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Is crying allowed?

Death is part of life, though it’s not expected, at the beginning of life, at the verge of being born. Hope, expectations and signs of life are meant to bring joyous happiness. But unexpected death, over a period of few minutes or gradual deterioration over few days or months fills us with grief and sadness. We live in floating world of ‘disenfranchised grief’ (grief experienced when there is loss that is not or cannot be openly acknowledged, publicly mourned, or socially supported). Nevertheless we do empathise with parents and grieve along with them, even though we might have known them for just few minutes and shed tears. Does crying make us emotionally weak, guilty or unprofessional?

Disenfranchised grief is particularly relevant to medical professionals, wherein one is not particularly close to a parent, but still able to feel their grief and mourn with them. As part of grieving process, we should be able to pay heed to our own emotions and understand them.

An internet search to look at whether doctors cry and grieve with the parents and the attitudes of both other professionals and parents whilst dealing with it. Some of these studies/ articles/ blogs/ books were hand picked for this review.

A poll conducted by Gulland A (2014) on BMJ’s community web-site, out of 528 people, 138 (26%) said that doctors should not cry under any circumstances. Wagner et al (1997) in their survey found 57% of doctors had cried at work in the hospital at least once.

Parents describe warm and sincere display of emotion at the time their child’s death as moving “..some of the young doctors were in tears..” (Meert et al 2008)
Crowe L (2019) in her blog talks about crying, not able to sleep and rumination of the events in question and those in past. These raw emotions are often faced by many doctors, but not often talked openly. A Haaland, encouraging to manage these emerging emotions and vulnerability says, “the main benefit of becoming aware of your emotions is that you can then recognise when you’re in danger of burning out and can take action to prevent it.” (Robinson 2019). “When we strive to make a difference in the lives of our patients, our patients also touch our lives. Making sense of death involves the creation of an internal narrative, which requires adequate time and guidance to heal from guilt, sadness, isolation, and conflict.” (Kim 2019)

Frank A (1991), emphasising on mourning mentions, “To grieve well is to value what you have lost. When you value even the feeling of loss, you value life itself, and you begin to live again.” In a caring empathetic society, ‘disenfranchised grief’ should be acknowledged and crying allowed. We should be making more effort in talking openly about grief amongst our colleagues, embed it in our curriculum and include in our debriefing strategies.

References:

Crowe L (April 2019) St Emlyns blog: Wellbeing for the broken Part 1. https:// www.stemlynsblog.org/wellbeing-for-the-broken-part-1-liz-crowe-for-st-emlyns/

Frank A (1991) At the Will of the Body: Reflections on Illness. New York, Houghton Mifflin Company,

Gulland A, (Dec 2014) BMJ blog: https://blogs.bmj.com/bmj/2014/12/15/anne-gulland-is-it- okay-to-cry-in-front-of-patients

Meert KL, Eggly S, Pollack M, Anand K, Zimmerman J, Carcillo, MD, Newth C, Dean M, Willson D, Nicholson C, and the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (Jan 2008); Parents’ perspectives on physician-parent communication near the time of a child’s death in the pediatric intensive care unit. Paed Crit Care Med; 9(1): 2–7.

Kim M The right to grieve (April 2019) JAMA; 321 (16) 1569-70

Robinson F (Feb 2019), Should doctors cry at work? BMJ 364:l690

Wagner RE, Hexel M, Bauer WW, Kropiunigg U (Aug 1997) Crying in hospitals: a survey of

doctors’, nurses’ and medical students’ experience and attitudes. Med J A 166:13-6.

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