Establishing a Link
In a blog post I wrote back in 2018, I touched upon bereavement and dealing with grief whilst living with a mental illness. In all honesty, I wrote it early one morning when I couldn’t sleep; my mind was busy with thoughts and ideas. I wrote the post several days before Christmas, a week before my grandfather’s funeral, and very soon after I started to really struggle with my mental health. My mind ventured down some dark paths, and In the New Year I took some time off work to recover. Reading the post now, what I wrote seems reasonable and accurately summarised my thoughts at the time. It was rather brief though and only scraped the surface of this incredibly complex topic. I also said that I didn’t suffer a relapse in my mental health, which, of course, turned out not to be the case.
In this post, with a clearer mind, I plan to talk about death and grief in more detail, as well as exploring a concept I worked on in therapy. I hope this is not only informative and interesting to those reading, but also helpful to those who may be struggling with the loss of a loved one. Understandably this blog post can be potentially triggering with topics of death, loss and bereavement so please read with caution. If you’re currently struggling with your mental health, please speak to someone.
A Mindful Moment
Before I delve into the main points of this post, I want to just recap and talk about the present whilst reflecting on the not-so-distant past. I’ve recently started a new job in intensive care having spent the last two and a half years working in A&E, so it’s been quite a transition. In my last job I felt comfortable, settled and confident in my working life. I knew pretty much all my colleagues and going to work with them felt like a genuine privilege.
Working in intensive care, at least for now, feels very different. I’m enjoying the job, learning things every day, and meeting some extraordinary people, and I appreciate the transition process takes time. But, having been so comfortable and sure of myself in A&E for so long, this new world looks completely alien to me. I remember one of the main reasons I decided to move into a brand new work environment was to challenge myself – to go outside of my comfort zone in order to strengthen current attributes as well as build and develop new ones.
Although my loyalties still lie with emergency medicine, where I plan to secure a training post in the near future, it feels important to branch out. I do see the similarities as well. Both EM and intensive care deal in managing very sick patients. And, as with many branches of medicine, they deal with death.
In A&E, patients who tend to be acutely unwell have the potential to come around and recover very quickly. From my experience so far in ITU, this isn’t necessarily the case. Patients who are admitted to the unit often have lengthy stays and tend to endure lots of complex medical treatment and life sustaining care. I’m very fortunate I didn’t have to work in ITU during the peak of the Covid pandemic. It would’ve been relentless and almost certainly have taken its toll on my mental health. With that being said, there’ve been some moments since starting that I’ve found very difficult to process. Prior to starting this job, I held a common misconception about ITU: that everyone eventually gets better. This isn’t necessarily the case. Despite receiving the highest possible acuity of care within a very specialised medical unit, a lot of patients don’t survive.
Although I have a fair amount of experience dealing with death within a hospital setting, nothing prepared me for this. I remember speaking to my older brother over the phone back in August, sobbing about a recent death on the unit. I wasn’t particularly close with this patient. I’m not even sure I exchanged any words with them, but I saw them get sicker and sicker, until their condition deteriorated to the point where we had to withdraw all treatment. They died with their mother holding their hand.
I was at a loss. How could this happen? How could they have died, despite receiving the highest level of care whilst on multi-organ support? I still continue to reflect on this moment as well as several others. I may be a healthcare professional, and dealing with death is part of the job, but I’m only human. Seeing death in the workplace is tough. As a junior doctor on ITU, it’s my job to help look after the sickest patients in the hospital and provide the best care possible; but I felt completely hopeless in this situation, as if my efforts and those of my colleagues were completely futile. Part of me felt like I wasn’t doing my job properly – that I’d failed this person. I grieved for them in the weeks following their death, despite having no personal connection with them. I’d never done this before. In the past I’d only ever grieved the losses of family and close friends.
My First Experience of Loss
Bereavement and grief will always be a difficult process. We are unique individuals and experience loss in a multitude of ways. No two situations are ever the same, even if it’s the same person being grieved for. Experiences of grief vary as dramatically as the relationships and dynamics they echo the loss of. I know from my own past, the ways in which I’ve dealt with death have been unique on each occasion. The circumstances which led to each death, my relationship with that person, how old I was at the time, and the strength of my mental resilience were all major contributing factors.
I was eight years old when my uncle died. He was 48, one of my dad’s older brothers and my godfather. He was on a fishing trip in Ireland. This was a sudden and unexpected death and utterly tragic. I was almost inconsolable at the time and didn’t understand how or why this had happened. At the age of eight I found it very difficult to comprehend how someone that was so much younger than my grandparents didn’t live longer. He passed away leaving my two cousins without a father.
Maintaining those Connections
Over the last twenty years I’ve become very close with my two cousins. In September my dad, brothers and cousins, travelled around the North coast of Scotland in a camper van. We originally went on a family holiday to Ireland shortly after my uncle’s death, and it seemed fitting to rekindle memories of that wonderful trip once again. His wife, my aunt, took it upon herself to act as a surrogate Godmother in his place. I’ve always felt so grateful and loved by this gesture, and she remains one of my amazing Godmothers today.
For my 19th birthday, she bought me a watch that closely resembled the one my uncle wore. This was, understandably, a very emotional moment. I still have this watch and treasure it dearly. Although I’m not particularly spiritual, nor am I religious, I sometimes look at the watch and think of my uncle. Despite the fact he’s no longer with us, I like to think that the idea of him or some of his spirit lives on and exists in my watch. This concept is something called continuing bonds.
To be clear, I don’t think that my watch is possessed or inhabited by a ghostly spirit. That’s not something I personally believe in. For me, it’s a way of connecting with my uncle. Although he’s no longer physically here on earth, the relationship I had with him still remains fondly in my mind. I can still recall countless memories of my childhood where his presence had an impact. No, I’ve not moved on, nor have I let go of him as a figure in my life. To do that would be too difficult and, perhaps more importantly, unhealthy. My memories of him won’t just disappear, so suppressing them in order to ‘move on’ seems misguided.
This concept of continuing bonds is a relatively new theory; it was first mentioned in the mid-90s. It adds a lot to our understanding of dealing with death and grief – a real game-changer. Rather than ‘cutting ties’, ‘finding closure’ or ‘moving on’, this theory supports the idea of maintaining a connection with the loved one. It argues that the older model of detachment is an unhealthy approach. To completely withhold thoughts of someone who’s died, as mentioned earlier, would simply be a repression of genuine emotions. As I’ve experienced in the past, repressed emotions will surface eventually and can be detrimental to mental health.
Having the capacity to maintain a bond with someone who’s died not only allows the individual to truly feel their emotions, it also eases the grieving process. Despite being a relatively new psychological theory, it’s more common in practice than you might think. Because it’s not just restricted to things like a watch, which I’ll come on to shortly, it’s very accessible.
Not Just Objects
The theory of continuing bonds doesn’t necessarily require a connection through a physical object. It can be maintained through other means as well. For example, what really reminds me of my late paternal grandparents is the song ‘Everywhere’ by Fleetwood Mac. I distinctly remember when my grandfather was in his final stages of life, my grandmother walked up to him and gave him a kiss whilst ‘Everywhere’ was playing on the radio. Not only is it a beautiful song, but that brief moment really captured my grandmother’s love for her dying husband of 60 years.
Now when I hear that 80s hit, I’m often taken back to that moment. Depending on where my emotions are at the time, my feelings can vary in response to the music. Sometimes feelings of sadness and sometimes of joy, but above all the song connects me with two relatives who are no longer here. I know I can’t speak to them in person anymore, but somehow the lyrics feel like a form of communication with them; they live on, so to speak, within my mind and through the song. Their presence is also still very apparent and tangible through the bonds that exist within our wider family.
Can You Feel the Love?
The concept is not just restricted to adults either. In fact, I think it’s very much our inner child maintaining that connection with those we’ve lost. Especially if the relative or loved one had a paternal or maternal influence in our lives. This is explored in Disney’s The Lion King. As a matter of fact, the song from the intro sequence in the sequel film, Simba’s Pride, originally written for the stage musical, connects me with my maternal grandfather. ‘He Lives in Me’ is a song that takes my emotions back to the passing of my grandpa. I played the track in the car on the way back from his funeral with my Mum, and ever since it’s held a valuable place in my heart. Not only do the lyrics emphasise the concept of continuing bonds, the fact that my maternal grandparents worked and lived in East Africa for over a decade also strengthens this link.
I See the Light
As I mentioned earlier, I see a lot of deaths in ITU. Although I may not hold particularly close connections with patients that pass on the unit, I can still think about their journey through intensive care without feeling traumatised. I may not have known them on a personal level or outside of work, and despite not surviving, I’m capable of reflecting on the positives in the overall care they received.
As a department, we receive praise from patient’s relatives regularly. This isn’t necessarily just from relatives of those who make it out of ITU alive. I remember the mother of a patient, who we’d spent hours trying to resuscitate, expressed her heartfelt thanks to my senior the night he died. I recently attended a reflection session on this particular patient, held by the unit’s lead psychologist. The discussion was heavily focussed on the night of the resuscitation, and what hit me the hardest was that we referred to him by his first name. I reflected on what I did well, and how I felt that night. I felt by the end of the session, having recounted the situation, that I had closure.
When a patient dies in intensive care, it’s often difficult to stay positive. However, the gratitude we receive from relatives, despite their loss, attests to our efforts. It justifies the work we do. Of course, I’m not failing the patients I care for; we’ve given them the best fighting chance possible. This isn’t a poor reflection on my clinical practice, rather it’s a reflection of the nature of intensive care. You need to be very sick to be there. The body succumbs to immense physiological changes and pressures, and despite optimum treatment, it can fail.
Continuing bonds with loved ones lost allows me to reminisce and think positively about them. It helps me look at the light in spite of the darkness that’s cast from their passing. Utilising the concept of continuing bonds in practice also helps me empathise with bereaved families. On several occasions, I’ve seen members of my own family in their final stages of life. I’ve seen the work that goes into caring for them, and similarly, I’ve expressed my gratitude towards the healthcare workers involved. Parallel to this, I’ve felt the sadness, grief and shock that comes with the sudden death of a loved one. I know what it feels like to grieve the loss of family and friends who have passed away, especially when it didn’t feel like it was their time to go.
Discovering this concept through therapy has allowed me to better express my emotions when managing grief. It’s also allowed me to transfer that strength in feeling across to my working life. Maintaining a level of detachment whilst in the thick of it may be a form of self-preservation; but having the capacity to feel something in times of calm enables me to process events. Dealing with all of the associated emotions around death, loss, and grief are just one of many facets of truly living.