- Doctors are trained to seek patterns in diagnosis
- The so-called 5 stages of grief are denial, anger, bargaining, depression and acceptance
- Grief after loss is not neat and tidy; it is messy and complex
(CNN)In medicine, we like rules.
Digestible, consistent patterns can be easily recognized, analyzed and lead to a swift diagnosis.
An alcoholic with yellowish skin and eyes, spider veins on the legs, weakness and a protuberant belly. The pattern points to cirrhosis of the liver.
A woman who has no pain whatsoever when sitting, but who consistently develops a dull ache in her legs after just a few steps. That is likely peripheral arterial disease.
Doctors are trained to seek such patterns. They are easy to teach and easy to learn, which is ideal for how much information needs to be absorbed in medical school.
However, the convenience of learning through patterns is not always pragmatic. Patients break patterns and defy the rules all the time, and when they do, following such patterns can get in the way of the patient's needs.
Such was the case with my friend and former CNN correspondent, Miles O'Brien, who suffered an injury that led to an amputation of his left arm.
Miles had been in the Philippines working on a story when an equipment case had fallen on his arm. The injury was far worse than Miles first realized, and within 48 hours, he had developed Acute Compartment Syndrome. When Miles went under general anesthesia, he didn't know what the outcome of the operation would be, but over the next couple of hours the surgeons learned they needed to amputate his arm to save his life.
I've known Miles for 14 years. He was gracious to me when I started at CNN and I learned something from his reporting on space every time he appeared on television. We often joked that together we were the rocket scientist and the brain surgeon of CNN. And over the years our friendship grew as we covered wars and natural disaster (including Hurricane Katrina) together.
So it was personally upsetting to first hear of his injury and then later as he described the moments after he awoke, his brain still registering the presence of the phantom limb. I cried when Miles told me he had breathed a sigh of relief only to look down and see that a part of him was gone. What stunned me more, though was that for a week after his operation he stayed in the Philippines, worked on his stories, and told...no one. Neither his family nor his friends. He didn't even tell his bosses back in Washington, DC as he continued to submit his work. Within minutes after losing his left arm, Miles was grieving, and within days he was working out of acceptance or denial, as if it hadn't happened. He was already starting to break the rules.
The pattern that would seem to apply to Miles's loss comes from the widely taught paradigm of grieving from Elizabeth Kubler-Ross's influential "On Death and Dying," first published in 1969. In it, Kubler-Ross introduced the five stages of grief people go through when dealing with a loved one who had become terminally ill. Even Kubler-Ross never intended for her stages of grief to be taken so literally, but there was no denying how alluring this pattern could be.
First denial, then anger, bargaining, depression and finally acceptance. It made sense, and helped instill empathy. It was also a pattern that fit neatly into the way medical students could be taught and tested. If I had placed Miles into that pattern, however, I would've failed my exam.
In the months that have followed Miles's amputation, he fluctuated wildly between denial, straight to acceptance, and apparently backward into depression. At times, he was going a thousand miles an hour, seemingly thankful for the life lessons his loss had provided, and then straight into a state where he might be a little ticked off, even angry.
Rules are made to be broken. Grief after loss cannot possibly follow a pattern. It is not so neat and tidy. It is messy, complex. At times grief is illogical and unpredictable. We will all suffer types of loss in our lives so it is valuable to know that how we grieve will follow no rules. And that is absolutely ok.
As always, my friend Miles taught me that.