Permission to Grieve

This piece is not about one patient. It is not about one moment. It is not about now

It is about every patient I have ever lost. It is about the ones whose names I carry in silence, whose faces appear without warning, whose deaths I was never given permission to grieve out loud. It is about the losses that accumulate over a career in psychiatry. About losses that have no official place in our training, our documentation, our supervision, or our medical culture.

Physician grief after patient suicide is among the most isolating experiences in medicine. Most will process it alone.

This is my attempt to not do that. And an invitation for you to not do it either.

I cannot share with the world when I met you or when you died. I cannot really share how you died. All I can share is how you changed my life. You changed my life by living. You changed my life by dying.

The call came on a late afternoon while I was home with my family. A colleague’s voice, gentle and deliberate. She walked me through what had happened.

I thanked her. I hung up.

The next day, I went back to work.

I kept moving.

Then I began to count.

I did not count the number of patients on my schedule or the calls I still had to return. I was counting the places I might have missed something. The moment I should have asked one more question. The phrase I should have said differently. The tone. The timing. The decision that now sits in the same room with me, even when I am alone.

It is tempting, in that moment, to make the story simple. To assign blame in a tidy circle that ends at yourself. To believe that if you punish yourself enough, you will somehow pay the debt.

But suicide does not bend easily to our need for clean explanations. We do not have the power to predict it with certainty, and pretending otherwise only deepens the wound.

Still. The not-knowing can feel unbearable.

So you scan yourself for failure. You become suspicious of your own clinical judgment. You start to second-guess the warmth you offered, as if humanity itself were a risk factor. A new voice enters the room with your next patient:

Be more cautious. Admit less. Control more.

That voice can sound like professionalism. It can sound like prudence. It can sound like the safety you owe everyone else.

But underneath it is fear. And fear, left unchecked, shrinks the very thing that keeps people alive: connection.

I have never felt the sense of shattering, visceral, and twisting grief that I felt when I learned about your death. It felt like a violent whirlpool that picked me up and slammed me down over, and over. My first day back at work my entire body ached. My muscle fibres trembled and gasped for air. My head swam in a distant fog. I was present but absent at the same time.

Although much has been written about how it feels when a doctor loses a patient, your death defies any previous description. The grief of losing you is different because it is grief compounded with grief and loss amplified by loss. We are all grieving and losing everything we once knew. The world that you once inhabited has gone with you.

I just wanted permission to be a person.

To say that even when a therapeutic relationship is bounded, it is still real. That you can be trained in assessment and management and still feel your stomach drop when you hear the outcome. That you can understand intellectually that this happens to many clinicians and still feel, in your own body, like you are the only one.

Your hair. Your eyes. Your smile and your practiced politeness.

I still see you sometimes. I see you in my other patients and in my children. Traces of you are everywhere, yet I avoid reminders whenever I can. I tell myself to flick off the switch. I try to compartmentalize my humanity. I scold myself for feeling too much.

How dare I grieve and mourn someone who was my patient. I am a doctor. I am a professional. I am not supposed to be human.

They tell me that everything has a silver lining. They tell me to be positive and cheer up. They don’t want me to shatter their fantasy with my reality.

You remember them, right? They told you the same things. We talked about how they pushed you into silence. You told me how you were building up your courage to tell them how you truly felt.

I remember how I told you that you don’t need anyone else’s permission to feel. I told you that you don’t need to be afraid of being your authentic self. I told you the same things I need to start telling myself: That your worth is infinite. That I believe in you.

How can I start believing in myself again?

How can I start believing in our brutal, empty, heartless world?

Grief has a new meaning now. Mourning is no longer a mere expression of sorrow. It is a constant, arduous, and active process.

I used to think we could always find hope within, that it burns inside us and can never be extinguished. Now I know that what we once knew as light is always tinged with darkness.

There are times when the light goes out entirely. Every second in that darkness feels like an eternity. But it does not stay dark forever.

We can rekindle the flame. But we cannot do it alone.

In medical school we were sold a lie that we could burn twice as bright for twice as long. We were convinced to keep giving without worrying about losing. Now we know that when our flame burns out, we need others to light our path out of the darkness.

The outcome is not the sole measure of my care.

My care is the way I stayed with you in the room. The way I refused to reduce you to a checklist. The way I tried, however imperfectly, to hold both safety and dignity in the same hands.

And when the day is over, when the building quiets, when the hallway lights dim, I let myself name what I once tried to outrun:

I am grieving.

I am not alone in that grief, even when it feels like it.

And I can keep choosing my humanity because being human is still the most honest thing I have to offer.

Note: any identifying details have been altered.

If you are a clinician who has lost a patient to suicide and are carrying this alone: you are not alone, and you are not to blame. The American Foundation for Suicide Prevention offers clinician-specific support at afsp.org.

If you or anyone you know is struggling please reach out to 988 or a trusted person right away.