Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Reflecting on Boundaries During Times of Loss


Recently, my eyes filled with tears upon learning of a death in my patient’s family. Empathizing with patients who have suffered a loss can bring up strong feelings. How much of this is ok for clinicians to reveal?

In pediatric mental health we’re fortunately rarely confronted with death. Given the ongoing pandemic, this week has been particularly rough as three of my patients lost someone close to them: a younger sibling, a stepparent, and a grandparent. Each one is a tragedy in its own right.


The younger sibling, a teen, was a beloved family member who brought joy and love to both their family and pets. When my patient’s parent recounted the story of her child’s death, my eyes filled with tears.


Though we’re healthcare professionals, we’re also human, and I’m left wondering what is an appropriate response and is there even such a thing? In psychiatry, we’re taught to keep boundaries to preserve the role of patient and clinician for the success of the therapeutic relationship. But it’s hard to know where those boundaries are when trying to comfort a family you’ve known for many years through an unimaginable loss. With the permission of our young adult patient, my colleague and I paid respects to the family before the funeral ceremony. The parent eagerly introduced us to other family members who all knew of us. When my colleague and I reached the sign-in book we declined to write our names to maintain the boundary we’re taught is essential to care. However, it left me wondering if colleagues in other areas of medicine also decline to write their names, or only in the field of mental health.


The next loss was a stepparent of a teen patient; someone who had been a stabilizing presence for both the adolescent and parent.  What will their life be like now?


The third, most recent loss I learned of was a beloved grandparent to a preadolescent patient, already trying to recover from the loss of another beloved family member a few months ago.  This grandparent supported both my patient and their parent, and I cannot even imagine the impact of this loss on both.


Confronting and managing loss isn’t something new for most clinicians. Yet with these three losses occurring so close together, I found myself reflecting on how mental health professionals interact with patients and families while consoling and comforting them. While I don’t have a clear pathway through, I know processing with my colleagues and talking with family and friends has been helpful.









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.