A Medical Student's

Love Letter to Grief

– By Neha Pal, B.S.

4th Year Medical Student

I didn’t cry at my mother’s funeral; I think of that often.

In our culture, when a woman dies young, we dress her as a bride before cremating her. I remember walking into the backroom of the chapel, my mom’s friends huddled and whispering their concerns that I’d have to see her corpse again. I felt no less fine than I had since her diagnosis four months prior. The group had decided to put makeup on her to “give her some color,” the absurdity of which was not lost to me, and there was a moment of pause. No one wanted to be the one to touch her. Her best friends looked at me like they were scared I’d fall apart.

Looking back, I know those women, who loved me so dearly, wished they had it in them to spare me this final act. I took the lipstick and rubbed some pink on her cold, leathery cheeks. Stepping back, I found that she looked like, well, a dead woman with lipstick on her cheeks. The women surrounded me and hugged me, tears in their eyes as they told me how strong I was.

Later that night, when our home was

crowded with friends and family, I

almost fainted in the bathroom.

Vasovagal syncope, I’m told, the body’s response to extreme emotional distress. Upon learning this, I was relieved. I was relieved that at one moment in time there was physical evidence that I felt something that day.

I’ve been called strong more times than I can count, and lately I wonder how true it is. I was strong enough to become the decision-maker, the caretaker when I needed to be. Everyone around me seemed overwhelmed with sadness, and I felt that I couldn’t add to it.

Now I feel as if I went too long without

the strength to face my own grief, the

reality of what I experienced.

I am so different than I was, now with a knowledge of medicine and death that feels like a burden. I know what it is to be on the other side of bad news, to envy the physicians who could weave in and out of my mother’s day while I felt stuck. I have, at times, found myself unable to forgive the most human instincts in the people I love. I have held the hand of the most important person in my life, knowing our time together was somewhere between fleeting and borrowed.

There is a price caregivers

pay for being strong.

We do what needs to be done,

but the longer our emotions are

suppressed for the sake of our

loved ones, the harder it is

to connect with them.

We are the front line for that person, and having a bad day just isn’t an option. But when that person is gone, and there are no insurance companies to argue with, no rushed drives to the emergency department, no little fires to put out at home ...

... you find that you are wholly

unprepared for the inevitable.

There is a newfound freedom to, quite simply, feel, and you find yourself unable to feel much of anything.

I was a first-year medical student when my mom was diagnosed, and I took a leave of absence to be with her and the rest of my family. My return to school was enveloped in the fear that my loss would make me “less than” within the uncompromising walls of a hospital.

To my surprise, every single day I am

surrounded by physicians and students

who themselves struggle with grief.

I hear it in the way our voices change and become harder, more clinical when we talk about our negative outcomes—the way our snarky comments about people not taking care of themselves make it feel just a tiny bit easier when we watch them suffer. Although I am not excusing this behavior, I find myself unable to look at my colleagues from some sort of moral high ground. After all, at times I viewed my own mother as “stage IV cholangiocarcinoma” to survive the most trying time of my life.

Grief at its core

Grief at its core is a contradictory thing—it hurts to feel it, and it hurts even more when you don’t.

I couldn’t give you one specific reason I, or anyone else, would want to hide from our grief. Perhaps as physicians, we cannot extricate grief from the feeling that we failed our patients. Perhaps, as humans we hide because it feels selfish, because our grief appears to serve no one but ourselves. Perhaps it is that we are much more comfortable with feeling guilt than with the act of healing ourselves.

My own path to accept my grief has been slow and riddled with self-made hurdles. It’s taken well over two years and the forced stillness of a pandemic to make the progress I have.

What I can share is this:

If tragedy is shattering your life into

a million pieces, grief is the opportunity

to put it back together—never the same,

but not so different as you’d feared.

Grief is a pain we carry with us, a

remnant of something beautiful that

we were once lucky enough

to call ours.

These days my own grief is a familiar friend. She is my shadow as I walk the halls of my hospital, as I enter the rooms of patients. She is present in every interaction I have, and yet I want her to be just mine.

Reprinted from JAMA April 5, 2022 

“A fight is going on inside me,” said an old man to his son.

“It is a terrible fight between two wolves. One wolf is evil. He is anger, envy, sorrow, regret, greed, arrogance, self-pity, resentment, lies, false pride, superiority, and ego.

"The other wolf is good. He is love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, and compassion.

"The same fight is going on inside you.”

The son thought about it for a minute and then asked,

“Which wolf will win?”

The old man replied simply, “The one you feed.”