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Coping with grief

file0001465861740Grief passes through us in waves, taking us over in rhythmic contractions. It can come over us at any time after we have experienced a loss, whether it is the death of a loved one, the ending of a relationship, or the change of a situation we had grown to be comfortable in. Whatever it is that we grieve, the feeling is the same. It is like a vice grip around our heart, as if an old bitter woman’s deformed fingers are clawing at us, reaching into our lungs, causing each breath to travel into us with the exquisite torture of knowing we are still alive while what we loved is not. Usually, if we stay with this feeling and breathe through it, we find that the old woman eases her grip a bit, forgetting us for a brief moment in her slumber. But eventually she wakes, and remembers.

This process of grieving is universal, and something we cannot experience without first calling ourselves human. It is felt at all ages and life circumstances. Grief is the cost of being alive in this world. At some point, we will lose someone or something close to us. And while we often grieve the absence of others, what is hidden within the layers of that grief is the sense that we have lost a part of ourselves. Even if we are grieving a loved one’s death, it feels like a part of us has also died.

What I have learned from experiencing my own grief, however, is that rather than representing a death, it actually is a form of giving birth. Grief is experienced in waves, like labor pains, contractions meant to bring forth new life. In the midst of a grief contraction, the only thing I can do is breathe. I focus on my breath, allowing it to flow through me along the waves of pain I feel that travel through my body in a very physical way. Eventually, the contraction subsides and I am fine again, until the next wave. Intense periods of grief consist of these contractions that may occur over a period of days, weeks or even years. It will last as long as needed to birth what is wanting to be born. The more we turn away from it, the longer our labor; and those who never face it may even die with a part of themselves trapped within, yearning to be allowed even one breath of this wonderful life.

Grief is a process that the spiritual and physical body undergoes to bring new life into this world. The life we choose to bring forth is up to us, but it will usually be greater than anything we could have imagined.

To anyone experiencing a loss, here is a guided meditation that I have found helpful for myself:

Breathe through the waves of grief you are feeling like a mother in labor breathing through a contraction. Let the feeling pass. Once you find stillness, ask yourself this simple question: What am I birthing into the world right now? It’s ok if no answer comes to mind, or if several come at once. The point is to acknowledge that you are in a transition phase right now, between death of the old, and life of the new. You have the strength and courage to accept all of your feelings, no matter how painful they may be, because you are delivering into the world a part of yourself that is very much loved and needed at this time. Envision this part of you existing right now in the core of your being. Breath into your core, relaxing your body, so that you can allow this new life to emerge.

How I lost my spirit in medicine (and what I did to get it back)

file1291253622910Over the past several years, my perspective on myself and life has slowly undergone a shift. In my late teens and early twenties when I was going through medical school, I felt like I had little time to work on self-development and so I didn’t. I figured going through medical school was development enough, and in some ways it was. I pushed the limits of my knowledge further than I ever had before. I accepted that I wasn’t the “best and the brightest”, in the group of talented individuals I was blessed to call my peers. But what I didn’t realize happening was that I was slowly becoming a more and more negative person. I was surviving in a difficult environment, and when we are thrown into survival mode often our perception of threats looms much larger than it should, because it seems our life depends on it. When we become adept at identifying potential threats, we stop living in a balanced world and instead blend into the negativity the way a chameleon blends into the leaves he hides behind.

There is probably no other training out there more efficient in making a person feel inadequate and small as medicine. It’s unfortunate, because this is the profession based on teaching and healing others. No doctor should come out of the process worse for wear, no matter how much information they have to memorize and how sick the patients are that they see. But what often happens is that we enter our esteemed profession with a more negative mindset than what we came in with. We now try to anticipate all the things that can go wrong, not just with our patients, but with ourselves as we are learning. What if we get asked a question that we don’t know the answer to, and it’s the mean attending on rounds today? What if in our attempt to learn a new procedure, we screw it up and get yelled at, or worse, cause harm to the patient? And in some scenarios, the questions are even harder to answer, especially for women. What if we are sexually harassed by a superior? When I was a student, a surgeon used my body as a sweat rag for his forehead in the middle of a case. Years later, a chairman inappropriately placed his hand on my thigh when asking me a question. Worse has happened to other women. If that doesn’t teach you to survive by being on the lookout for threats, I don’t know what will.

It wasn’t until I made it out of residency and fellowship training that I finally could take stock of what I had even been through for the past decade. I was looking at a landscape within myself that I didn’t even recognize anymore. I finally had the time to evaluate what teachings I wanted to keep from that time, and what I wanted to throw out. It was a mental and emotional clearing of my closet (or medicine cabinet, if you will). I got rid of any thought that I wasn’t smart enough, I wasn’t good enough, I wasn’t a hard worker, I had to get everything right (especially the first time), and that if I didn’t know the answer to something then that meant I was a failure. None of those thoughts were original to my self-concept when I started medical school, and yet each one had grown its roots into my psyche by the time I started private practice. It’s one thing to prepare future physicians for the stresses they will face in their medical careers; it’s another thing entirely to short circuit their brains with fear and negativity.

What I wish I had known back then, all those years ago, was that I didn’t have to go through the experience like velcro for other people’s negativity. I was sensitive and young, and took very seriously my experiences with those who were older and wiser. It took several years before I realized that attendings, professors, senior residents or even administrators were still capable of acting like children, ruled by their egos. Because I gave them all the benefit of the doubt, and myself none, I learned a way of being that ultimately kept myself small and dormant. This is not to say that everyone experiences what I went through, but those who are more emotionally sensitive (often women) share similar stories. Practicing meditation, self-compassion, loving detachment and other stress resilience techniques might not have changed my circumstances, but they would have helped me cope with them more effectively, leading to a lot less suffering. I was detached from my spirit, and only reconnected to it once I had time to breathe.

No one is perfect, and this career takes a toll on everyone. You can’t go through medical training and come out the same person as you went in, nor should you. What we live through changes us on a fundamental level, but if it isn’t changing us for the better, how can we really contribute to positive change in the world? It’s not a lofty or naive goal at all to go to medical school in hopes of making a difference in the world. I would hope that most of us in medicine are humanitarians on some level. After years of delayed income, sleepless nights, mental and physical strain, and often failed relationships in the process, it’s certainly not all about the “money”. There is a deeper purpose, a spiritual seed, that is ready to germinate and nourish ourselves and others, but only in the right conditions. It is the responsibility of each individual involved in medical education to understand that ultimately, we are all in this together for a purpose larger than ourselves.

In any circumstance we face, there is truth and there is illusion. Differentiating between the two in my medical career has been the only way to keep the strong connection to my higher Self, while progressing in an institution that is still very much in its spiritual infancy.