My mom’s illness really started getting bad as I was starting on internal medicine. She would occasionally call me and let me know bits and pieces of what was going on, but she was living across the state, and I knew she didn’t want me to know how bad it actually was. One week when I had two days off in a row, I drove up to see her and I realized how much weight she had lost, how little she was eating, how much she was vomiting, and passing out. She was having complex migraines too, but at that time, we didn’t know that was part of her disorder. We didn’t know what was wrong with her. When I was there that weekend, I thought she was having a stroke. One half of her face was lopsided and she couldn’t move her arm. I wanted to drive her to the hospital, but she told me that it happened all the time...it would pass. When it was time to leave, I cried. And then I cried all the way home. 

During this time, one of my patients at the VA was a man in his 60s with diffuse large B-cell lymphoma. He’d been at the VA for over a month. His daughter had left her job in Georgia to sit at his bedside. I would try and escape the team room every afternoon to sit with them and try to explain what the hematologist had said, or bring him puzzles. His daughter had brought pictures of her kids and lined them up against the window. I remember thinking that she was such a good daughter, and I was such a bad one. I was a bad daughter, and a bad medical student.

This month, Auxocardia is collaborating with a narrative medicine project exploring grief and grief education in medical curricula. Project director Erin Currey shares the following reflection, and asks for your contributions to this important new project.

“This too shall pass,” is the punchline of my favorite parable. The story starts with a great king who sent a message throughout the land, promising riches and wealth to anyone who could bring him an object that would make him happy when he was sad and sad when he was happy. A humble metalsmith won the prize when he brought the king a simple, gold ring with the inscription, “This too shall pass.”

This pithy moralism was my guiding principle throughout my clinical year of medical school training. Clinical year, or the second year of medical school at the University of Michigan, is when students complete their rotations through the major divisions of the hospital: Surgery and medicine, neurology and psychiatry, family medicine, pediatrics, and OB/GYN . Ideally, this rotation gives students a foundational understanding of the breadth of medicine before they begin to specialize. In reality, this year is a hectic time. Students are trying to find time to learn the fundamentals of clinical practice while working with new bosses and teams every 2-3 weeks and studying for end-of-rotation exams. Each rotation has a specific culture, and students have to rapidly move from the rapid efficiency of surgery to hour-long psychiatry assessments. Quietly saying to myself, “This too shall pass,” was my reminder not to fight the changes I had no control over. It helped me to remember that all my rotations, the ones I loved and the ones I hated, would not last forever. 

“This too shall pass,” was also my approach to managing my emotional reactions to my family’s illnesses. I had several family members become critically ill during my first two years of medical school, and two of my grandparents transitioned to hospice care. On my family’s good days, I yearned for our phone calls to last forever, listening to stories from my grandmother and hearing her reactions to my medical school antics. On bad days, I wept with frustration and powerlessness in the face of my relatives’ suffering. “This too shall pass,” was an internal acknowledgement that I needed to live in the moment to find joy and fulfilment in the time I had left with my loved ones. 

In medical school and my life, I was beset by changes I had no power to influence. What I could control was my learning. In response to my involvement with my grandparent’s care, I began to ask more questions about dying. I found myself drawn to patients with terminal illnesses, like someone afraid of heights who insists on peering over the edge of a cliff. At times I was nauseous with anxiety, but I was rewarded with a spectacular view of the immense depths and nuances of my patient’s lives for having the courage to lean into my fear of their inevitable deaths. 

My patients taught me uncountable lessons about death and loss. In one example from our stroke service, I worked with a patient who had suffered a massive stroke, likely due to his terminal cancer. The first day, we sat in silence. He intermittently asked me to explain and reiterate what he had just experienced, but mostly we sat together. The second day brought tears. He cried as the neurologist offered a painful choice between pursuing inpatient rehab and discharging home. Inpatient rehabilitation promised the hope of returning physical function, though we could not predict how much could return. In COVID times, this would mean weeks without physical visitation with his family. On the other hand, my patient could discharge home with hospice, likely spending the remainder of his days bed bound but physically with his family. When the attending left, my patient spoke of his dream to return to his home, walk to pour a hot cup of coffee, and watch the sunrise on the porch. The third day brought clarity of purpose. He elected to go to rehab to pursue his dream of being able to move between his coffee pot and his porch. This was griefwork, the emotional and mental process of grappling with loss. I have seen echoes of this patient, his struggles in the face of acute illness to articulate his values, in so many of my patients. 

However, I struggled to have conversations about grief with my fellow healthcare providers. I had no formal expectations set for me by the medical school about how to approach discussions about death with my residents or attendings. As such, I copied what I saw my superiors demonstrating - distant, clinical judgement that focused on “the facts'' of difficult cases and neglected any mention of my emotional reaction to the case. I assumed that I was alone in wishing we, as a profession, talked more about caring for dying patients and the impact that caring for the dying had on me, personally, as a healthcare provider. While the whirlwind of emotions I experienced during my clinical year is a natural part of grieving, the inexorable silence about grief, death and dying that permeated my workplace was not natural. This silence was built and enforced by physician culture.

One day, my own silence broke. I had to step away from rounds to take a call from home. Everything was OK; my mother had not realized I was working that weekend. As I rejoined the medical team, I mentioned to my fellow medical students that I always had to answer calls from home because two of my relatives were in hospice. The support I received from those classmates was immediate and unconditional. In response to the support I received, I started opening up more with my peers about my experiences of loss and grief, my sorrows and my fears. I found that I had numerous classmates whose experiences of death, in their families or witnessed in their patients, were impacting them emotionally and influencing how they approached clinical care. I had thought I was alone, but I was not. I began to wonder how many of us were trying to work up the courage to lean into our patient’s stories, and how many of us were struggling to understand how to process our own experiences of loss in the context of providing care to dying patients. 

“Coping with Crisis on the Wards” is a novel curriculum designed to introduce medical students to reflective journaling while providing education on grief, death and dying. This project stems directly from my experiences in my clerkship year. As part of the development of this curriculum, my co-investigator and I are facilitating connections between medical students and illustrators. The medical students are submitting stories about their experiences of grief to be captured in visual art. These illustrations will be featured in a self-directed workbook that provides education about the pathophysiology of dying, the process of grieving, and other topics related to end-of-life care for medical students. The workbook will also provide space for reflective journaling, a well established tool for increasing emotional literacy and engaging in meaning-making. 

Ultimately, the goal of this project is to increase medical student’s emotional literacy around grief. As a second year medical student, I struggled with knowing how and when to address my grief. However, my grief has made me a better healthcare provider because my peers gave me support and encouragement that allowed my struggles to be formative rather than destructive. Providing this support in a formal curriculum will standardize medical student education about grief and normalize discussions of how physicians experience grief in their clinical practice. Ultimately, I posit that medical students who are more literate in their own grief are better prepared to identify and respond to their patients’ grief. 

I am honored to have a story and illustration from this project featured in Auxocardia, and I encourage anyone interested in seeing the final workbook reach out to me at ecurrey@med.umich.edu.

Submit a Story!

The Coping with Crisis on the Wards project is accepting stories from medical students about their experiences with death and dying on the wards.

Submit here.

Enter the Contest!

If you’re interested in submitting art to be potentially featured on the textbook cover, as well as a $300 prize, please consider entering the Coping with Crisis on the Wards cover art contest.

Submissions & guidelines here.