One of my more difficult, draining and yet rewarding consultations in general practice has been one centered around grief and loss. I saw a new patient who had moved to the area with her husband just over 12 months ago when they had both just retired in their early 60s – soon after, he was having elective surgery and tragically he died suddenly after the operation from an unrelated cause. She then had a heart attack on that same day and required urgent cardiac stenting.
My heart ached for her. Needless to say, she was still struggling somewhat with all of this, about 15 months down the track. What could I say? I did my best to listen and offer support. She was thankful for the 45 years of a wonderful marriage relationship with her late husband, and for the children they raised together, but it was partly the fact that she knew just how much she had lost which made it so difficult for her to keep on keeping on. She felt guilty that she had outlived someone she saw as such a great person, with so much to offer to world still.
We both agreed that the pain of her loss will never completely go away – she will never ‘get over it’ or ‘move on’, but she will learn to live with the grief – the alternative being not to live at all. I realised however, the shameful lack of counselling skills I had been taught in medical school, even though by the end of the consult, rapport was good and she thanked me for listening. I wished there was more I could do to assist her. I felt terribly helpless – and she knew I could not do anything to take her pain away.
So is there such a thing as ‘good grief’? Can one ‘grieve well’? What are the principles of counselling someone suffering with grief?
I would love to hear your thoughts.
GreenGP 
Great post, Mel. I don’t have anything to add with regards to the right way to go about grief counselling but I’m sure your patient would be really appreciative of you just taking time to listen. I, too, have sat with patients in all sorts of heart-breakingly difficult circumstances and it is difficult to fight the urge to “fix it”. But perhaps sometimes, the thing they really need is to have a space where they can convert all of their tumultuous feelings and thoughts into words without fear of being a burden or of being judged. And maybe the only thing we need to say is “anytime you need to talk, my door is always open to you.” Keep up the great work, Mel. I can’t think of a more caring GP for helping their patients in times of great emotional need.
Grief hurts ‘cos we have lost something we care for … the stronger the attachment, the greater the loss
No, I don’t think something painful can be made ‘good’. It hurts because we care, we feel the loss because our lives have a hole, an emptiness. Grief is an emotional journey and getting stuck is a risk. Grief can be balanced and accepted but you’re right, you don’t ‘get over it’. You can learn to live with it and carry it with you, though
BUT this doesn’t mean its a bad thing. It’s there as a reflection of our loving nature. It’s the balance that exists. The only way to avoid the grief is to avoid the care and love in the first place
As Health Professionals, we can listen, we can explain [if needed], we can educate [if appropriate] but above all we can be simply present with our patient as a person. We can represent a constant, reliable influence for some; we can be a confidant for others
There is nothing to ‘fix’ here, there is nothing to ‘treat’. This is an opportunity to be with our patients, at a time when often they are at their most honest and vulnerable. Ironically, it is often a time when you can develop the greatest trust and connection as well
Frankly Mel, you don’t need special teaching for this – be open to their story, don’t judge or try to fix things, allow the time to happen, try to recognise your OWN feelings and reactions [and not project them on to the patient] and don’t try to fix what is normal, unavoidable and probably necessary.
Listening to the patients losses often is reflected in recollecting our own – that’s what gives empathy and compassion – but remember you need balance and compassion too. When you are done being ‘the doctor’, remember to be generous and kind to yourself and let Mel the person be nurtured as well.
Phil