Dear Dr. Horton #7: Mourning

Welcome to this week's edition of Dear Dr. Horton. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?

Signed,

Mourning in Secret

Dear Mourning,

Let’s start by getting “professionalism” out of the way.

Literally, let’s get it out of the way. It’s an important word, but it’s an awful word for the heart of what we do. Somewhere along the way, the minimum criteria for being a professional in an entrustable field have replaced the aspirational. Some of this might be because we chose a term that evokes a perfunctory word cloud — expertise, manners, a business suit, a briefcase, a handshake. It’s a sterile word for a fertile thing. Horton, we have a problem.

David Sackett, the father of evidence-based medicine, once told new medical students that the greatest therapeutic tool they will ever have is their personality. “Professionalism” doesn’t leave much room for something as messy as personality. Our word choice has left young doctors wondering if they are supposed to check their personhood at the door.

I was going to beg you not to do that, Mourning, but I can tell I don’t need to. You know about your patient’s dog. You know what play they're missing next season at the theatre. You’re picturing their empty chair. That hurts.

Let it hurt. And then learn how to sit with that hurt… how to be affected, but not decimated by it.

Mindfulness is one tool that helps me sit with grief. I see patients with serious illnesses and hard lives. Sometimes they remind me of my own parents, or my late sister, or other patients I’ve cared for who have died. Sometimes, in a room with someone, talking to a family or sitting holding someone’s hand, my eyes well up. Sometimes I cry. I don’t try to stop, suppress, or edit it because it’s not “professional.” Those emotions are part of the experience of caring for that individual. I just notice what arises. I believe and accept that it is meant to be part of the experience.

Don’t we want to attach? Where else in life is that not a goal? If your hairdresser heard that you died tomorrow, wouldn’t you kind of hope that she’d get tears in her eyes and think of you every time she heard a song that she knew you liked? Why on earth would the expectation be any different for your doctor? This has nothing to do with being professional and everything to do with being human. And it comes back to the misleading nature of that word: “professionalism.”

What if you work with preceptors who feel differently? Well, there’s more than one way to be a doctor. Early on, we crumble when someone tells us we’re too this-or-that. Meanwhile, some of us are apples, and some are oranges. When someone chastises you for getting too “attached,” ask yourself: is there a reason their feedback could be valid? Or is this really an orange telling me how to be an orange, when I am and always will be an apple?

You asked me how to navigate the intersection of professionalism and mourning another human being you felt connected to.

It is not an intersection. It is one road. We are all on it, together, going in the same direction.

Yours,

Dr. Horton

 


Dr. Jillian Horton is a graduate of McMaster Medical School and completed her residency and fellowship in general internal medicine at the University of Toronto in 2004. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine. She has won awards for mentorship, professionalism, and teaching at the undergraduate level. She is also a mother, musician, and writer. As an Associate Dean, she cared so much about undergraduate students because she never forgot what it felt like to be one of them.

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