THE SURGICAL CONUNDRUM

Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.

These stresses, if unmanaged or poorly managed, can carry severe consequences for physicians. Burnout is rampant among docs (and trainees, too). Doctors have high rates of divorce, substance abuse and have the highest suicide rate of any profession.

A normal day at my job is hard: I’m running nonstop for 8 to 12 hours, I’m constantly interrupted, I have patients making demands of my attention and empathy, I’m saturated with information and need to make rapid decision without adequate information, and I know that if I make an error or miss some important piece of information, the human, professional and financial consequences can be disastrous. It’s a pressure cooker.

And that’s a day where things go well. A bad day can be very bad indeed. Sometimes it’s just the emotional strain of dealing with particularly difficult patients. Maybe you go through a run of giving out terrible diagnoses. Maybe you deal with the death of a child. Or a patient who pulls at your heartstrings in some unique and personal way. Maybe someone dies on you unexpectedly. Worse, maybe someone dies on you and you’re not sure if it was your fault or not. Perhaps you know you made an error, and that you’re going to have to face accountability for it.

These are the days that drive physicians over the edge. I’ve had them, and I remember them so vividly even years later. There was the one lady with a gallbladder attack on Thanksgiving, many years ago. She had classic signs and I saw gallstones on my bedside ultrasound. She crashed and died right in front of me from a ruptured thoraco-abdominal aortic aneurysm. Her abdominal aorta had looked normal on my scan; the aneurysm was in the chest and ruptured into the thorax, which is very unusual. That didn’t make it any easier to go home and sleep that night.

So I guess my take on the question is not how do we deal with the psychological stress but how should we? I am not an expert, but here are my thoughts.

The first step, which most practicing professionals have already accomplished, is to learn what is called “professional detachment.” This is an unnatural skill in which you must suppress your innate sympathy for the suffering experienced by a fellow human being, pain which you may be personally inflicting. The first time you stick someone with a needle, it’s probably as traumatic for you as for the patient. More advanced applications involve you ignoring someone’s pain or personal tragedy while trying to figure out the hidden life threat. This is a necessary skill if you are to function in the medical environment.

Another way to think of the same skill is to maintain a sense of distance. Remember, an older teaching physician once told me, the patient is the one with the disease. This helps you remember that the patient’s condition is not your doing (usually) and their outcome, if negative, is the result of their disease and not necessarily a reflection on your care.

While this detachment is useful and necessary, it can be maladaptive if taken to extremes. First of all, as a physician you do need to express empathy and compassion. It’s part of the job. But the emotional demands will be overwhelming if not governed in some fashion; we have limited capacity for caring. My solution is to dole out my compassion and empathy in measured doses, as appropriate to the case and my own mental state. This is not a license to be callous and uncaring in other cases, but rather to be polite, professional and reserved, emotionally.

Furthermore, you need to understand that the professional reserve does not equate to repression of emotion. You suppress it, in the moment, set it aside to get the job done, but that doesn’t mean it never happened. For minor stuff it probably is okay to suppress it & forget it. But the bad things — they won’t go away on their own, but will fester and bubble up at the most inopportune moments. You need to take some time, when appropriate, to unpack the experience and re-live the emotions to deal with them. Maybe it will be just turning the case over in your head the next day. Maybe it needs to be more immediate. We’ve sent docs home after bad pediatric arrests when it was clear they were so upset they needed some time. It’s essential, in any case, to explore the disturbing feelings so you can come to a resolution and move on.

Many institutions will have formal critical incident debriefings for the entire team, for particularly awful events. While this doesn’t need to be performed formally for routine events, it’s a good idea to informally debrief with a trusted partner, superior or mentor. Talk through the case, review the medicine and the science, review your actions and outcomes, and your emotional response to the situation. It is helpful to do this with someone you respect, so he or she can give you valuable feedback. This can be over coffee or a beer or three; possibly better that way.

There can be a lot of shame involved when there was a bad case, even when well-handled, but especially so when you know that you made an error or may have. A lot of docs like to bury these as deep as possible. But these in particular are helpful to talk about, and the more publicly the better. This is not easy, but can be invaluable. We instinctively shy away from openly talking about our mistakes, but when you do you will probably receive a lot of support from your colleagues, many of whom have done the same or understand that “there but for the grace of god go I.” An additional benefit is that your mistakes may have been due to a system error or a cognitive bias and by reframing the discussion in an educational light, by seeking out the root causes, you can improve the quality of your own care and that of your partners.

Keep a sense of perspective, and try to stay positive. When the job is really getting you down, take a break, go out to the ambulance bay, take a few deep breaths and try to remember the big picture. We have a great job. It’s a privilege and an honor to be allowed to care for patients. We can sometimes make a huge difference in people’s lives. We have respect and status in society, and are quite well paid for it. Many people would give their right arm to be where you are. Yes, seeing the 10th drug seeker of your shift is a drag, but damn, it’s still better than sitting at a desk and moving numbers from column A to column B.

Sublimation is a defense technique that is particularly valuable in the ER. It is a form of displacement where the negative feelings are transformed into something positive, or at least more-or-less acceptable. The most common form it takes is “gallows humor.” Tragedy and comedy are deeply linked, and a morbid witticism can provide a lot of relief of the emotional tension that builds up in a clinical setting. Others may channel these feelings into art or literature. To each their own. If this is not your thing, find an outlet. I practice karate, and there’s nothing like pounding the hell out of the heavy bag — or a white belt —after a bad day.

Finally, and possibly most importantly, when you know you screwed up, when you know there was an error that harmed or may have harmed a patient: forgive yourself. You are human, as are we all, and we make mistakes. Take the time to understand it, do your best to learn from it, and forgive yourself. Let go of it, file it away, and move on. If you don’t or can’t, self-doubt and self-hate will paralyze you and in the end it will sink you.

One last thing: if you are really having trouble, get professional help. If you’re self-medicating, or if you are bringing work home to the point it’s affecting your family, be humble and realize that doctors can benefit as much as (or more than) any other patient from psychological counseling and support. Many hospitals have a confidential Physician Assistance Program, staffed by professional counselors trained to deal with the issues doctors struggle with. I’ve seen doctors torpedo their careers with behavior and substance issues, and I’ve seen programs like these successfully rehabilitate physicians who were in a downward spiral. Check with your medical staff office and use the resources that they offer.

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THE DIRTIEST DRAIN

You know that feeling, where you just feel nothing at all? Numbness. Not happiness, not sadness can be felt. Cold veins and an absent heart. It’s literally hard to think… let alone have any thoughts on anything going on. You just can’t concentrate. Like someone’s unplugged your thoughts from current life and all your emotions have just drained out. Emotionally drained???

The greatest gift that God gave us while fashioning us, was the gift of emotions. As human beings, we do come to situations everyday wherein we show emotions. It varies as per our situation but it affects us in a big way.

The other day, while sitting in my Out Patient Department I encountered a patient with Abdominal Trauma. The man was bleeding from a wound in the abdomen. When I examined him, I discovered that the wound was penetrating in nature and his abdominal contents were going to come out. I explained to his relatives that he needed emergency surgery, if we are to save him. He was not ready for the same and wanted just medications. Thinking, perhaps that he has a money problem, I also assured him if a good concession but he remained unmoved. It frustrated me to an unreasonable limit and I got angry. In anger, I referred him and walked home. At home, the anger spilled over to my maid, who I thought wasn’t cleaning the floor well. She got in turn angry and threatened to leave her job and walked home and then I got scolded by my wife for shooing away the maid. Nothing worked for me. My world suddenly turned upside down and that too, as per my thinking without my fault. That night, I sat and analysed the situation and came to a conclusion that because I was too emotional, the eventual emotional drain happened.

The incident taught me several lessons of vital importance:

1. Always being emotional is good but everyday we need to ask God to control it for us. Only then can we manage not to enter that dirty drain. To be drained emotionally is then equable with leading a Godfree life. That is unacceptable if we are to stay in sanity.

2. I n our emotional status, we need to not hurt others or for that matter ourselves. When we are emotionally down, we need to calm ourselves down. I could have avoided an altercation with the patient. It actually would have helped me find a better way out to treat him. Helped me also to understand his status better. How is that possible? It’s only possible when we have good friends and well wishers around. They would understand us better and help us out.

3. Emotions can get the better of us when we allow to linger on it longer than usual. We need to break the emotional chain as I call it. The Bible says, A cheerful heart is a good offering but a downcast spirit dries up the bones”.

Friends! When you are drain out emotionally RUN TO GOD, SHARE WITH CLOSE-ONES and STOP LINGERING.

​PEBBLE IN THE SHOE

“It Isn’t the Mountain Ahead That Wears You Out; It Is the Pebble in Your Shoe.” – Muhammad Ali

Tom and his mentor Dwyer were on their customary weekly walk through the forest when Dwyer sat down on a large rock to take off his shoe.

What are you doing?” asked Tom.

I have a pebble in my shoe,” explained Dwyer.

What are you stopping for? I have a pebble in my shoe as well, but we don’t have time to stop, so stop slowing us down. This is not acceptable. For a small problem of yours, you are  not only slowing yourself down but even involving me.

I can assure you Tom, me stopping isn’t holding us back at all, but will end up saving us time and probably pain further down the track. So be sensible and stop blaming it all on me.

Pfft,” said the young man as he turned and walked on by himself, leaving the old man behind to remove the annoying pebble.

After about 20 minutes of walking, Tom could hear footsteps behind him and was surprised to see Dwyer making ground on him.

Why are you limping?” the old man asked with a glint in his eye.

You know why?  I have a pebble in my shoe!” Tom retorted.

Why don’t you just stop and remove it?”

Because I don’t have time.”

They walked side by side for a while, but eventually, despite his best efforts and pride, Tom’s sore foot really started to slow him down and his limp became more pronounced.

He was determined not to show any pain, but he was conscious that he was now slowing down his walking partner, so he sat down on a large log and took off his shoe to remove the pebble.

When he did, he noticed a small amount of blood seeping through his sock. He removed that too and saw that he had a very sore, bleeding welt where the pebble had been rubbing.

He grimaced as he looked up at his mentor who smiled broadly, showing very little pity for his young protégé.

You know what the message here is don’t you? By not dealing with your problem to immediate effect, you not only affected your performance on the long run  but immediately blamed it on me. Whenever the, blame game starts, it eventually ends up in compromised performance.  Always deal with problems straight away.  You may think that you don’t have the time, but you’ll save yourself a lot of time and pain if you get the pebble out of your shoe before you get too far down the road.”

If you do not take out the pebble immediately, the resultant is the birth of another pebble called blame, that not only destroys Your Own performance but affects even the performance of your co-worker and colleague.

Tom nodded as he put his bloodied sock back on.

According to Jim Fanin, the World famous coach for nearly 25 NBA, Basketball stars, “Some pebbles are lodged only in your business shoes. Some reside in your house slippers that you tuck under your bed. Some pebbles find their way into your golf shoes while others form in the shoes worn while you parent. Unfortunately, some pebbles travel in all your shoes regardless of where you walk or run”.

The other day, I came across a patient, who was complaining of occasional pain in her abdomen. She was a retired Professor in English and quite a Scholar of her times. When I asked her the details of her condition, she was highly guarded and did not want to say anything. On careful prodding, she disclosed that she had a CT scan report with her, which categorically states that she had, Early stage Cancer of the Stomach. When I viewed the report, it was as she had said. I asked her, why, inspite of knowing this, she had not consulted a Surgeon and got herself treated. The reply she gave was amazing. She said, “My mother, had Cancer of the Stomach, and died of it, despite having got operated, hence I decided that since post Surgery she had died, I would never get operated.” All the time, while she was living with Cancer, she had this wrong notion that Surgery killed her mother and not the Cancer, which was quite advanced. Like the Pebble in the Shoe, the Cancer was hurting her daily but she wasn’t ready to do away with it. It could have been removed by going to a Surgeon, and just clarifying facts and notions. She did not address it immediately and that led to the birth of another pebble, which was a form of blame, which fell on the Surgeon. I assured her, that the Cancer, is a Gastro-Intestinal Stromal Tumour, as the report suggested and only Surgery will cure her and it does not have recurrence. Her Pebble was her wrong notion, that Surgery kills people.

Muhammad Ali, the most famous among the World Heavyweight Boxing Champions, was thinking, about this Pebble, in his shoe, when he was readying himself to fight, Sonny Liston. They all said that Sonny Liston could never be beaten and Ali bought that thought and lived with it for quite some time, until his trainers and advisors helped him remove that Pebble. Sonny Liston lasted just 10 minutes on the day of the fight.

While the mountain, our life’s purpose, is always ahead of us, the pebbles often trip us up.  We may perpetuate unhealthy behaviors, patterns and thoughts in our lives by worrying about all the what ifs, could have beens and never-going-to-be’s.

Keep your eyes fixed on that mountain!  Eliminate the pebbles, one by one. Use these tips to clear out the pesky hindrances to your progress:

1. Fix the small stuff.

In our lifetimes, we will spend four solid years doing housework and an entire year just looking for things we have lost in our homes.  Precious days of our life are squandered if we lack discipline and preparation.  You envision opening your own business one day, for example, yet haven’t made real progress towards this goal. The small stuff, the perpetual pebbles, is holding you back.

Do you keep looking for that form you need?  Do you need a better way to organize your bills? Taking care of these small, yet taxing tasks, will free you up for the road ahead.  Take the time to organize your home, balance your checkbook and clear out the clutter; make the preparations necessary to focus your time and effort on the real game.

2. Stop the development of a Second Pebble called Blame.

Many times we find it impossible to accept that the first pebble is hurting. In these settings, the development of a second pebble called, “Blame”develops. Blaming it on others makes it then impossible for us to remove the first pebble that was initially hurting us.

3. Never lose sight of your goal.

We must remain committed to our purpose and passion. This goes beyond lip service. Which steps can we take every day towards being a better co-worker, friend or spouse? Which actions can we point to in our lives that have cultivated not only our dream careers but also better care of ourselves?

Cornell University researchers studied something called the “endowment effect.” When we take complete ownership of our goals, we are more committed to their completion.  Writing them down and mapping out expectations for ourselves is key. There are hundreds of tools to write down and track our goals online. This chart called “Your 101 Life Goals List” is a great place to start.

4.  Lose the emotional pebbles.

Our emotional well-being is vital to tackling the mountain.  The daily pebbles we carry of stress, anxiety and disappointment slip us up.  Break down these rocks of emotional baggage the minute they creep up.  Push back against stress with a different one of the stress relieving strategies every day.  Most importantly “stop striving for perfection”, it teaches and reminds us that being easier on ourselves will start a chain reaction of positivity in our lives.  Once these daily pressures find relief, we have a more fruitful journey.

Our lives are priceless; let’s thrive by carrying a lighter load every day.  The extraction of the pebbles of distraction from your life will help you begin your ascension.

(PICTURE CREDIT: GOOGLE INC.)

SLEEP LESS TO BE MORE PRODUCTIVE

” The next time you are rudely awakened by restless children or overtly loud planes in a dawn chorus, remember this , for Penelope Cruz, nothing less than 15 minutes will do”
      Penelope Cruz , Hollywood Actress

Most people sleep more than they need to. They fall into the trap of spending some of the best hours of their lives on a mattress. They squander their potentially breathtaking gifts under the covers. They lose The Battle of The Bed. They trade their greatness for a snooze
button.

Here’s an insight I invite you to consider: sleep begets sleep. The more sleep you take, the more you need. Ever noticed that as you sleep more, you feel sleepier? Strange isn’t it.
But it’s true. Yes, I get that sleep is essential to keep us bright and renewed and healthy. My fear is too much sleep. The kind that keeps great people small. The kind that minimizes high-potential lives. The kind that sucks the living out of human beings destined to shine (and you know who you are). Happens to a lot of us. Because we fall in love with a pillow.

Evidence suggests that taking excessive sleep is counter-productive because you are more likely to wake up depressed and miserable. Research also suggests that if you are already sad and miserable, actually reducing the time spent sleeping can be of benefit.”
In fact, scientists still know very little about what constitutes the perfect night’s sleep and why we seem to need so much of it. Despite centuries of endeavour by some of the finest minds, the biological function of sleep remains a mystery, and precisely what
goes on in the brain and body during it is also unknown. As late as the middle of the last century, sleep was thought to be a time of inactivity when the brain switched off and took time out, but it’s now known, thanks to modern scanning equipment, that the brain is
highly industrious during sleep. The eyes may be closed, but behind the shutters there is a hiveof activity.

One of the most persistent theories down the centuries has been that sleep is needed to allow the body to rest. But research shows that sleep deprivation has little effect on the body.

“If you deprive people of sleep, nothing seems to go wrong physically. We can usually rest and relax quite adequately during wakefulness, and there is only a modest further energy saving to be gained by sleeping. When we go without sleep it is our brain and thinking and behaviour which is affected more than anything else,î says Professor Horne. Sleep appears to be triggered by the discharge of particular nerve cells in the brain. These cells fire off messages telling the body to wind down and chemicals that cause drowsiness begin to circulate in the blood. Once we are asleep, there are two different types, REM or rapid eye
movement, which is the time for dreams, and deep sleep when there are no dreams.
The purpose of deep sleep,it’s suggested, is to allow the brain to recover from the day’s exertions,a time for it to regenerate and reorganise. It is thought that four hours is needed for this. While the body and its vital organs are kept ticking over, the brain works off-line on a variety of housekeeping tasks, including remembering, prioritising and filing experiences of the previous waking period.

Hormones are also produced during sleep to carry out running repairs and to boost the immune system ready for the next day. The skin, too,gets a helping hand, and so do muscles. Dr Neil Kavey, director of the sleep centre at Columbia Presbyterian Medical Center, New York, says that sleep improves muscle tone and skin appearance. “With adequate sleep,athletes run better, swim better and lift more weights. W e also see a difference in immune responses depending on how much someone sleeps. 

Sleep is also the time when the body does most of its repair work, muscle tissue is rebuilt and restored. We know, too, for example, that growth hormone is secreted during sleep.î
Professor Horne says sleep must serve some vital function other than just energy conservation: “Whereas the body can relax and recover both when we are awake and asleep, the brain can’t switch off during the waking time. The idea that you can rest your brain without going to sleep is nonsense.

“While you are awake, the brain is in a state of quiet readiness ready
to respond. Even during sleep it only goes offline in the first four
hours, when some kind of recovery seems to take place.”

The importance of those first four hours may explain why some people can get by on a few hours’ sleep. Research suggests the average adult needs seven to eight hours a night, though, according to the National Sleep Foundation, only a third of us manages that. Disturbed or interrupted sleep is a common problem, although it seems to be normal for most people to wake once or twice a night. Sleep disturbance only becomes a problem if the sufferer feels tired during the day. Insomnia is lack of quality sleep rather than lack of sleep, and sufferers – up to a third of the population at some time – may have unwanted awakenings,difficulty in falling asleep or daytime
drowsiness.

Two out of three people in Britain suffer from insomnia, mostly linked to stress and anxiety, according to one study. People heavily involved in their work and job are among those at higher risk, especially in the 25-35 age group. And Sunday is the night of the week when we have the most sleep difficulties, possibly because the brain is already preparing for the week ahead. So is the Cruz school of laziness any better for us? Professor Horne is not convinced: “It is all too easy to eat and drink well beyond our biological need – that second helping of enticing dessert, the delicious ice cream, another pint of beer … the same applies to sleep,” he says.

“Sleeping for nine or more hours a night is not necessarily beneficial to health. We have studied people who extended their sleep for many nights,remaining in bed for 10 hours after lights-out and sleeping for as long as they wanted.“They gained little and discovered distinct disadvantages – it took them longer to fall asleep, they woke up more during the night and
found getting up in the morning to be no easier.”

THE WHYS AND THE WHEREFORES

“Why did this happen to me?” he shot back. His eyes were almost bloodshot. His whole body was shaking, gesturing the disbelief in his soul. I could hear the clock ticking by as a cloud of silence encompassed us. He continued, “Never in my life have I touched liquor nor do I have any bad habits, then why?” From the corner of his right eye, I did see a tear drop fall. “They said, you are on the best around here, can you not do something? Are you really telling the correct thing?” he questioningly smiled at me while tears flowed down like a leaking drain pipe. I nodded in unison only to find him suddenly slouching on his chair, to collapse.

Scenes like this happen at my Surgical out Patient Clinic on a daily basis. He had come with complaints of acidity, heartburn, vomiting and significant weight loss. Investigations revealed that he had Cancer of the Stomach and as a Surgeon I had to tell him this. The myriad of emotions that he displayed came very suddenly, just when I explained him his condition. Youngish man of 38 years, his whole world came crashing down. As a doctor I knew his pain and thought process. His myriad of emotions that flowed through him, asking the “The Whys and Wherefores” is how we define Grief.  Every time grief makes its presence felt in my office, lines written by the Poet Delmira Agustini come alive:

“Suddenly I laugh and at the same time cry

And in pleasure many a grief endure

My happiness wanes and yet it lasts unchanged

All at once I dry up and grow green”

(Excerpted from the Poem, I Live I Die I Burn I drown by Delimira Agustini)

 

Grief is a natural response to loss. It’s the questionable emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense the grief will be. However, even subtle losses can lead to grief. For example, you might experience grief after moving away from home, graduating from college, changing jobs, selling your family home, or retiring from a career you loved. Grieving is a personal and highly individual experience. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and the nature of the loss. The grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

In her groundbreaking book, On Death and Dying noted Swiss-American Psychiatrist and pioneer of Near Death Studies, Elisabeth Kubler-Ross, says that there are 5 stages of the grieving process.

  • Denial:“This can’t be happening to me.”
  • Anger:Why is this happening? Who is to blame?”
  • Bargaining:“Make this not happen, and in return I will ____.”
  • Depression:“I’m too sad to do anything.”
  • Acceptance:“I’m at peace with what happened.”

If you are experiencing any of these emotions following a loss, it may help to know that your reaction is natural and that you’ll heal in time. However, not everyone who grieves goes through all of these stages—and that’s okay. Contrary to popular belief, you do not have to go through each stage in order to heal. In fact, some people resolve their grief without going through any of these stages. And if you do go through these stages of grief, you probably won’t experience them in a neat, sequential order, so don’t worry about what you “should” be feeling or which stage you’re supposed to be in.

Grief is not a medical condition until depression sets in and adds injury to insult and yet Psychiatrists have gone ahead to define a Symtomatology for it. While loss affects people in different ways, many experience the following symptoms when they’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious beliefs.

  • Shock and disbelief– Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting him or her to show up, even though you know he or she is gone.
  • Sadness– Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.
  • Guilt– You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.
  • Anger– Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.
  • Fear– A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.
  • Physical symptoms– We often think of grief as a strictly emotional process, but grief often involves physical problems, including fatigue, nausea, lowered immunity, weight loss or weight gain, aches and pains, and insomnia.

Grief though is just a passing phase. It fades away with time but is the first step towards depression. If handled correctly it is a roller – coaster that ends quickly. As a doctor I often have to deal with this and this had lead to a care plan that starts immediately I encounter grief in action.

  • Turn to friends and family members– Family members and friends are superb in doing this. I might be technically better at handling grief but strong family bonding wins over all technicalities. It then boils down to one fact, “Better Relationships lead to better grief handling”. A grieving person should have good inter-personal relationships to handle grief better.
  • Draw comfort from your faith– If you follow a religious tradition, embrace the comfort its mourning rituals can provide. Spiritual activities that are meaningful to you—such as praying, meditating, or going to church—can offer solace. If you’re questioning your faith in the wake of the loss, talk to a clergy member or Elder in your religious community.
  • Join a support group– Grief can feel very lonely, even when you have loved ones around. Sharing your sorrow with others who have experienced similar losses can help. To find a bereavement support group in your area, contact local hospitals, hospices, funeral homes, and counseling centers. Look to open up on social media if you can’t open up to anyone. Social Media nowadays has various openings for grieving people.
  • Talk to a therapist or grief counselor– If your grief feels like too much to bear, call a mental health professional with experience in grief counseling. An experienced therapist can help you work through intense emotions and overcome obstacles to your grieving.
  • Take care of yourself and your family. Eating well, exercising and getting plenty of rest help us get through each day and move forward. 
  • Remember and celebrate the lives of your loved ones. Possibilities include donating to a favorite charity of the deceased, framing photos of fun times, passing on a family name to a baby or planting a garden in memory. What you choose is up to you, as long as it allows you honor that unique relationship in a way that feels right to you. If you feel stuck or overwhelmed by your emotions, it may be helpful to talk with a licensed psychologist or other mental health professional who can help you cope with your feelings and find ways to get back on track.

It is no secret that we live in a throwaway society and that goes for bereavement too. People don’t want to hear too much about your grief when they are too busy living. It forces them to look in the mirror and confront their own mortality. Thinking too much about grief is maudlin and thinking too much about death seems macabre and wasteful. Let’s choose to examine the open wound of our grief and almost befriend it. It has visited and cast its shadow over our life. We can only live with it. We should be open to what it has to teach us, that when those we love die, they leave holes in our lives that can never be filled. Grief is the fate of us all. Maybe it’s about time we all had an honest conversation about it.

If I should go before the rest of you 
Break not a flower nor inscribe a stone, 
Nor when I’m gone speak in a Sunday voice 
But be the usual selves that I have known. 
Weep if you must, Parting is hell, 
But Life goes on, So sing as well.

Joyce Grenfell

THE ROAD NOT TAKEN

There was a certain chill in the air, as I walked out of my house, with the clock striking three. The stillness of the night had not yet given way to the open arms of the dawn. The leaves rustled with the slow westerly breeze that was rushing past. I walked with certain quickness, with the tapping sound of the shoe reverberating, as if telling the snakes, “Nay!!…thou shalt not cross mine path”. A patient with a surgical problem had come, and I whistled past to have a look at his problem and find a cure. The hospital was quiet with patients still in slumber. An argument caught my ear. Two patient relatives were telling a hospital staff, to tell the doctor to refer the patient for an MRI scan. I quietly stood in the dark to hear. There was a good incentive involved, Rs.1500/- for the staff and Rs. 5000/- for the doctor. The Hospital staff thought over it for 10 minutes. I liked what the Hospital staff, who gets a meager Rs. 5000/- as salary said. He said, “Out here the decision of a referral definitely lies with the doctor but I wouldn’t even tell him this and he wouldn’t do such a thing. We are a hospital that treats well within the limits of Integrity.” How true I thought. Every day in the Medical Profession I arrive at a decision making crossroad, with one road called Integrity and the other called Money. Robert Frost’s lines still ring very clear

 “I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.”

(Excerpted from the Poem, “The Road Not Taken” by Robert Frost)

An Integrity filled life is a daily process that doesn’t end until your life does. My experiments with this truth called Integrity, tells me that there is that initial disappointment associated with Integrity that one has to overcome to actually pursue it. Questions arise about what’s integral in Integrity that it needs to nurtured and followed. We actually fall in that initial disappointment zone. We suddenly argue for the immediate benefits overlooking the eternal honour. At every such dilemma I found these following rules of Integrity to life quite life saving

Decide now, not later:  Many men have not thought through their personal value system. They’re not sure who they are or what they stand for, and they wait until the breaking of a crisis to make their decision. At that point, it’s too late. Faced then with great pressure, you will be more prone to take the route which is easier in that moment. Decide now what you will and will not compromise on. Then, when faced with ethical choices, the decision will have already been made.

Quit the rationalisations: There’s always a million reasons to compromise your integrity. You hear them on the news every day as corporate bigwigs struggle to justify their fat bonus checks. You can always come up with justifications that seemingly make good sense and let you sleep better at night. But at the end of the day, when you place your rationalisations on a scale next to integrity, you’ll realise you sold out something priceless for a measly pittance. There’s nothing more valuable than your good name and the ability to look at yourself in the mirror each day with a clear conscience.

 Don’t take the first step : When a great man falls from grace, we often wonder how he could have ever messed up so royally. The truth is that he didn’t wake up one day and decide to commit an egregious blunder. It started with a little fudging here, a tiny bit of lying there. From there he just kept on sliding down the slippery slope of compromise. Don’t compromise on the little things, and you won’t on the bigger ones.

 Don’t justify the means for the end:  This is probably the most popular rationalisation for breaking with your integrity. In reality, the journey towards an accomplishment or decision is just as important as the destination itself. Even if you are richly rewarded at the end, if you cannot look back on the means used to get there with anything but shame, your victory will be hollow indeed.

 Take personal responsibility for your life: At the heart of integrity is the ability to own up to the fact that you are in control of your life. You are responsible for both your successes and your failures. Nobody else but you.

TURBULENT TIMES AND THE SPARK OF SUCCESS

“Sweet are the uses of adversity

Which, like a toad ugly and venomous,

Wears yet a precious jewel in its head;”

William Shakespeare, through the mouth of Duke Senior, in his famous play, As You likes It, Act 2 Scene 1.

Yes, you are right!……the same old words. Your eyes and ears must have passed these words several times in your career, although William Shakespeare wrote them way back in 1599, and not until 1623 did it make its public debut. Some of us have even read it as part of our English curriculum in School. Two days back, when the very same words, crossed my eyes, for the umpteenth time though, in a newspaper column, it forced me to rethink its meaning in new light. Turbulent times, if endured are definitely the gateway to success.

World renowned American Author and Motivational Speaker, Og Mandino, once said, “Obstacles are necessary for success because in selling, as in all careers of importance, victory comes after many struggles and countless defeats.” There was a phase in my surgical career, wherein every Suprapubic Prostatectomy, i.e. Surgery to remove enlarged Prostate Gland , that I did was ending up with bleeding and eventually getting re-opened. It was just not happening for me. I wasn’t sure whether it was wrong technique that was causing this or poor assisting by my surgical assistants or a combination of both. Slowly a sense of fear crept in and it forced me to avoid doing Prostatectomies anymore. 

I could not sleep at night because doubts about ability and technique crept in pretty quickly. I called my Boss, to watch over me while I operate in order to catch any wrong steps, but alas! None existed. It led us to go back to our books and resources on the net and after exhaustive reading we made some procedural changes. Its been 4 years since that epochal day and not a single Prostatectomy patient has bled. Those procedural changes have become very popular among many surgery specialists. Had my patients not bled a better procedure would never have evolved.

The other day watching an interview of World famous, Skier and Olympic Gold Medalist, Jean-Claude Kelly nailed the idea completely. While skiing, some of the most treacherous runs on Earth, something remarkable happened with him. Out of the razor’s edge, where he felt his greatest discomfort wherein his limiting beliefs started to scream through his brains and tell him that he would never make it down, it was at that opportune moment that he felt the most alive.

He said, “The fear you move through when you go to the edge of your limits actually causes your limits to expand.” This is true not only of Skiing but life as well. That expansion leads to not only better work but greater performance. As Nietzsche said:  “What doesn’t kill you makes you stronger.” 

Most people hide in their shells when the going gets rough. They retreat into their bunkers. They push away anything that’s pulls them the least bit out of their comfort zone. And sadly, in so doing, they push away their chances for growth, mastery and lasting achievements. The brave don’t run. The brave eat their fear before their fear eats them.

If that’s not enough, deep change is a purifier of sorts. Yes, it can tear down the very foundations on which your thinking and way of operating have been built. But just maybe those old foundations need to come down to create space for even better ones to be installed. And during the transition process that lies between the old structures coming down and the new ones being put up in place, it’s a real stress filled, uncertain time. But just maybe it’s like the transition of the Caterpillar morphing into the Butterfly. It looks like a mess but something beautiful is being created. As Novelist Richard Bach, once famously said, “What the Caterpillar calls the end of the World, the Master calls the Butterfly.”

Author’s Bio: Dr. Anupam Dey is a General Surgeon in a Mission Hospital at BISSAMCUTTACK, ODISHA. He is a thinker and a thought provoking writer.