A Personal Perspective

Becoming a medical student is a process filled with stress, joy, anticipation, and worry. None of us could quite imagine the changes that would take place in our lives. The first few days and weeks of classes, our anatomy group was still getting accustomed to the long hours and personalities, not to mention preparing for our first oral exam. It was difficult, but exciting and new at the same time.

About a month after school began that summer, I was at the family clinic with my Primary Care preceptor on a Wednesday afternoon. I was wearing my white coat, meeting patients and discussing nutrition with my preceptor. When my pager went off three times in a row, I knew it was something important. I dialed my sister’s number in San Francisco, wondering what could possibly be so urgent. When her voice on the other line uttered the words, "It's Daddy. He's gone…(silence)...Dad died this morning," it was all I could do to keep myself standing. The tears came with such a force that I could not stop them. It was absolutely the worst news I had ever received; my body went numb, yet there I was, in my white coat, trying to get control over my own emotions.

I arrived home and began calling people. The dean at school was understanding – "Take all the time you need," she said. My anatomy professor gave similar condolences. Everyone reassured me that this would not affect my standing at school, that "everything will be fine."

During the next week, my family and I put together a beautiful memorial service for my father, including an Indian feast complete with chicken tikka masala, daal and samosa. Our many friends who had become Dad’s friends in the four months that he lived with us in San Francisco were there, and they shared their precious memories. I felt OK that week, surrounded by my sisters and many friends who knew my dad and wanted to memorialize his life as I did. Medical school became a distant world.

After returning to school, it seemed as if I was walking around observing everything, rather than participating. I felt like an outsider – the focus and drive that I saw in every face was foreign to me now. I felt that I, alone, did not belong. Although every professor and friend offered to help, there was not much they could do. All of my classmates were so worried about passing the tests themselves that there was little they could do to assure me that I would. I felt like I needed help, yet I did not know what that was nor did I believe that anyone could really help me. The only people I felt comfortable reaching out to were my mother and fiancée and fortunately, I lived with them at the time.

While our school did offer mental health services, there was only one counselor available, and based on my previous limited contact with him, I did not feel comfortable going to him. He did not return a couple of my emails or phone calls regarding a referral to a female counselor. I figured it was a waste of time and stopped trying. I resolved to "deal" with my grief the best I could at home, and to try to be as productive as I could at school.

In the end, I passed all of my classes that year. My relationship with my fiancée grew stronger and we were married the following summer. Although I would have loved to have my father there with me for all of it, I know that he was present in his own way. My spiritual sense of self and life in general grew and I reached a healthy acceptance of my father’s death. I still think about my father every day, and in the end, these thoughts have helped keep me going.

How Is This Relevant?

Looking back at my first year of medical school, it is difficult to believe the anger, sadness, and alienation that I felt during most of the year. I had read about the grieving process prior to losing my father, but I never had to internalize it before. During my second year of medical school, I became aware of classmates who were experiencing devastating losses. The brother of one classmate was shot and killed the week before our finals. He chose to take the exams at the scheduled time because his only alternative would have been to take oral exams later which would have been significantly more difficult to pass. In essence, he felt that he did not have a viable choice other than to study intensely and take exams during a time of profound grief and sadness.

I believe that medical students experiencing grief and loss are particularly vulnerable to problems stemming from a lack of support because of the demands of our training process. To feel that one "does not have time to grieve" is painful and unhealthy, yet very real for many students in this position. Now that I am in the hospital and coming into contact with very sick and dying patients, I realize that this issue is relevant to every medical student.

The rigors of our training demand that we be almost "super-human" at times, placing unrealistic expectations on us, even when we are in a healthy state. Because of this, medical schools should have in place comprehensive, approachable resources that are easily and quickly accessed at times when students in grief need them most.

What We Can Do

AMSA can help in this endeavor. Because part of our mission is to address the needs of medical students, AMSA chapters can and should help to ensure that their schools have the resources needed for grieving students. Following are some concrete examples of what individual AMSA chapters can do:

1. Contact your school’s counseling/mental health services. Find out who the counselors are, their hours, etc. Inquire about the diversity of the staff: are there men and women counselors available? If not, ask if referrals are available for students who request them. If you find some aspect of the services to be lacking, consider compiling a proposal and approaching your administration regarding the needed changes. If your school does not already provide it, be sure that your AMSA chapter provides all students with a list of on-campus mental health/counseling resources and contact information.
2. Survey the incoming class during orientation as to their needs regarding grief/loss issues. Ask questions such as, "Have you lost a friend or loved one recently? Do you anticipate the need for counseling services? Do you have friends or family living near by?" Consider using your survey results in your proposal if you are approaching your administration to request additional services.
3. Have a list of community resources ready and available for students. Find out what support groups exist in your area and put them on this list. If there are none or very few, consider starting a peer-run support group on your campus. Besides the many books and internet sources available to help you start such a group, some students may have peer counseling experience. Try to find them and enlist their help in starting such a group on campus.
4. Consider putting into place a network of students who will be available to help grieving students cope with everyday tasks. It is important to realize that the loneliness and isolation those in grief may feel can be debilitating. Simple tasks like making meals, going to the grocery store, and doing laundry can become nearly insurmountable. Having a network of 10 to 20 students in place who can rotate in helping a grieving student with these tasks could make an incredible difference to that student. Just taking turns bringing movies over and spending time with the person could help significantly. Although medical students are very busy, we can all spare a couple of hours in a week to help our classmates make it through a very difficult time.
5. Find out what academic support resources are available to students in grief. Do the Deans or Professors help set up tutors for students upon their return to school after a loss? Are such tutors available at minimal or no cost to the student? Perhaps your AMSA chapter could help set up a "study buddy" program where students in need would have an automatic study partner available at convenient times to both students. Finally, find out what your school’s policy is regarding make-up exams for students dealing with grief and loss. If current policy is either absent or lacking in creating real options for students, consider approaching your administration with a proposal that will allow grieving students the time they need to readjust to the rigorous study schedule.

These are just a few ideas as to how your AMSA chapter can help make resources available at your school for grieving students. By cultivating the type of support that medical students in grief truly need, we will all become better physicians.

If you have further input or ideas regarding this topic, please contact Anita Gaind at: anita_gaind@nymc.edu or (914) 478-4776.