By listening to a patient’s story of loss, we bear witness and affirm their experience.
My patient was 81 years old and I was in her room with the physical therapist, Eleanor. She’d been refusing physical therapy for three days. “I don’t want physical therapy. I have too much on my plate already,” she said. She then launched into a monologue. “My male friend of 30 years, Harvey, died. I didn’t want to marry him, but he was my love. I don’t want to die. He fell one day while getting mail. He’s never coming back. I’m afraid of falling. I don’t want to fall and die like he did. It’s not my time yet. He comes in my dreams. He’s in heaven. He was buried two weeks ago.”
“Let’s have Eleanor help you get out of bed,” I said.
My patient gently repositioned in bed and used her arms to sit up. She sat up on the edge of the bed and kept talking. “See my nails. I need a manicure. I’m going to get French next time. Doctor, you have cute shoes, what size do you wear? 6?” I smiled and nodded. “I wear size 6 too,” she said. “I have a shoe addiction. I love cute shoes. I ordered a hardboiled egg and a muffin for breakfast today.” My patient went on and on and I just listened.
She let the physical therapist help her walk down the hallway. When she got back into her bed, she started crying. “Harvey is never coming back, he’s dead. He died. He was a beautiful man. I love him. I miss him.”
I just kept listening. Stories of grief need to be told. They need to be told again and again until they no longer need to be told.
When patients are experiencing grief, we must know that they may have feelings of sadness that can come in waves unprovoked. When a patient expresses emotions, clinicians listen and bear witness to their anguish. Rather than interrupting with things like, “It’s going to be ok,” or, “You have so many loved ones supporting you,” which can invalidate a patient’s sadness, I recommend that we stay present to allow the arc of story to take its course. We can acknowledge and affirm a patient’s experience by repeating the patient’s words.
“Harvey died and it’s very sad,” I said. Listening and validating feelings can help establish a strong therapeutic connection. I believe it helped my patient work with the physical therapist and eat that hardboiled egg with a muffin for breakfast.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.