I had a wonderful podcast interview last week with a pediatrician who wanted to explore the topic of professional grief in healthcare, and that made me think it would be good to write a new post with some refreshed thoughts on the topic.

What are we referring to when we talk about professional grief? There are various layers and nuances to this, some of which may not be so blatantly obvious. 

First, professional grief is the natural human emotion we feel over losses we witness and/or experience in people that we have built connections with in the context of a professional relationship. As obvious as the definition seems, I can hear the questions pushing back as I write this. “If it’s a professional relationship, shouldn’t you be distanced enough such that you don’t feel grief over these patients?” 

In response, I ask you to consider two things. First, what drew the vast majority of healthcare workers into this field was the compassion we feel for suffering people and the deep desire to help and make a meaningful difference. This is inextricably tied to our internal emotions. Secondly, there is a reason why we don’t simply walk into a patient room, push medications through lines and tubes, adjust breathing machines, and walk out without saying a word to the patient or family. Truly high quality healthcare is marked by personalization, human connection and shared presence. In other words, we bring our personhood. We all know of patients and families with whom we have built real, meaningful relationships over time. These aspects to our profession make our work both professional and personal. We may not experience the same intensity of grief as the patients’ primary family and friends, but we experience normal, human grief over their suffering and deaths nonetheless. We have permission to grieve too.

Secondly, as we recognize the systemic context and our unique relationship to our patients and their family members, we find that professional grief includes an aspect of grief for ourselves when we come up against painful limitations in our ability to heal and fix.

The vast majority of our training centers around this idea that if we think critically enough, work hard enough, perform enough of all the right interventions, surely we can fix most anything. Modern medicine truly can feel full of wondrous miracles. 

But it’s the school-aged child who had already overcome so many health obstacles as an infant, who was starting to thrive in kindergarten, whose parents brought them into our Emergency Department with standard complaints of vomiting and diarrhea, who suddenly and repeatedly coded in the ED and then died a few hours later in our PICU, who sends us all reeling a bit with the hard slap of reality that we cannot always fix everything, no matter how thorough our training, how advanced our technology, how diligent our work.

It’s the cancer patient who we gave all the right medications and treatments to, who spent years in our hospital, whose favorite songs and activities we got to know so well, who we worked so hard to get into remission, who caught the most random infection and died of sepsis just as they seemed to be on the brink of going home, who has us all asking why our hearts hurt so much not only over our patient but over our job and our role in the whole thing. 

We grieve for ourselves, for our limitations and the moments we have to look into the family members’ eyes and say, “I’m so sorry we couldn’t save them.” 

I’ll end for now with making a brief third and final point here about professional grief. Professional grief for healthcare workers also involves grieving the loss of the more naive or idealized worldview we had, before we saw all the things we see in healthcare.  

Of course I knew that people – including kids – got sick, got hurt, and died, before I became a nurse. Even still, I only really understood on a gutteral level what terribly wild, almost unbelievable things could happen to kids after I became a pediatric ICU nurse. The patient stories that live inside of me have only accumulated over time. I’ve had to wrestle with earlier versions of Christian faith, earlier versions of what optimism and hope looked like to me, earlier versions of how I saw mankind, and I’ve had to grieve the loss of those earlier, simpler versions. I’ve certainly grown and matured in immeasurable ways, but as we are talking about professional grief, the loss of what felt like lighter versions of me has certainly been very real. 

This is what we mean when we speak of professional grief. The kindness we must show ourselves and each other starts with the acknowledgment that these layers of losses are real, and our professional grief is valid.