I broke down crying. Again. — In this cold heart, I can live, or I can die. — It isn’t even on my sad song playlist, so why am I so upset? My scientific brain encouraged me to recreate the environment, remove the variables, and play the song again in isolation. — I believe if I just try, You believe in you and I — Oh no, it’s happening a third time. Reproducible, we say in medicine. Why does this particular song make me bawl my sad-little-baby eyes out with great gasping breaths trying to fill the huge hole in my chest?

Since the onset of my foray into medicine, random bouts with sorrow have struck me at seemingly random intervals, and I couldn’t seem to make sense of it. I have taken to calling the experience “having a sad.” This best defines those moments where one doesn’t flee from but, rather, leans into the feeling of sadness. Moments where you accept the sadness and feel it as strongly as you can bear until you are done. Sometimes these episodes have a clear trigger; a bad patient outcome, making a mistake at work, or more recently unease about the state of the world during the COVID-19 pandemic. More often though, there is no provoking event, no obvious stimuli to label as scapegoats.

Rather than other possible word choices, I prefer my idiom because “having a sad” reminds me that these moments are temporary, as evidenced by the fact that “a” is singular. The present participle “having” is a verb, and the process is therefore active and transformative. I also believe that the process is whole unto itself and that connection to the experience in its entirety is necessary. For me, it is akin to emotional vegetables, not always fun to eat but important to your health.

This time though, I was not alone. My wife found me. She noticed puffy eyes and a waver in my voice and, through careful reflection, helped me find the answer to my question of why a song can wreck my afternoon. The truth is that the feeling I am responding to is not sadness. It is hope. In those moments, it was actually about the reconciliation, the transcendence to a state of acceptance. You might be asking, “Why then the waterworks?” In the clarity which followed, I discovered that I had lost hope over the past few years; I mean, not all of it and not in every scenario, but a portion of my hope is gone.

Well, not gone. Lost.

Once in a while, lost becomes found. Hope finds me. It usually starts with a few bubbles breaking on the surface of the sea of my unconscious. The Great Sky of my consciousness looks down upon the sea intrigued, pondering the size of a beast that could bring the sea to a boil, hidden in the inky black. And then it comes. Terrible and fantastic, enormous; the way we think of God as big, but not hideous. No, not at all. It is overwhelming to be in the presence of something so beautiful, so fundamentally human, and to be reminded that I was the one who banished it to the depths. Being bludgeoned with hope and finding grief instead should be confusing, but it is obvious to me now in retrospect.

I believe that to do my work, I must be realistic and pragmatic, to armor against the inevitable failure of treatment plans, broken health care systems, and human frailty. I am not sad because I bear witness to hopelessness. I am sad that I push hope down to protect myself. Remembering that I cannot cultivate hope and interact with the world as it is, breaks my cold little heart.

So if you need me, I’ll just be over here, having a sad.

Russell Prichard is an emergency medicine resident.

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