An Overwhelming Need to Grieve

By Melissa Sparrow

It may come as a surprise, but I have found that residents—who may just witness death in more concentrated doses than any other individuals in this hospital—have the least opportunity to grieve. I am concerned about how this affects our sensibilities over the long run, and in turn, how it affects our ability to help others grieve.

The ability to grieve, I believe, is at the root of the art of medicine. To allow someone the psychological space and the opportunity to mourn a death is a willful act, not a passive one. It requires a combination of words and silence. Above all, it requires acknowledgment.

This need seems even more pertinent in the wake of the Sept. 11 attacks. We residents learned of the terrorist attacks during our workday, as we made rounds or otherwise took care of patients. We witnessed the devastation of the World Trade Center Towers and the people who worked in them on television sets perched like vultures in the corners of patients' rooms. We scraped up pieces of information from here and there as we continued our daily business, the way we learn most news of the outside world, in small caches and phrases, from someone else's source. And like perhaps many other groups in the hospital, we were told we could not return home that day until the "code red" declared by Dean/CEO Edward Miller had been rescinded. It eventually was.

The night of Sept. 11 one of my fellow residents learned, as she juggled the nighttime coverage of four pediatric services, that a close childhood friend of hers had been on the 101st floor of the second tower. She learned that after the plane had crashed into the building he and his colleagues were told to lie down on the floor and cover themselves with articles of clothing to prevent smoke inhalation. They would, they believed, be rescued from above by helicopters. Then the building collapsed. I was standing next to my friend at the ninth-floor nurses' station when she learned of her friend's death by telephone. I watched her move in and out of shock and sadness, letting herself go for a moment, then pulling back the reins of control, letting go, pulling back.

The morning after the attack it was business as usual on the hospital wards. At a meeting with several attending physicians, we residents were asked to present and discuss patients. We sat, a bit stunned and not particularly articulate going through our duties, wondering if someone, anyone, was going to ask, "How are you doing?" Or, "Was anyone you know killed?"

On the way out of the meeting I asked another resident who I knew has a very good friend who worked in the World Trade Center, if she had been able to make contact with her. She answered yes, with a look of pale relief. Her friend had gone to a breakfast meeting somewhere else. "Thank you for asking."

The next day, I attended a noon conference, again hoping someone would provide a format for at least a few minutes of conversation about the terrorist attack and how it was affecting us. But given the already established venue for the afternoon and a reigning medical culture that doesn't include much opportunity for self-reflection, no conversation took place. I felt lost, unable to concentrate or even to follow the lecture's ideas.

On the following Friday, I asked attendings and residents if we could please remember the five minutes of silence at noon to honor the dead. When the time arrived, I was at a lecture, listening to a talk about a disease process. I couldn't stop thinking about my need to participate in the 12 o'clock ritual taking place across the nation. At three minutes before the hour, I ducked out of the lecture room, risking, I worried, disrespect, and hurried downstairs to sit in the chapel in silence. My need to grieve had begun to feel shameful.

One month later, I rotated through the Pediatric Intensive Care Unit. The first week was devastating. I took a baby without brainstem reflexes for a study to confirm that he had no more blood flow to his brain. I struggled to maintain adequate blood perfusion (for the purpose of organ donation) in the body of a 15-year-old girl killed while playing outdoors with her brother. Then on Friday evening, I was on call and helped take care of a little boy who had fallen out of a second-floor window while waving hello to a neighbor. His brain was swelling rapidly, his intracranial pressure shooting up, and we couldn't stop it. I sat alone at the nurses' station, struggling to fill out patient histories.

A woman with freckles and golden hair approached me. I think she was a minister, but it could have been anyone more experienced with a part of her heart to share. She sat down on the countertop next to me and somehow a conversation opened up between us. Words. Silence. Acknowledgment.

"I imagine it's difficult in here right now, isn't it?" she said. "I don't have any words to help you. I do know, though, that these parents have faith. The father of the little boy who fell said God gave him this child and God would take him away. It must be very hard on you residents. You need to talk about it. It's okay to be sad, you know. It's not crazy. It's not selfish."