizing or disconnecting from patients. However, whenever I tried to do this, it made my work feel meaningless. I lost motivation to come to work if I wasn't connecting with my patients and getting to know them as people.
I've learned that I'd rather deeply connect with my patients, even if this means that the grief will be more profound if they pass. Many of my colleagues have found the same to be true for them, too.
Here are some coping strategies that help me when I face grief and loss in my work:
1. Allow space for healing, and know this is often not possible in the middle of a clinical day.
It can be jarring when a patient unexpectedly dies, either in the hospital or if you learn of their death while working in the clinic. It's hard to know what to do with your emotions at this moment. Often, I have other patients I need to see immediately, other staff who rely on me, and learners in my clinic.
If it's a particularly difficult loss (a patient I was very connected with), I may take a moment to go to the restroom and allow myself to briefly cry and honor that person's life.
More often, I reserve space for this processing after my clinical work is done.
2. Find ways to process the deaths of patients
There are many ways you can process and cope. For some, that means talking with your clinical team, debriefing (especially if an unexpected or traumatic death), and remembering them together. It can also help to talk to their family or loved ones, either in person or over the phone. My team and I try to do this as much as possible, thanking the family for allowing us to be part of their lives.
I also take time to remember them on my own. This can look like taking a few minutes of silence on your commute home, thinking of them, and saying a prayer. You could go for a walk and honor them. You could journal in a HIPPA-compliant way (no names or identifying details). I do this a lot. You could light a candle. You could write their name in sand or a whiteboard before wiping it away.
Having a ritual to help you cope can be helpful.
3. Consider therapy
One of the most helpful strategies for me is talking to my therapist.
Before I started therapy, I used to talk to my husband about patient losses. While he was very supportive, I didn't want to always put this burden on him. I wanted to have other support in place, too.
My therapist provides a space for me to discuss my patients in a HIPPA-compliant way, and she helps me cope. This has been particularly helpful in situations where patients have died unexpectedly.
Having a structure in place before you need it (especially with therapy) can be very helpful.
4. Make time for the things that restore you
A "normal" day for us in our work is not normal. We witness illness, trauma, and another person's final breaths. While our work is important, it can take a toll on us.
Do something each day that restores you, even if it’s for only two minutes. For me, that’s laughing with the people I love, going outside, cycling or doing yoga, spending time in my garden, petting my dog, writing, and reading books that inspire me.
Don’t forget your humanity along this journey.
5. Honor the patients you have lost by living well
The people you have lost will stay with you. Their story is now part of yours. Honor their lives by living well.
Be present in the moment. Make time for the people who matter most. Laugh each day. Spend time in nature. Be grateful for the days you have. Be grateful for your health and relationships.
One of the most meaningful ways we can remember and honor our patients is to be fiercely present in life.
Sending you peace as you navigate through loss in your work. It's hard. Some days are extremely hard. Know your work is important, and keep carving out ways to cope.
xx
Laura