mourn

 One thing I did not expect when I finished residency was that in the quiet moments, my mind would default back to the patients who died and the cases in which I feel that failed: I missed the diagnosis, I was too slow to respond to an evolving situation.

I thought that maybe I could bookend my residency with a ceremony, or graduation, or moving on.  Or maybe this or that accomplishment.  I finally went on a trip by myself.  I don't know what I expected - perhaps that there would be rainbows and unicorns, and that the idea that nature was healing would mean that I was happy the whole time and just filled with positive feelings.

Solitude was profoundly uncomfortable because I could not get away from those failures and ghosts.  It simply was.  How many times have I reviewed the case?  How many times will I cry about the patients I have lost?  I finally realized that  there was no magical healing, that coming on this trip, running that trail, seeing these friends wouldn't take away the deaths I have seen and mistakes I have made: those experiences are part of me and will always be with me.  Just as grieving is nonlinear and no door is shut causing you to forget a loved one or live as if they never existed, healing from all the trauma of being a physician doesn't mean you forget your patients or live as if you never made a mistake.  On the contrary, I do many things in medicine because I have made mistakes - I double check things and have incorporated certain practices in my hospital rounds.  It is because, not in spite of of the ghosts, that I become better at medicine.

The grief of a patient lost is is different, yet not so different than the grief of losing a complex person whose life story you know in some part.  It is sharp but likely with a shorter half-life because you only ever knew a few hours or days of that person's life, and because you knew them as a sick person, not in their full magnificence.  The sharpness of the pain of loss fades - as do all things - with repeated review, but the lesson is clear:

This will always be part of me.  That's the price of medicine, even if I never see a patient again for the rest of my life.