Mourning and Resilience

Linda L. Isaacs, M.D.

March 2017

When I was in my mid-30s, I wrote an article entitled “Emotional and Spiritual Aspects of Healing,” (click here for an updated version) which I placed on the website I shared with the late Nicholas J. Gonzalez, M.D. The idea for the article came to me in a sudden burst of inspiration. I went through the list of patients in our practice with remarkable outcomes and looked for personal qualities common among them. The article discussed these qualities: diligence, perseverance, joy, trust, love, and truth. I hoped it would be helpful to our patients.

Over the years, on reviewing the article I have felt both pleased by how it came out and challenged by the aspects of it that I needed to put into practice myself. Recently, based on the events of the past two years of my life, I realized that there was a big piece missing. That piece is resilience, the ability to face and recover from adversity and loss.

While most physicians deal with loss on a regular basis professionally, in my personal life I have been fortunate, as most people in my family have had long lives. My grandparents were already 75 or older when I was born; we did not live nearby and I never got to know them. Over the years, aunts and uncles passed away, but they were all in their 80s and 90s and their deaths seemed almost “normal” to my shallow teenaged self.

When I was 42 and my father was 80, he died of myelodysplastic syndrome, a form of leukemia. His final illness lasted two years, and death came as a relief to him. But he himself told me that those two years had been very productive. He came to terms and was at peace with decisions he had made in his life and with his relationships with his children. While I mourned his loss very deeply, and I still miss him, there were no unresolved issues when he left us. We had plenty of time to deal with every issue we could have had.

As time went on, my mother’s well-being became an increasing concern. She insisted on living alone, with no family and few friends nearby, while her ability to take care of herself deteriorated. She stubbornly refused to wear an alert pendant or to have someone check on her more than once a week, even as she had trouble accomplishing the basic functions of life.

During the last few years, as I waited for some disaster to overtake my mother, I noticed that my blood pressure gradually began to creep up, at times into territory that warranted medication. Like many physicians, I am not a good patient. I was able to rationalize delaying conventional treatment, instead taking extra magnesium supplements and practicing restful thoughts before getting out the blood pressure cuff. Then, in March 2015, during a busy day at my office, I got a call from an ambulance driver who told me that my mother had fallen, was unable to get up by herself, and had spent four days on the floor before she was found.

I persuaded my mother to go to the emergency room, where she was admitted to the hospital. Fortunately, she had not broken anything or sustained any lasting damage. She then went to a rehabilitation center, and bit by bit she decided that she could not go back home. Over two week-long trips, my husband and I were able to find an assisted living facility, move in some of her belongings, and start cleaning her house and disposing of unneeded possessions. After dealing with the first layer of accumulated clutter such as junk mail and sale fliers, I developed decision fatigue as I encountered items of sentimental value. I didn’t know why she had saved a dress that she made me when I was in high school, 40 years earlier, but it was hard to throw it out nonetheless.

I was planning to make another trip to see if my mother had what she wanted in the assisted living facility and to deal with her house, when suddenly another issue arose. Our landlady informed us that she was selling the property and would not be renewing the lease for the apartment where my husband and I had lived for 13 years. We had only six weeks to find a new place, sort, pack and move. On July 18, 2015, the moving van came, and we began figuring out how to fit our things into a smaller apartment.

Four days later, I was appalled on arising to find a number of messages on my telephone. I had not realized that in my new apartment, I had left the phone where I could not hear it in the bedroom. The first message was from my colleague Dr. Nicholas Gonzalez’ wife, asking that I call her immediately. I picked up the phone and dialed, expecting to hear that he had a minor illness and needed me to see his patients. I still remember her exact words: “Nick is dead.”

“What?”

“Nick is dead.”

The previous evening, he had come home from work as usual, but later, after his wife had gone to bed, he stayed up to watch television for a few more minutes. He got up, took a few steps, and she heard him fall. She went to check on him and found that he was unresponsive; he could not be revived.

After this call, not only was I distraught because of the loss of my long-time friend and colleague, I was suddenly extremely busy. I had not scheduled any patients that week since I knew I was moving and would need to unpack. But Nick’s schedule was full. I immediately went to the office and found that his first patients were also personal friends of Nick’s and mine. I was able to reach them before they left for their appointments. My own shock and grief were mirrored in their reactions, and the reactions of so many others as I went through the day: the office staff, the new patient who was expecting to see Nick but got me instead, the callers to the office. Later that day, a radio show host called to say that he planned to do a lengthy tribute to Nick that evening and it was strongly suggested that I participate. By the time the show started, I was completely exhausted. I lasted ten minutes, choking back tears, then returned to my apartment, where my husband was valiantly unpacking boxes by himself.

(To listen to the radio show interview segment with Dr. Isaacs, click here or play it below. For the complete tribute show for Dr. Gonzalez, click here.)

Nick’s funeral passed in a blur. The next days, weeks and months were the most difficult of my life. I dealt with his patients and my patients, many of whom would sit down in my office and burst into tears. I found and moved into new office space. I made many business decisions, big and small. I finally made it back to my mother’s place and finished up there, hastily removing items for her and myself before putting the house up for sale. In the midst of all this activity I found myself getting more and more irritable, more and more fatigued, and more and more hypertensive.

Finally, several months after Nick’s death, I found myself unable to make a decision about a business matter. I sought advice from a friend, who heard me out and then gave me his input: “You need to take some time for yourself and go process how you are feeling about all of this.”

I was resistant, but in my heart I knew that he was right. I was taught in my medical residency that you cannot take care of anyone else if you do not take care of yourself, but in the firestorm that I had fallen into, I had lost track of that. So I cleared a few days in my schedule, bought the book The Grief Recovery Handbook (affiliate link), and a few weeks later I headed to the New Jersey Shore during brisk spring weather to focus on mourning my losses.

I needed to reconcile myself to Nick’s death, to all of the unspoken questions that I would never be able to ask him because of the suddenness of it all, to all of the emotions that came up as I acknowledged how large a hole had been created in my professional life and in my heart. But I also needed to grieve regarding the changes in my mother’s life and the loss of the last vestiges of my childhood home. She is still alive, at age 94, (note: since this article was written, she passed away at age 95 on January 21, 2018) and has been wonderfully supportive during this whole experience. But I will never again get to visit her and be in the environment I grew up in; I will never be able to cook a meal with her in her kitchen, never be able to see her living the life she led before age and frailty took it all away from her. Just recently, I realized that the bowl she always put cranberry sauce in at Thanksgiving is gone, because I did not have time to sort out the contents of her china cabinet. The Christmas ornaments are gone, including some I made when I was a child; I did not have time to find the box where they were stored. There have been so many small and large losses over the last two years; common losses, as death, ageing, and frailty visit all of us, but no less painful for being shared.

In my four-day grief retreat, I wrote and thought and examined my feelings about Nick’s death and about my mother’s situation. I prayed. I cried. I went for long walks. I tried my best to come to terms with it all. And while it is a process—just this last week I found myself sad all over again—overall, I am much less irritable. And for the most part, my blood pressure is back to normal: 121/70, when I checked it a few minutes ago. When it starts to creep up, I know I need to take time to deal with my own emotions.

I don’t claim to be an expert on grief; I believe that each of us needs to find our own path through the inevitable dark times that life brings us. I know that acknowledging and taking time to process my own sadness has improved my health, and has helped me be able to find joy and inspiration again. I have been helped along the way by patients and friends who have learned resiliency by facing the hardships and losses of their own lives, and have found meaning and strength within themselves. I hope to be able to look back and see that I too have become more resilient, and to take my turn in helping others.

“The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.” Chödrön P. When Things Fall Apart: Heart Advice for Difficult Times.

“Nothing was resolved or changed ... but acknowledging my grief made it easier to bear, now that I was not wasting strength on denying it.” Addison K. The Grief of Stones.