Grief 13

G rief is an inevitable part of life. We grieve our own per-

sonal losses and at times we grieve for the deaths of
patients we have encountered through our work. We wit-
ness the grief of patients’ loved ones and are often called to
offer comfort and support. As health care providers, we are
expected to effectively deal with our own grief so that we
don’t become overwhelmed by it, and so that we can remain
emotionally available to patients and families. This emotional
availability requires of us the capacity to move through our
own periods of mourning in a manner that is thoughtful and
constructive, and yet rarely are we taught how to do this.
Mindfulness provides some useful principles.
Deliberate self-assessment is the first step. Acknowledging
our losses and considering their meaning help to leave us
more open to further our self-understanding. Mining our
inner experience for both obvious and more subtle emo-
tions helps us uncover hidden feelings. Bringing these feel-
ings forward to be examined in Reason Mind, where they
can be viewed from multiple perspectives, made sense of,
and processed, is the next step. In Reason Mind, we bring
in facts to consider and place our emotions in context.
 III. Everyday Manners in Difficult Clinical Situations

Wise Mind allows us to appreciate our experiences, accept

our vulnerabilities, and move back into the patient care
arena with a sense of renewed capacity for shifting our
focus outward again.
Lindsey Moore is a seasoned oncology nurse. She
works as a nurse navigator with patients diagnosed with
breast cancer. In her role, she manages a large caseload of
patients and oversees the coordination of their care across
medical-oncology, surgical-oncology, radiation-oncology,
and other services. Recently, several of her long-term
patients have entered the end-stage disease phase of their
illness. Lindsey has known many of these women for 5
years or longer. Through her work she has come to know
their partners, their children, and some of their siblings.
She is considered by many of them to be a critically impor-
tant part of their illness experience. Two of her favorite
patients died in the past month. For one of those patients,
she gave the eulogy at the patient’s memorial service.
In the past week, Lindsey has found herself tearful and
apprehensive during her morning drive to work. She is
short-tempered with colleagues, demanding of lab person-
nel, and emotionally distant with her immediate supervisor.
She is counting the days until her 2-week vacation but the
departure date is still months away. She avoids return-
ing patient phone calls, then finds herself stuck late at her
office, trying to catch up. She’s been saying things to her
husband like “What’s it all for? All this work and effort
and energy and they just die anyway! I thought I would be
working on a team that saved lives, but it seems like all we
do now is attend funerals.”
Lindsey is tired, overwhelmed, and no longer able to
maintain a balanced perspective. She is lost in her emotions
and struggling to make sense of her experience. Her dis-
tress is leaking out into her work but she’s not consciously

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 13. Grief

aware that her attitude is serving only to aggravate the situ-

ation. Her suffering is palpable but her insight is obscured.
Were Lindsey to move into a state of mindfulness, she
might be able to begin to “unpack” her distress. The con-
nection between her change in demeanor and the deaths
of two important patients might be more obvious to her.
Her grief, her anger, her sense of disappointment, and
her frustration would be more accessible. Having identi-
fied these, she might be able to see that each one of these
emotions is valid, a natural part of grieving. She could talk
about these feelings with her supervisor or her husband
and unload some of the strain she is experiencing by hold-
ing these emotions inside. With a body scan, she might be
able to sense where she is holding her grief and how it is
manifesting itself physically. She might also then see the
value in relaxing in a manner that is soothing, perhaps
through walking, yoga, or taking a bath. Accessing Reason
Mind might allow her to think clearly about the stages of
grief, the nature of loss, and the typical feelings that grief
evokes. And, eventually, when she is able to enter Wise
Mind, she can reconsider the perspective that she cannot
keep patients alive, but she can add significantly to their
quality of life and help immeasurably as they transition to
death.

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