By Dr. Victor S. Sierpina
(This is the first part of a two-part series)

 I have been grieving the loss of several patients lately. You may have never reflected on this, but doctors, by the very nature of our work, constantly must live through and with the death and dying of patients. No matter how good a doctor you are, this is an inevitable part of our calling.

Many of these folks have grown into near and dear relationships with us through years of care. Richard (not his real name) died recently at nearly 100.

When I read his obituary, I was so impressed with the man he had been. So many accomplishments, such a wonderful life, family and service to church and community. His passing was surely a loss to the world.

As Richard gradually became more frail during the past 10 years or so, I came to see him this dignified man grow increasingly demented, frail, skeletal and weak, like many people in their 90s.

I sent his wife a copy of a book, “Good Grief,” by Dr. Granger Westberg, a medical school mentor to me. This book is in its 50th year of publication, and I wrote about it a couple years ago on these pages.

If you know anyone among your friends or family who is in grief, gift them with a copy.

Grief does not come only from the loss of someone through death; it can also result when there is a divorce, loss of job, downturn in finances and other life-changing events. Whatever the cause, the stages of grief are similar.

Let me describe them to you in brief so you can understand that grief is a process of recovery, of growth and a normal process not to be medicated nor suppressed emotionally.

Stage 1: We are in a state of shock

How could this have happened? We may be angry at God. We do not want to believe it.

We may push others away, who don’t quite know what to say or how to support us at this vulnerable time.

Keeping busy, dealing with necessary issues, doing our best to accept it emotionally, and being grateful for well meant, sometimes awkward condolences helps us move through this tough stage.

Stage 2: We express emotion

Cry if you can. You know you are crying inside. Our society has erected an unwritten taboo about expressing grief and emotion. Tears can heal. They call for hugs.

The first thing I teach my medical students and resident doctors about grief is not to panic and feel like you have to write a prescription just because someone is demonstrating a normal human emotion in the face of loss.

Just be with them. Empathize. Show true caring, compassion, and imagine it was you or a loved one going through this experience.

Stage 3: We feel depressed, very lonely

No one could possibly understand my pain, my hurt. I am alone. This is where support groups, family and friends need to reach out actively and be with the grieving person. After the body is in the ground, the divorce is final, the job loss a done deal, the sorrow continues.

There isn’t usually a quick phrase, solipsism, wise affirmation, or sprightly comment that can bring about a quick remedy.

Instead, being with the gray clouds and the person under them until the sun inevitably shines again requires patience, perseverance and plain plugging along.

Things will get better, in their own time.

Stage 4: We may experience physical symptoms of distress

I can recall so many times when a patient came to see me with a variety of new complaints or even a follow-up on old, long-standing problems that had mysteriously gotten worse.

As I inquired on their psychosocial and spiritual history, I often find they have suffered a recent loss and are in grief: the estrangement of a daughter, the financial fraud that cost them their retirement savings, a major motor vehicle or other physically damaging accident, the loss of a loved one.

All of these and more are stressors that require philosophical and spiritual adaptation. While those responses are developing, people often develop all sorts of maladies from headaches, backaches, chest pain, stomach problems, to panic attacks, insomnia, fatigue and more. Recognizing that the symptoms are caused by something deeper allows me to address root causes.

For the other four stages of grief, tune in next week.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.