For Every Tear, a Hundred Smiles
“Tank” our Maine Coon cat who became my “pet soulmate.” A gentle giant and escape artist, he made a dash one day and never came back, likely killed by a predator. The lack of closure perpetuated the grieving process, but provided empathy for families of lost or missing persons.
Carey -
This section addresses the grieving process of family and friends. Because of the stigma associated with death, many of us are sorely unprepared to think about that grieving process until it unexpectedly confronts us. Forced upon us through an unanticipated tragedy, our response oftentimes is suboptimal or even pathologic, ranging from compartmentalization and denial to, on the other end of the spectrum, an obsessive depression that creates loss of interest in life activities. As an Emergency Medicine physician, I was well versed in the process of compartmentalism, often burying the event seemingly permanently. Three events prior to my diagnosis forced a reckoning with how I participate in the grieving process.
The first occurred some years ago at work. I had just finished a particularly challenging “quiet room notification” that involved telling a large family that their 13 year old had died from traumatic injuries just prior to their arrival. I left the quiet room emotionally drained, and was erecting the necessary walls that would allow me to provide care for my other patients. As I walked back into the ED, a family member at the bedside of her mother accosted me, yelling “Doctor! Doctor! We’ve been asking for a glass of water for our mother for over 30 minutes. We’ve told 2 nurses and still have nothing!” I turned to her and said, “Let me get that glass of water for her right now. I’m sorry for your wait.” The disconnect between what was happening literally 30 feet apart in those 2 rooms slapped me in the face. I felt like screaming “I just had to tell a family that their 13 year old son is dead!” Instead I delivered the water with a forced smile and again apologized for their wait. I failed to process this and it still haunts me some 10 years later. Walls are necessary sometimes when addressing grief - but only when there is a door to unlock at some future time. Unprocessed grief is not good.
The second event involved our last cat, “Tank.” For those of you who have never had a pet soulmate (I think we each get only one of these in our lifetime), I’ll say that you are very unfortunate - and very lucky as invariably you’ll outlive your pet and will need to process the grief. Tank, a huge Maine Coon gentle giant escaped from our house and never came back. Likely killed by a predator. As each day passed, the searching diminished and hope was replaced by naked grief. I obsessively pondered what had gotten him, and wondered if he died quickly and painlessly, or was left mortally wounded to die alone. The lack of closure contributed to the difficulty processing this grief. I couldn’t talk about him for over a year. I still miss him over 3 years later.
The third event involved the tragic murder of one of my closest friends and work colleagues for many years, Dr. Kevin Rodgers, in Nov 2017. The grief that I felt and witnessed in so many who held him dear, created by this sudden and unanticipated death, forced me to finally learn more about healthy grieving processes. The story, Riding the Wave, (author unknown but widely available on the internet) provided perhaps the best perspective on how grief feels and changes over time.
Grieving is an attribute of empathy, and empathy is one of the most important human attributes. So I’ve learned about riding waves. Tank visits me in my dreams. I hope that he’ll be there at the end. This summer we had a number of friends visit, but due to COVID I cooked most of the meals alone in the kitchen as company socially distanced on the deck. In addition to being a great husband, father, physician and educator, Kevin was a great cook. He served as the chef for our eldest daughter’s rehearsal dinner and wedding dinner. He was as an inspiration for me to up my game in the kitchen. Together we prepared literally hundreds of meals. So this summer I had a lot of “Kevin time” while preparing meals for others - replaying conversations and past cooking events as if they were yesterday. And always with a smile, even when I’d hear him complain about how I was cutting something incorrectly or not seasoning adequately. These memories occur for me in an atmosphere of peace and tranquility and I’m grateful to have them.
So now I’m faced with the hope of moving loved ones towards a “good place” in this dying process and after my death. I think sharing the journey and being very open about the process will assist. There will be tears, but my motto is “For Every Tear, a Hundred Smiles.” Tears of sadness can ultimately transform into tears of happiness and a big smile. I’d prefer that my memory not be a downer, thank you. We each process grief differently and at variable speeds. Hopefully in my case, death will be painless and speedy. And after I die, that memories of me will bring a smile to those who knew and cared for me.
Colleague and close friend Kevin Rodgers, MD pictured here with me in our medical simulation lab. Kevin was a homicide victim in a home invasion at his house in Nov 2017. His unexpected death sent shock waves through all who knew him.
Nicole -
Anticipatory Grief. The grief we feel as people who are dying and also as loved ones and friends who are aware of the upcoming death of someone we care about deeply. I like to think that between two people there is an energy which is unique only to them. When one person dies those of us left behind grieve not just the loss of the other person, but the loss of the piece of ourselves that existed only with them. Acknowledging this loss of ourselves in addition to the loss of the other person is double grief. But double grieving both the loss of a piece of ourselves and the person who has left makes the grief less complicated in the long run.
Anticipatory grief is the mountain that is bigger than life. We know what is coming but we don’t know how bad it is going to be. Can we handle it? Who will we be afterwards? In the case of losing a parent or life partner or a decades long relationship, we don’t remember or know who we were without that person in our lives. One foot in front of the other, just like climbing a mountain is the start.
Trusting that we can handle the grief and create a new space in our lives for the person who has left is the next step. I don’t believe in letting go of people but rather of creating a new type of space for them. A permanent space in our lives and in our hearts so that we can walk forward with them always but in a different way. It may not feel real enough in a physical sense but the feeling and love of the person can still be there. We can continue to love them and simultaneously miss them, forever. There will be anger that the person had to go and there will be tears, but there will also be continuing smiles. And toasts with spilled wine. And the hope that when it is our turn to take the dying journey ourself, those that we love may be waiting.
I am very sad that Carey is dying. I would have preferred to learn he lived in the area through an alumni news letter and enjoyed many years hiking and creating amazing meals together with our families. As a physician, I don’t have enough formal time to grieve my patients who have died and there are so many of them. I’m going to use Carey’s death (which I know will affect me greatly) as an opportunity to remember all my patients and their smiles. And be grateful that I played a role in each of their journeys. And to remember that for each tear I shed, I must smile a hundred smiles.
Robin -
“Well, the first days are the hardest days, don’t you worry anymore.” ~ Jerry Garcia
I am thankful that we have had time to prepare for Carey’s death. We have all had time to say the things that need to be said and do the things that need to be done. We have been able to spend meaningful time together building lasting memories. There is nothing easy about preparing for the death of a loved one but sharing the journey is enlightening and rewarding. There will be sadness and grief tempered by love and laughter. Carey and I were talking about a farewell toast with a great bottle of wine and laughing because Kelsey will spill hers (as she always does).
Carey has cursed all who know him with the “curse of curiosity.” It might be lifelong learning, cooking something new, trying something out of your comfort zone, or seeing what is around the next corner. Every trip or hike we take we will think of him and push on just to see around one more corner or over the top of the next hill.
Sunset on the California Coast
Tyler -
“The Earth holds every possibility inside it, and the mystery of transformation, one thing into another. This is the wildest comfort.” – Kathleen Dean Moore
While some compare their grief to a roller coaster, I like to compare my grief to a trail through the North Cascades, which one could say is a roller coaster, just much, much slower. Anticipatory grief is indeed a slow process with periods of highs and periods of lows, moments of exhilaration and moments of utter bone-aching exhaustion. Pain and struggle complemented with fleeting moments of a summit’s tranquility. Feeling completely put together one moment, then falling apart the next.
While difficult, I am thankful that we have had three good years since the diagnosis to make new memories and to process the anticipated loss. Throughout this journey as a family we have become closer, shared more with each other, and explored the depths of sorrow as well as many moments of joy.
At the beginning, I mourned the eventual loss of my sidekick in silliness, my accomplice of antics, my sous chef, my adventure buddy. Now I know that even when he’s gone, he’ll still be with me in every terrible dance move (thanks, dad!), delicious meal, and goofy outfit. And I will forever have a hiking partner, because he will be with me through every connection with the natural world I feel. The peaceful quiet of a moonlit night, the solitude of a summit, a raven’s call, a fern unfurling. My father’s spirit for adventure, to question “what’s around the next corner” will continue to inspire and lead me onto the next journey.
In addition to being a gifted clinician and medical educator, Kevin was an outstanding chef (seen here cooking his famous crab cakes at one of our residency retreats). Kevin taught me much about cooking, and spurred me to “up my game” quite a bit over the years. We both view cooking as an expression of love for others. Our homes were often opened to large groups for whom we cooked. The logistics of procurement, prep, cooking and clean-up afforded an element of control for two docs working in Emergency Departments where so many things were beyond control (such as the numbers and seriousness of illnesses of patients arriving for care). But most of all I recall the loud, vivrant chatter of participants and their smiles and laughter. Kevin served as the chef at our eldest daughter’s rehearsal dinner and wedding dinner.