Navigating grief: a doctor’s personal journey [PODCAST]

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Join Humeira Badsha, a rheumatologist, as she shares her recent, unexpected journey through grief, offering profound insights into the emotional challenges faced by medical professionals. From a tearful moment of vulnerability with a patient to the traumatic experience of watching her beloved mother in the ICU, her story reveals the human side of health care.

Humeira Badsha is a rheumatologist.

She discusses the KevinMD article, “A doctor’s grief.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Humeira Badsha. She’s a rheumatologist, and today’s KevinMD article is titled “A doctor’s grief.” Humeira, welcome to the show.

Humeira Badsha: Thank you so much for having me, Kevin.

Kevin Pho: So I want to start by having you briefly share your story and journey to where you are.

Humeira Badsha: I’m a rheumatologist, and I’ve had a long journey. I started off training in India, then moved to the States in the early ’90s. I trained in Connecticut and then at UCLA in rheumatology, and I worked in Boston for some time. Then I moved to Dubai several years ago, where I’ve been practicing. I mainly moved to be closer to my aging parents in India and to take care of them as they grew older. My kids grew up here, and they’re back in the States now, but I’m still here in Dubai.

Kevin Pho: All right. So what’s it like to practice rheumatology in Dubai, having trained in the United States?

Humeira Badsha: Initially it was very different. When I first arrived, there were very few rheumatologists, but now it’s very Westernized, mostly Western-trained rheumatologists from the U.K. and the U.S. It’s great. We have a great community, and we attend conferences around the world. It’s been a very exciting, interesting experience to work in a different culture and to learn from it.

Kevin Pho: And from a medical standpoint, what are some of the contrasts and differences between practicing in Dubai and in the States?

Humeira Badsha: There are two tracks here. We have a government system, which is free for nationals who belong to the country, and then we have a private practice system, which is very much like the United States. You have insurance payers and all the usual hassles of documentation, CPT codes, DRGs, burnout and everything else we get in the United States. So it’s actually very similar in a lot of ways.

Kevin Pho: And if a patient wanted to see you, a rheumatologist, a medical specialist, are there normally long wait times, as elsewhere in the world, or can they see you relatively quickly?

Humeira Badsha: Relatively quickly, actually. We’re pretty well staffed here. There are lots of doctors and lots of access to care. There’s mandatory health insurance for everyone, because the majority of the population in Dubai is expatriate. People come from everywhere in the world, and they have to have health insurance. So it’s pretty easy. There are many doctors here, and they’re well trained. The health care system is quite good.

Kevin Pho: All right, so let’s talk about your KevinMD article, titled “A doctor’s grief.” Tell me how this story and this article came together.

Humeira Badsha: It happened a year ago, when I was with my mother in the intensive care unit, observing what was going on. It was her slow progression to death over a week. She fell and broke her arm, and she was 90 years old, but otherwise she was feisty, very interested in everything around her. She talked to me every day for half an hour on the phone, telling me her stories. She was interested in politics, dashing off angry letters to the newspaper. So luckily she had her mental faculties; she was very alert and a very alive person. But she fell and broke her arm, and that set off a domino effect: One by one, her organs started shutting down, and she passed away.

When someone very close to you is in intensive care and you’re just standing around observing, and I was with her the whole time, they allowed me to stay with her in the ICU, what you observe is not what we see as doctors. What we observed was just chaos and noise: people running around, a code blue in the next room, people shouting, monitors beeping. It’s noisy, and it’s not peaceful at all. So I saw the struggle at the end of life, which wasn’t very pleasant. It’s not slipping away into the night, as we would all like to. We don’t see that when we are the physicians. We’re trying to save lives. We’re trying to put that IV in, get that central line, do that CPR, give shocks. We’re just trying to get people back, and sometimes, I think, we’re not letting people go peacefully. That was something I observed.

The second part of this was the grief, which came after the funeral. I came back to work, and people were giving me their condolences, my longtime patients, and you just hold it in as a doctor. We don’t express our emotions at work. We are supposed to be stoic, and we’re taught that from a very early stage in our careers: not to express emotion, to gracefully accept death, to gracefully accept life, whatever we do. There was one patient who had had many losses herself; she had lost a few children. She came in, and I think she saw it in my face. Maybe she recognized grief. She held me, and I wept. That was a very unusual experience for me, to just weep in a patient’s arms. That was a few weeks after I’d come back from the funeral, and it made me think about how we process grief as doctors and write the article. That’s where it came from, because we do tear up sometimes over patients’ stories, but we don’t really fall into a patient’s arms.

Kevin Pho: Now, you said earlier that doctors are stereotypically trained to be stoic and not show emotion. Talk about some of the pressures you faced during training that reinforced that stereotype and pressured you not to show emotion.

Humeira Badsha: As residents, we face death for the first time. As interns, they call us to declare a person dead, and we come in and try to be professional, and we break the news to the family. I remember so many difficult moments during training when you break bad news to patients. Once, as a fellow in rheumatology, I had to tell a family that their only son had terminal, incurable bone cancer. When we break bad news, it’s heartbreaking sometimes, and we do tear up. But I think it’s most impactful during training, because that’s when we’re first encountering it. As an older doctor now, I feel you become more inured to it, more resistant to so much emotion. You learn to hold it in, and I think we’re not really processing our grief.

We haven’t been trained for it. I think there are now programs in place to help residents process grief when patients pass away, to break bad news, and to share that loss or sadness with the patient’s family. But when we trained, we did not have that sort of support. We had to hold it in. We would talk to each other, maybe, or cry a bit, and then have to get on with it. We’re just so busy: the next day, the next death, and the next. Then there are the people we save, and that always changes things, and that’s how we balanced it out. But I do think that’s not enough. We now have statistics showing that 30 percent of residents suffer from depression, and doctors have a higher rate of suicide than the general population, maybe because we hold so much in, not showing our emotions and not processing grief.

Kevin Pho: Now, after your mother passed away, when you didn’t feel that you could express that emotion and process your grief, how difficult was that period for you?

Humeira Badsha: It was very difficult, trying to be very stoic, because many of my patients knew I’d gone away for a funeral, and when they gave me their condolences, it was difficult not to think about my loss. I have friends who have lost a child and had to go back to work, because of course this is our calling, our profession. Those are more difficult losses, but they also had to be at work. So it was very difficult.

And after my article came out, I found that so many people reached out to me from around the world. There was a woman working in another country, not the United States, because of course the articles reach everyone everywhere in the world. She reached out to tell me that she had lost her mother. She’s a doctor, she didn’t feel like going back to work, she had been so close to her mother, and she just felt so depressed. She chatted with me for a while. People from the United States wrote to me and reached out to me, too, so it obviously struck a chord: Many of us go back to work and just try to get on with it, and we don’t process things enough. We don’t get help; maybe we don’t have time for grief counseling. All of these things could help us, and we need to learn self-care better.

Kevin Pho: How difficult was it for you to concentrate on work after you went back?

Humeira Badsha: I think, actually, for me, work saves me, because when I’m there, I really focus. You’re focusing on other people’s problems, their sickness and their stories, and I think that helps me a lot. Going back to work is actually my therapy. It’s sort of wrong to say, but when I’m at work, I feel better.

Kevin Pho: Now, in your ideal world, how would you envision doctors processing their grief? What would you like to see?

Humeira Badsha: I really think that psychiatrists go regularly to get counseled; they have to unburden themselves. And at this time, doctors are going through so much burnout and finding things so difficult. I belong to various doctors’ groups where people are talking about burnout. They just can’t work anymore; they’ve lost the joy in their profession. I think all of us need to go to either group sessions or therapy. We did organize this during COVID, with psychologists and psychiatrists, where we talked about how we would handle the pressures during COVID, and we came through a very difficult time, when there was a lot of burden and pressure on people and on our families, too, because we could be bringing infection home to them. So I think we do need help. We are not superheroes. We need regular sessions with people. We need support groups. We have a very good female support group here where we get together regularly, not for CME, just for support, doctors talking to each other, and I think that helps. Having friends helps, but I think we do need professional support structures, especially in hospitals where there are a lot of burned-out people, in the emergency room and in ICU settings. We do need that sort of help.

Kevin Pho: Now, you mentioned earlier that when your article was published on KevinMD, you received emails and similar stories from physicians around the world. What kind of advice did you give them? How did you counsel them through their periods of grief?

Humeira Badsha: Some of them were very depressed, and I told them to seek help. And they were afraid. This is the problem with our profession: They were afraid to seek help, because they don’t want to seem to be a damaged physician. If we take medication for depression, we might seem damaged. So they actually said that they didn’t want to see anyone, and they didn’t want anyone in their professional circles to know about their problems. This is something we also need to get past. Medical boards should look at us as people who are trying to help ourselves, be better people and seek help, and we should not be punished in some way for it.

Kevin Pho: Now, what are some of the things we could do to normalize that behavior of seeking help? How can we break the stigma around physicians seeking behavioral health care?

Humeira Badsha: I really think we need to speak up about this. We are human. There’s been a long tradition of silence about ourselves as human beings. I don’t know if this was similar in your training, but we were not encouraged early on to share our personal stories with patients, to talk about ourselves or to say, “Yes, that was my experience too.” Sometimes that helps. Patients sometimes talk to me about their kids, struggling with their teenagers, or struggling with something else in their marriage, and we’re not supposed to tell them, “Yes, that happened to my son too,” or “That happened to my kid too.” So we’re not seen as human. I think we need to start by regarding ourselves as human, and the culture around us needs to change. We are not superhumans. I think we need to be able to share our stories as well, to be more personal with our patients and get closer to them, and this whole culture, and the way we train our residents, needs to change.

Kevin Pho: Now, after going through this experience and processing your grief, how has it changed you as a physician when you see patients going forward?

Humeira Badsha: This was the big loss in my life, and I think I understand my patients’ losses much better now. So many people have talked to me about losing a parent or losing a child, and I really feel I can relate much better. It makes me a better person, because I relate better. It makes me closer to them and more empathetic, shall we say. I was empathetic before, but there are things you don’t understand when you don’t have close experience of them. It’s just like how doctors haven’t experienced illness, and when we do experience illness, we are on the other side, and we’re sort of different as patients. So with experiencing loss, and I don’t want anyone to experience loss, but it’s going to come to all of us at some point, it makes us understand other people’s losses better. And I think being human, and being regarded as human by our patients, is very, very important.

Kevin Pho: We’re talking to Humeira Badsha. She’s a rheumatologist. Today’s KevinMD article is titled “A doctor’s grief.” Humeira, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Humeira Badsha: I really feel that we physicians need to take time for ourselves. I know it sounds like a cliche, but travel, read, be interested in the arts, in music, in books or in whatever rocks your boat. Take time for that, because if not, we’re at the edge of burnout. All of us are at the edge of burnout, or already there. We need to get that passion back for what we do. I do still have the passion, because I love my patients’ stories. I love every single one of them. Everyone asks, “How can you be a rheumatologist for so long?” And I say it’s because every story is different. Every patient comes with a different set of problems and a different story, and you need to know the story behind the patient. They’re not just rheumatoid arthritis or lupus or type 2 diabetes. They each have their own story, and we need to get to know those stories, because that makes them interesting to us as human beings. And share a little bit of yourself with your patients, to make yourself interesting to them.

Kevin Pho: Well, thank you again for sharing your story, time, and insight, and thanks again for coming on the show.

Humeira Badsha: Thank you.

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