Grief Process Following the Sudden Death of a Patient
One foggy day last summer, I was broadsided by the news that one of my psychotherapy patients suffered an unforeseen cardiac event and did not survive. She was a married, working mother with two young children and a life on the rise. Almost instantly, I was acutely aware that I did not know how to proceed.
I had received training about how to process a patient suicide. Yet the sudden loss of a patient to a tragic event isn’t part of the psychotherapy playbook. I found only one article that discussed mourning the sudden loss of a therapy patient; and while this resource gave words to my experience, the literature seemed desperately thin. I reached out to colleagues, but none had lost a patient in this way.
I felt so alone. Our profession allows us the incredible honor of walking our patients’ lives with them. As we hold a therapeutic environment, we balance authenticity with boundary. We are a part of, and yet distinct from, their lives. I lost a dear person in my life, and yet my professional boundaries prohibited me from the natural process of grieving with a community. As a psychotherapist, I could not share my memories with those who knew her; I could not hear others’ memories of her.
I love my patients. Some I really love, and she was one of those. For weeks after her death, I went to bed crying and thought about her throughout the day. Sitting with other patients, I imagined her across from me with one leg folded underneath her. I remembered her quirks, pulling her mouth to the side in deep thought, rubbing her forefinger and thumb together, or twirling her hair while discussing anxiety-provoking topics.
She had an unresolved issue that I knew one day she would resolve; but now I am left holding it. The termination of a therapeutic process aims to review a patient’s growth and provide structure for moving forward. Yet this sudden, unexpected termination of our work will forever lack that structure.
How I Mourned
In my aloneness, I turned to traditions of my Jewish culture, attending Shabbat services to say the prayer for mourning.
I read every psychotherapy note I wrote about her. Unfortunately, as my medicalized notes are shorthand for the depth of our work, they were helpful but not satisfying.
I kept her hour open for a while, protecting that time for mourning.
I spoke with colleagues, who provided some comfort.
I hung a picture in my office of my favorite family vacation spot, a place that her family loved as well.
I repeatedly scrolled through the website her family created in her memory.
Days after her death, her husband emailed asking if he could come for a session. I agreed without hesitation, but this too was uncharted territory. How should I greet him? Should I hug him? Tell him how much I loved his wife, how hard she worked in therapy? What about HIPAA? Ultimately, I knew she would want him to know that she viewed him as her partner and loved him dearly.
In our session, he asked if I could be his therapist—a question I had pondered deeply, alone and in consultation. I realized I was driven by the desire to keep her present in my mind, and I recognized that my own mourning would interfere with my ability to support him. I referred him to my mentor, who now sees him regularly.
He shared a wish to give a eulogy at her funeral but worried that he wouldn’t be able to finish, and he asked for my guidance. I said that if any part of him wanted to speak, he should. In our final moments together, I shared that for a while, his memories of her would bring him tears, but one day, these same memories would make him smile.
A week later, I sat in a back row at her memorial service overcome with sadness and loneliness. I took comfort from being in the presence of her community. Her husband did give a eulogy. In it, he said, “One of her dearest friends recently said to me that these memories I have, that we all have of her, will bring tears to our eyes. But that one day these memories will bring smiles to our faces.” In this moment, he granted me the deepest validation of my work with her.
