Lost in Loss
Kortni Ferguson (MD ’21, MPH ’21) was only days into her second year of medical school when her mother died unexpectedly of unknown natural causes. At the same time, Ferguson’s classmate Priya Roy (MD ’19) was struggling with the devastating news of her father’s esophageal cancer diagnosis. Roy’s father died a year-and-a-half later.
Grieving the loss of a parent while taking on the daily challenges of coursework and rounds was overwhelming. Ferguson and Roy found support in one another, yet they never found any scientific research or support groups relating to their particular circumstances as bereaved medical students.
“There’s a lot of resources on how to cope with medical school. There are a lot of resources on how to cope with grief,” says Ferguson, who is now a psychiatry resident at Stanford. “But there’s really nothing that addresses the intersectionality of being a young bereaved person and a medical trainee who’s constantly exposed to morbidity and mortality.”
In 2019, Ferguson and Roy cofounded a nonprofit called BereaveMed to help medical students address their experiences with death and grief—whether the experience is the loss of a family member, a patient or a way of life (as has happened with the COVID-19 pandemic). BereaveMed has expanded to include volunteer staff members from medical schools beyond Pitt, and the team hopes to one day partner with national medical organizations. Their website includes links to research studies about grief, a blog with expert interviews and personal stories.
“One of the most cathartic experiences I had was writing my story for the website,” says Roy, who is now an internal medicine resident at the University of Wisconsin-Madison. “For a long time I was kind of struggling silently, as many medical students do through experiences like this. And it wasn’t until I put proverbial pen to paper that I realized what I was going through.
“There’s something really cathartic about just sharing your story,” Roy adds. “That’s what I’ve heard from other students who have read our site as well and started writing their own stories for us to publish. You really get this space to be completely open and honest about what you’ve been going through.”
The essays that follow are excerpted with permission from BereaveMed.com.
The Gift of Time
By Priya Roy
It was the summer after my first year of medical school when I got the call.
“I have some bad news,” my sister started.
Our dad had been having some difficulty swallowing lately and had unintentionally lost about 20 pounds in the past eight weeks. That afternoon, he had gone to the hospital for an upper GI endoscopy, and they found a 5-centimeter mass in his distal esophagus. Listening to her describe it, I couldn’t help but think back to the previous fall, when our anatomy instructor summoned the class around a cadaver in the anatomy lab to examine a particularly impressive example of esophageal cancer. The spidery black tumor was plastered across what was left of the cadaver’s posterior chest wall. It was like looking at a Jackson Pollock painting. My conversation with my sister was punctuated by silence, neither of us knowing quite what to say. Finally, after a particularly long pause, I told her that I loved her, hung the phone up and broke into tears.
The next few days were a blur. I sent a frantic email to my mentor to inform him that I had to suspend my summer research. Little did I know, I wouldn’t come back to it for another year and a half. I booked a one-way ticket home for later that week and spent the next few days just trying to distract myself. At 3 a.m., the morning of my flight, I sat in bed weeping while I drafted an email to my friends, explaining the situation. It had been five days since I had gotten the news, and I was still shell-shocked. I hadn’t been able to work up the courage to tell them in person, knowing that I would dissolve into a blubbering mess if I tried to answer the question “How are you?” honestly. Typing it out for the first time was excruciating. This may sound cliché, but putting my dad’s diagnosis into words for the first time really did make it all feel so much more real.
In the coming weeks, we would learn his official diagnosis: stage 3 esophageal adenocarcinoma of the GE junction. My sister and mother are both doctors, so like the diligent, evidence-based medical providers that we are, the first thing that the three of us did was perform a literature search on PubMed.
Weird, I know.
So, no one showed up at my door one day to warn me about how hard it was going to be. How exhausting it would be to lie every day, pretending for my patients and classmates and attendings like nothing was wrong. No one prepared me for the confusion I would feel when I slowly began to hate all of my friends—how I wanted to scream at them when they couldn’t seem to understand why I might be having a bad day. I even started to resent my classmates for their accomplishments, though rationally I knew that they deserved their success. They don’t know how lucky they are, I would think to myself. How unfair it is that they have the luxury of focusing all of their energy on school while I’m trying to juggle a dying parent and a family that’s falling apart. And now residency programs expect me to compete with my classmates? Seriously?
I began to hate how angry and self-centered I had become.
Through trial and error, I slowly found little ways to fight back. I tried my best to compartmentalize and forgave myself for the days when I couldn’t. I learned that I can (and should) push back when I need help but am told “no.” I made conscious efforts to shift my perspective, and each day I would force myself to write down one thing I was proud of accomplishing or one thing I’d witnessed that had brought me joy. Most importantly, I stopped bottling everything up inside of me and started talking to the people I loved about what I was going through.
So if you happen to be a student who is struggling, know that you are not alone. That may sound obvious from the outside looking in, but when you’re in the trenches and fighting for your life, it can be hard to look beyond the obstacles in front of you to recognize that there are others by your side. It’s okay to lean on them. In 2017, 1 in 4 medical students reported being depressed. So that feeling of loneliness? Like no one can relate? It’s an illusion. A lie. Complete and total bullshit.
But here’s the kicker: Only 16% of students will ever seek professional help. That number seems to surprise the deans of medical schools across the country, but it really shouldn’t. After all, it takes courage to admit that you’re struggling. And it takes energy and strength that you don’t always have to ask for help. Like me, you may also feel conflicted when you realize that we can also become our own biggest obstacles. There’s pressure to outperform each other (and ourselves): to have the highest board score, to get honors, to showcase our dedication by being the first to arrive in the morning and the last to leave. But there’s not much talk about how that mindset can really harm us in the long run. For example, I didn’t seek help for my depression until nearly a year after I recognized that something was wrong. I remember knowing that I needed to talk to a psychiatrist but not being able to fathom how I could even fit a doctor’s appointment into my schedule. As a third-year medical student, I wondered, Can I just leave rounds? Is that allowed? What if my resident thinks I’m being lazy? Or what if that’s my only day on service with a particular attending? How will they be able to grade me if I’m not there? I put so much pressure on myself to be “the perfect student” on paper that I had also put off the task of working through the one thing that was holding me back. As it turned out, I did have the time to see a therapist. Really. I had the time to start taking an antidepressant. I had the time and the power to delay a shelf exam or request an extra study month. I had the time to get help. I only wish I had learned that lesson sooner.
Six months ago, my dad was diagnosed with metastatic disease. He’s on a palliative chemotherapy regimen that, on average, maintains efficacy for about five months; in the back of my mind, I’m just waiting for the other shoe to drop: For his CEA levels to rise. For his ascites to return. After two years, I’ve grown used to the uncertainty of it all. For now, he’ll keep getting his biweekly infusions. Eventually those drugs will stop working; so we’ll move on to the next one and then the one after that, until we run out of options.
I’ll take next year off school and join a research program [so I can be near him]. I don’t mean for that to sound bleak. It’s just the truth. It’s the reality of trying to be a full-time daughter within the pillared constraints of medical education. We’ll manage his side effects for now and brace ourselves for what’s to come. We’ll continue to live each day. We’ll watch. We’ll wait.
So it goes.
NOTES ON THE ARTWORK:
Top Image: The diagram is meant to be a tongue-in-cheek representation of the “gift” of the remaining time that I had with my dad and points out the unique cruelty of anticipatory loss. On the one hand, I wanted to spend as much time as I could with my dad before he died. And even looking back now, I feel lucky to have been able to step away from medical school to be able to do that. On the other hand, I recognized the inevitability of my dad’s death and the tumultuous nature of his illness, which made his progressive decline even more difficult to bear witness to.
The Path to Resilience
By Kortni Ferguson
Hey Kortni! Your mom just sent you a text message,” Michael, my fiancé
(now husband) told me.
I walked into the living room to check the message:
I responded with, WHAT'S UP? not fully understanding the gravity of her message. Letting her text message sink a little further in, I called her immediately. I asked her what was happening.
"Can't breathe," she said.
I told her that I was going to hang up and call an ambulance. She managed an “OK,” and we hung up. I don’t remember if I told her I loved her, but I hope that I did. I couldn’t just call 911 from Pittsburgh. I started looking for the emergency contact information for Sacramento, California. It. Took. Forever.
I was forwarded again and again. When I finally got in touch with someone who could help, they dispatched an ambulance to her location. I then texted her to let her know that the ambulance was on the way.
The last time we’d corresponded was two days prior. I’d told her that I loved her, and that I would call her soon. I didn’t call. I still feel guilty about that.
I waited one hour to call, because I didn’t want to interfere with the process. I didn’t want to interrupt my mother’s phoneline if they were trying to contact her. I paced my apartment for the full hour. Michael was trying to make light of the situation, telling me that my mom was probably just having a panic attack. I wasn’t convinced. After exactly an hour, I called the fire department back, and they referred me to the hospital they took her to.
I was connected to the emergency department and asked about her status. It turned out that she was brought in as a “Jane Doe.” I eventually got connected to a woman who told me that I needed to “come in” to discuss the status. That didn’t sound good.
I explained to her that I was in Pennsylvania. She said something along the lines of, “Oh dear,” and put me on hold. Having worked as a scribe in the ED before medical school, I knew that they always asked survivors of loved ones to come in to discuss deaths. I said nothing—not fully committed to her death, but not at all optimistic either. I was then connected to a physician.
He started with, “We did all that we could. We gave her some medicines—”
I cut him off. “Did she die?”
My role model, cheerleader and inspiration to live a life of service was gone.
Dr. Samson (not her real name) was acting as our attending for two weeks. She noticed how long I was taking to write, and rewrite, patient notes in the team room. The first time I met her, she was sweet, but she asked a question that I recommend no one ask an adult:
“Where do your parents live?”
I was caught off guard; no one had asked me that kind of question since my mother had died. I paused, then my eyes started to well up with tears, so she walked me outside of the team room. I told her a brief story of how I struggled through second year, having lost my mom at the beginning. This turned out to be a big mistake.
For two weeks, she was patient with me. She sugar-coated everything and rarely gave feedback; but at the end of the rotation, she revealed what she really thought. She told me about a friend of hers who had a similar situation to mine and explained her understanding of that experience. She’d interpreted my stating that I’d struggled in second year as meaning that I was a terrible student that year.
“In order to be a good student in third year, you have to be a good student in second year,” she said.
Not to mention how long it took me to finish my patient notes! Honors students don’t spend hours on notes.
Then she said, “Of all the students I’ve worked with, I would want you to be my physician one day. You’re not an honors student or a high pass student, but we can get you there.”
I claimed that my issue was my anxiety, but she refused to accept it. She knew my experience better than I did. In that moment, I felt powerless to a situation completely out of my control. I regretted ever sharing a piece of my life. I regretted showing any weakness. I regretted trusting her. I began to cry.
It was the first time in my life in which I’d cried after receiving feedback.
My mother raised me with the perspective that we are forever students in life, that change should be embraced and that self-growth is important. That meant that I should be honest with myself about what my strengths and weaknesses are and be receptive to constructive feedback.
Dr. Samson looked at me and said, “It’s a good thing that I don’t cry when other people cry, or else I would be crying right now.”
Was I that pathetic?
That moment changed everything for me.
I asked my doctor to prescribe me propranolol for my performance anxiety. I started every day practicing power stances in the bathroom. I shared no details about my life with my teams. And I became a shell of a person. Months rolled on. I became less and less myself. I would be enthusiastic at work because I really did care about the wellness of my patients, but when I went home, I stared at a wall. I was exhausted. Wearing a mask for 12-plus hours a day took everything out of me.
Near the end of third year, I had my psychiatry rotation. When talking with my patients, I found out that many of them were suicidal after losing important people in their lives. I had never attempted suicide myself, but I’d had my own moments of hopelessness, loneliness and self-loathing.
It was the first time I’d talked to a counselor about grief. Not my grief, of course—our patients’ grief.
I couldn’t process it all. I started experiencing flashbacks of my mother’s death and how alone I’d felt. I was starting to remember my mother’s voice and her demeanor. I didn’t even realize that I’d forced myself to forget her until the memories came back. The fact that I’d pushed her away contributed to the pain. How could I push away my best friend? The intensity of my feelings turned ugly, and I started to feel suicidal ideation again.
After counseling patients, our team would go into a room and discuss the treatment plan. I felt like I did not belong there. I didn’t belong with the physicians. I was more like a patient. I felt like an imposter. So, I just stopped going. Eventually, the course director called me in and told me to find a therapist. I did.
That therapist was exactly who I needed. It took years of work, but I’m now on the other side of my “complicated grief.”
I finally took a break. I visited Michael’s family and thought about what had happened to me throughout the past two years. I was living a lie. I was forcing myself to believe that I was fine, and that I was done grieving. Yet, after the shock had passed, I never truly allowed myself to grieve. During those years, I told myself over and over that “medicine doesn’t wait.” I wanted to be the high-functioning Kortni again. The AMSA president. The interview coordinator. The SNMA volunteer coordinator. The otolaryngology tinnitus lab rat. The [insert ambition here]. I wanted to go back to who I used to be, and I constantly punished myself for not being able to. I was in denial for so long that I had no idea what normal looked or felt like anymore. The truth was that I couldn’t go back. My life was forever changed. Accepting that allowed me to consider moving forward instead.
After starting my break, I began considering a research year. When looking into a possible focus on intimate partner violence and behavioral interventions, I realized I wasn’t experienced enough in the field. This led me to look into pursuing an MPH. A few phone calls and one application later, I matriculated into the Pitt Public Health Behavioral and Community Health Sciences master’s program. It was one of the best decisions I’ve ever made. I gained a wealth of knowledge for my research, learned what resilience really looks like and determined that behavioral change is extremely difficult.
I found myself thinking, “Why was I willing to be patient with individuals who’d experienced trauma from intimate partner violence but not with myself? Wasn’t losing my mother, the only relative I really had, traumatizing? Hadn’t I been living in defense for multiple years?”
These were the things I started to consider, and for the first time, I started to forgive myself for all my actions, all my mistakes, all my negative self-talk. This is what my therapist was trying to show me.
The behavior change was not easy. It took a lot of self-help audiobooks, a lot of conversations and a lot of journaling. I started applying behavioral intervention theories to my own life. All this time, I’d been focusing on a deficit-based approach, rather than identifying my assets.
I began celebrating my mother’s life through what she had taught me. I now strive to make strangers smile the way my mom did. (She welcomed and loved everyone, even the people some would argue were hard to love. And she somehow befriended the unlikeliest of strangers.)
I try to do something nice for people any chance I get, with nothing expected in return. Most importantly, I’ve learned to establish boundaries. My mom was an altruistic person; she gave what she could not afford to give. I’m inclined to believe that years of stress from past traumas and financial hardship led to her early death.
Now, I practice self love and give what I’m able to. That was a skill I had to learn on my own. But now, I have the energy to do much more than I ever did before—even before my mother’s death.
Healing is a process, and the happy ending is not the only thing that matters.