Change

Letting Go

Red alder leaf on partially submersed branch · Washington · USA

Loss.

It's inevitable.

And it hurts.

It could be the loss of material possession due to theft or natural disaster or repossession, an occupational severance, the passing of a beloved pet, the end of a relationship, a sudden or gradual physical incapacitation, or the death of a friend or family member. It might even be the formation of a crack in the foundation of one's longstanding faith. We've all incurred loss in some form or other and to varying degrees of severity and reverberant effects. Sometimes it's expected and we're afforded some precious time to come to terms with it at least partially; other times we're blindsided completely. And then, of course, there are times when it's fully anticipated but still nothing we do can adequately steel ourselves for the all-out assault upon gut, heart, and soul. An eminently wise and respected friend of mine refers to this as "irredeemable loss" resulting in "irredeemable suffering," and I've learned that this phenomenon is all too real and happens all too often. Whether it’s losing a child to cancer or learning of a downed passenger plane caught in the crossfire of warfare or seeing headlines of yet another senseless school slaying, there are some situations that are simply beyond comprehension, beyond reconciliation.

I went into palliative medicine with lofty and perhaps naïve aspirations, thinking I had the ability to make anyone feel better under any circumstance. And though that's still the ideal I strive for, the longer I do this work, the more I recognize it as just that: idealized. Because as joyful as life can be, it can be equally difficult and, all too often, downright cruel. And I've learned that sometimes as a physician the best thing isn't to try to slather salve upon the wound but to acknowledge its presence and admit to my powerlessness in remedying it. Some pains cannot be alleviated, but the suffering, to some degree, can be shared, and in the process of being shared, validated. The difference between “I’ll help you through this...things will get better” versus “I’m so, so sorry...this must hurt like hell” can be striking: Suddenly, any pretense of unbridgeable differences conferred by hospital gown and white coat dissolves away, the chasm between patient and doctor is narrowed, and we simply become two people sharing the burden of an otherwise unbearable pain, even if only temporarily. Quite often my patients and their families need that more than any medication or words of comfort could ever hope to provide.

And what we hope for--perhaps what we cleave to--is the adage that time heals all wounds. But what to do in the meantime? The first thing, I think, is to understand that healing isn’t a passive process. The passage of time could find you frozen in a state of arrested grief in the absence of any willful application of effort to move on from it. Despite Elizabeth Kubler-Ross’s landmark 1969 publication, there’s no set recipe for how things evolve from there. Just know that there will be tears of sorrow, tears of joy, and everything in between.

Too, I don't think that life is about carrying around the heaviness of inevitable loss with you day in and day out. That would simply be too much to bear every day, tethering you down to what you fear you might lose in the future rather than fostering an appreciative mindfulness of what you have in the present. Taking things for granted to some degree is actually okay...it’s human nature, and we should be allowed to be human. It lends the perspective needed to make poignant moments poignant. It frees you to lead a life buoyed by gratitude and thankfulness, not mired in fear.

Behold, then, the essence of deciduous hardwoods. In the spring their branches bud and blossom and thrive throughout the summer, leaves not haunted by their predecessors shed in autumns past but rather nurtured by the foundation of nutrients laid down by their very departure.

And all the while, the trees go on growing.