Friday, March 22, 2013

Join the club.

San Francisco Coffee Roasting Company

I am changing, trying every way I can.
I am changing, I'll be better than I am.
I'm trying to find a way to understand.
But I need you, I need you, I need a hand.

I am changing, seeing everything so clear.
I am changing, I'm gonna start right now, right here.
I'm hoping to work it out and I know that I can.
But I need you, I need a hand

~ from Dreamgirls


Today I spent part of my afternoon hanging out at the San Francisco Coffee Company having java and conversation with Anna H., one of our medical students. Anna is starting up her final year of medical school so we were trying to situate her schedule which was pretty much already together. That allowed us to move on to other things.

We somehow got on the subject of suffering and how that affects us as caregivers.

"I think losing my sister changed me," I told her. "Like. . . I don't know. . . . I somehow feel more connected to people who have loss and less like I'm watching a sad movie."

So Anna, in her thoughtful Anna way, looked at me intently and let that resonate before she spoke. And, like always, her words were selected with care. "Do you think that we have to endure some kind of suffering to really be effective at what we do as physicians?"

That question was a heavy one. It was. It was also a fair one because I'd said to her before this that I thought, after going through all of that, that such unspeakable grief had changed me and made me a more empathic doctor. We discussed how having your own kids helps you as a pediatrician or how having your own baby makes you better understand labor and relate to your patients more.

But this? This idea that you need to suffer and feel like the skin was ripped off of you to really and truly "get it?"  I wasn't sure of the answer to that.

I'm still not.

"I guess if you live long enough, this is a club you'll be initiated into. That or you'll do the initiating for someone."

And despite this macabre notion, Anna nodded in agreement.

"You know?" I said, "Now I say a lot less. I don't feel the need to fill the space with words because I know what helped me and what didn't. I just sit and listen and touch people more. I do say things but I'm more careful. And even though my urge to cry in front of my patients has shifted, my heart feels much more aligned with their feelings. Does that make sense?"

"I think so."

I wasn't even sure if it all made sense to me. But that's how I feel. It really and truly is.

There is this club. This club that has been quietly existing around me that no one really talks to you about until you find yourself thrust into the first meeting. Something happens--like losing a sibling or a parent--and fellow initiates come quietly out of the shadows. They give you their testimonies on tiny handwritten cards or in hushed hallways. Their eyes look different. Their words peppered with things you'd never heard because you weren't privy to such discussions.

Not before you entered the club.

I specifically said a parent or a sibling because I think losing a child or a spouse is altogether a different animal. I am careful not to ever relate my experience with Deanna's passing to what a parent has to walk through after funeralizing a child. Losing your child is so unnatural and out of order that, even as a member of this club, just a few moments of quiet reflection tells you that nothing about it is the same.


Several of my colleagues wrote me heartfelt notes in those weeks after Deanna left us. People I'd worked with shoulder to shoulder for years who I know very well. But I didn't know they were in this club. At least three spoke of losing siblings suddenly. And prematurely, too. They knew of the longing to call and recount old stories that only a sibling could laugh over. They knew of the agony of watching parents with distant, glistening eyes and the helplessness that follows because that club--that parent-who-lost-a-child-before-them club-- is altogether different. They knew. And before that, I had never known that they did.

I don't know if suffering is a necessary component for truly empathic doctoring. (It certainly helps song writers, that's for sure.) But I do know that the more we see ourselves in our patients and people in general, the better we can relate to them. And sometimes that's when they are suffering, yes. But other times, it's something else.

And no--not in that purely hypothetical watching-a-sad-movie kind of way, either. But in that way where you feel somehow intertwined and like your humanity is a continuum.

This is what changed in me on November 15. At least, that's what I think.


I was just thinking about this and wondering about Anna's thought-provoking question. I'd love to hear your thoughts, too.  And if I haven't said it recently, I deeply, deeply appreciate every single person who comes to read here. This has also made me a better doctor and person. We, too, are intertwined; our humanity is a continuum.

It is.

Happy late night Friday almost Saturday.

Now playing on my mental iPod. . . . . "I Am Changing" from the Dreamgirls soundtrack. Interesting. In this moment, I just remembered that Deanna loved this song. That just made me love it more.


  1. I totally agree with this feeling...I just never ever knew sorrow before I lost my dad. I am such a different person now you...Just too much to go into here but you pretty much said it all..when you lose someone you really love your life changes forever and if we can take those changes for the good then that truly honors their memory. And I try not to compare my grief with someone that is going through it...just the other day my cousin's family were having troubles and I told my mom "let them is their time to tell their story"..xo

    1. I love the idea of giving someone their time to tell their story. That's beautiful. It did comfort me to hear that others had been there and were quietly muddling their way through the rubble. But it is their rubble just like this is mine. Talking about it without trivializing the individual parts is important.

      Thanks for this, as always.

  2. From the deck of the Poop,
    Good morning Dr. KD,
    I woke up this morning about 4:30 which as you know is not unusual for the ole PoopDeck . I decided to get up and do a little reading. I came downstairs, made me a cup of coffee, got me an oatmeal square and proceeded to my favorite reading spot. "Mattie's spot. I spoke to Deanna, "hi Plinko", took my seat and opened this blog. Yikes!!! I don't know if you remember my attempting to describe the feeling I had when my big girl left us. As I recall, I said it was as if someone had reached into my chest cavity and grabbed my heart in their hand and just squeezed it as if they were trying to squeeze the life out of my body. I've lost my mother, father and seven sibling. For me, those paled in comparison to losing my daughter. I walk through my living room and look over at her " mini-shrine" , "she had so much that she wanted to do, why did she have to leave". Sometime I cry, sometimes I smile.
    I just know I don't want anyone reaching into my chest cavity again and pray that my children with children never have to experience that either.

    Now in the words of Sojourner Truth, "bilge y'all for listening (reading) but ole PoopDeck done said all he got to say"

    1. Poopdeck, you put it beautifully. I love you and I think your "shrine" to your first born daughter is a beautiful, beautiful thing. And the thought of a claw coming into my father's chest is just about more than I can bear.

      I love you, Dad.


  3. I think suffering deepens empathy. I remember that line from Wordsworth that seared itself into my brain the first time I read it: "A deep distress hath humanized my soul." But you? You were a good and caring doctor before losing your sister. I wish you never had to consider this question in this light. Arms around you, sweet friend.

    1. I love that quote and I feel those arms. Thanks.

  4. The first death that knocked me to my knees was that of a very, very close friend of mine. It changed me forever. It taught me about death and it taught me not to be so afraid and it taught me a million things.
    I tell you what, though. I hope never to have to learn what your parents learned. I realize however, that we don't get much choice in these things. I send love to all of you, knowing as I do that time does not heal all. And it has been such a short time. You are all blessed with each other and the love therein and I guess that is the thing that gets you through.

    1. Somehow your words always soothe. So thank you, okay? I mean that.

  5. I am so sorry for the loss of your sister and I don't wish that suffering on anyone. I do think having experienced such suffering has to make you a more empathetic doctor. It has to unless one closes down as a result of the suffering. I agree with Angella that you were a doctor who connected with her patients before you experienced your loss but I also believe the experience made your heart even bigger. I think loss/pain in your own life can be used for good and I think you live that goodness every day that you connect with your patients. Does that make sense? S. Jo

    1. That makes perfect sense to me. Thank you, Sweet Jo.

  6. Anna's question has been a frequent guest of my mind, in quiet moments on wards and in clinics, over the past 2 years of medical school. I have asked it in both directions - does personal suffering make someone a better or less effective clinician?

    Growing up with parents who struggled with depression (and more), losing two parents, being the victim of assault, are all threads that are woven into my worldview and inform my thoughts and actions. I spent a lot of extra time at the hospital, visiting and revisiting my patients. As and example, during my medicine rotation I rallied a number of people and spent the better part of a week getting resources and organizing the logistics to give a child, who could not come to the hospital, the chance to spend time with their dying parent.

    Did my past affect the A&Ps I made for my patients in a positive or negative way? I don't know. Were my actions something I felt I simply had to do? Yes. Did they make me a better medical student? I am not so sure - I could have spent that time reading to fill at least a few of my innumerable knowledge gaps, so I could be faster and more accurate in diagnosing and treating my patients in the future. Did they make a difference to my patients at the time? On an emotional level - I hope so, but clinically - I don't know, though I read this article last year and felt hopeful

    The one definite benefit of being in the club, is the comfort and ease with which I can be in the presence of illness and loss, listen to people, and speak with them.

    1. Thanks for your thoughts, WCD. I always appreciate your input.


  7. One of the sayings that I like and that fits for me as a therapist and seminarian is, "for it is through the cracks of our soul, in the scars of our skin and the sutures of our heart that the light comes in through the darkness". We are the light for one another in the darkness. We are all grieving some loss and although we cannot compare the level of grief, we can sure empathize with the soul sucking power of it. I would have never asked for the losses that I have received, but I actively choose to reinvent myself around these losses to be of service to others. We are constantly being presented with someone(s) that need mending and we have the skills and compassion to help them in their broken places because of what we have been through. I never would have wished that your sister died or that your parents would lose a precious daughter, it doesn't make any kind of sense, but it sounds like you are using that experience to be the light for others, what more could you ask for in such a solemn situation?

    1. Aaaah. Thanks, Jill. I'm hearing so many beautiful quotes today. Yes. Grief has "soul-sucking" power. If you let it, it does.

  8. My mother died when I was 16, suddenly, but of a chronic disease (alcoholism). It was not what I would have chosen for myself, but I do think it made me a more compassionate nurse and surely shaped my choice of career. If you reflect on your life's experiences, as you do, I think it helps you be the light for another in the darkness as Jill says. You did that before your dear sister went home, but it is a richer understanding now. That is the best we can hope for from a horrible situation. I pray for you and your parents daily.

  9. I urge you to watch this youtube video

    It is called "Empathy" and was presented by the CEO of the Cleveland Clinic to his staff the end of Feb. this year. It may answer your question, it will definitely speak to your heart.

    I have never met you but you hold a special place in my heart. thak you for being such a caring doctor.

    with Hope,
    ~ Chris A ~

  10. I know my losses have made me a better therapist to my patients, more able to tolerate suffering because I have lived through my own. And a dear older friend reluctantly *welcomed* my husband and me to the cancer club when my husband was diagnosed with a serious cancer several years back. At the time I found it a strange statement. Since then I have discovered what he meant. Suffering is a part of the human condition. So are joy and love.


  11. Miz,
    Had to wait a day to reply to this one... Being a member of this club kinda sucks, but I know how you feel. Part of my struggle has been when other members reach out to me, and I didn't even know they had lost a sibling, I'd think, "Why didn't I know that?? How did I not know my friend had lost a sibling??? What kind of friend am I to not know that?" As time goes on, I realize that it's not the kind of information I volunteer to everyone. Half the the time I talk about her in present tense like she's still here... because I don't feel like having the conversation about losing her and breaking down. But I am thankful for the people God put in my life who have gone through this already. Darneika & Tangye were life savers for me (and still are...) I was at such a loss when they lost Darrius so suddenly. Had no clue what to say or how to help. When we lost Deanna, Tangye told me that one of her best friends had lost a sibling maybe a year before they lost Darrius, and that friend helped her. So she payed it forward & helped me... and one day, unfortunately, I will pay it forward to some other new club member. She told me God prepared her to hold my hand... and she sure does do just that.

    Well, I'm rambling... I miss you, Mizzy. And I love you.

    Your Sister,
    Bumble Bee

    1. I almost called you yesterday because I knew you'd read this and that it had affected you. I'm glad you chimed in. I love you and am glad that we have each other's hands to old and phones to call about the things only a sister would understand.

      xo, Miz

  12. I think every kind of suffering brings you closer to other people, if you allow it, because there's always someone who has been there before you. When I had panic disorder in my 20s, I felt so much more empathy for people with mental illness. When my son was diagnosed with autism last year, it opened my awareness to a whole world of parents of kids with special needs. I can't say it's an experience I would have wanted, because it is a persistent source of grief and stress. But it has made life seem much more precious somehow, and also made me deeply appreciative of all the millions of people out there who devote their lives to helping kids like my son. People who could have made a lot more money doing a cushy office job but chose instead to do hard, often thankless work every day to help others. And, paradoxically, although I am stretched thinner now than I ever have been in terms of time, energy and money, I actually give more of all of these to others than I ever have before.
    I do have a lot less patience with selfish people now, though. :-)


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