Losing a child is one of the worst experiences a person can go through. The psychological research is consistent in finding that those who lose a child grieve for the longest, the most intensely, and with the most severe symptoms.
What happens though when the person grieving is the child's doctor? Are the symptoms of grief the same when it's a patient who dies?
My colleagues and I were interested in answering precisely this question. In a recently-published paper in the journal Pediatric Blood & Cancer, we report our findings. In this study, we used a qualitative method called Grounded Theory to interview 21 Canadian oncologists who treat children about how they feel when their patients die. What we found was surprising.
Just like every other griever, pediatric oncologists experienced sadness, crying, sleep loss, exhaustion, and a deep sense of personal loss when their patients died. As one of the oncologists explained,
"You feel sad, you think about the patient a lot. You think about the potential that they're going miss out on because they died. You know, you definitely ... I cry, I cry often when my patients die."
Unlike everyone else, however, they also reported feelings of guilt, failure, and helplessness when their patients couldn't be cured. This makes sense because unlike most mourners, oncologists are responsible for making medical decisions for their patients. While the vast majority of deaths are caused by the disease or complications from treatments, oncologists still feel a sense of responsibility whenever a patient doesn't make it leading to distressing feelings of self-questioning and sometimes self-doubt.
We also wanted to find out if this grief affected them in any way at home or at work. It turns out it does -- quite a bit. The oncologists reported being irritable at home, feeling disconnected from family members and friends, and feeling concern about turnover or burnout at work as a result of these constant deaths.
Most surprising, oncologists described the life long impact these patients had on them. While feelings of acute grief went away over time, oncologists spoke about remembering patients in great detail for a lifetime, even if 30 years had passed since their deaths. As one oncologist explained,
"There are several patients in my head. If I close my eyes I can see them, but they passed away 20 years ago, 15 years ago. There are some kids who make such a big impact in your life. I still grieve a little bit for them."
We often assume that doctors are objective and unemotional, but this simply isn't true. Doctors are people and their attachments and care for their patients are as real as they are in any other relationship. Doctors, like everyone else, grieve the loss of the child when they die.
Given that this grief is so hard to deal with, and given that patient loss is part of the life long job of the pediatric oncologist, medical schools and hospitals should include more training and support for these doctors who have to deal with the chronic pain of children dying. It's the least we can do for these dedicated oncologists who are doing the impossibly hard work that most of us would have a hard time coping with: treating children with cancer.