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Hospitalist Jasminka Vukanovic-Criley discusses her article, “When grief hits all at once: a morning of heartbreak and love.” Jasminka shares a deeply personal account of a Saturday morning where unexpected news of the passing of two friends, Natasa’s mother Mirjana and her friend Thomas, both from cancer, suddenly immersed her in profound grief. She reflects on the fragility of life and the ripple effect of these losses, which led to a cascade of memories: her grandfather who would have turned 116, his mother who passed away on his birthday 49 years prior, and her own mother, whose 486th day of absence she was marking. Jasminka explores the experience of noticing signs and seeking meaning in numbers like 486, pondering the universe’s mysterious ways of connecting events and emotions. The conversation delves into the nature of grief as an overwhelming yet navigable ocean, emphasizing the importance of cherishing loved ones, expressing love openly, and allowing oneself to feel sorrow, ultimately finding strength in remembrance and the enduring power of love. Jasminka’s narrative is a poignant reminder to live fully and love fiercely, even amidst the inevitability of loss.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Jasminka Vukanovic-Criley. She’s a hospitalist. Today’s KevinMD article is “When grief hits all at once: A morning of heartbreak and love.” Jasminka, welcome to the show.

Jasminka Vukanovic-Criley: Thank you, Kevin. It’s a great pleasure to be here.

Kevin Pho: Tell us, what led you to share this story on KevinMD?

Jasminka Vukanovic-Criley: I just wrote an article in the morning, and I thought it might be useful to your audience and to your clinicians to hear a little bit different perspective on the very important topic that is death and dying and the process of grief.

Kevin Pho: For those who didn’t get a chance to read your article yet, tell us the story.

Jasminka Vukanovic-Criley: OK. Maybe I can just share a little bit of my background. I’m an internal medicine physician, a hospitalist. I have over 30 years of experience at the bedside. Working in a hospital, we often take care of seriously ill patients; talking about end-of-life care, hospice, all this decision-making, it’s very familiar to us. We do that very, very often. In addition to that, I also advised palliative care and hospice companies to help them grow and improve the care, and yet nothing. Nothing prepared me, not my amazing internal medicine residency training at Vanderbilt University Medical Center, which is an absolutely amazing place, nor my abundant clinical experience at the bedside, for the depth of empathy and compassion that I developed after losing my mother.

Everything changed after I lost her. In addition to being a physician, I also had the experience of being a caregiver. I had been taking care of my parents-in-law for a number of years, and I was a primary caregiver for my own parents as well. I helped my mother-in-law transition into palliative care and hospice.

I already had those experiences, but really experiencing grief firsthand as a daughter increased the empathy and compassion to a level I think I could have never learned in medical training or at the bedside. It reshaped how I connect with others, and this is just a little bit of background because throughout my whole practice, I was always an advocate for patient-centered care. Advocating for the patient has been at the heart of how I practice medicine. Working in a hospital or working outside the hospital, being a physician and then a caregiver, I had an advantage that most other people who are not in the medical field have: knowing the systems, knowing the inpatient, knowing the outpatient. But then there is also that other intangible thing called emotion.

When we look at a patient’s chart, we cannot really gather how those emotions shaped up. As a caregiver, I saw both the emotional and the systemic realities the family faces outside the hospital, and that perspective really drives everything that I do. In addition to doing clinical work and having experience as a caregiver, I’m also the founder and CEO of Indelible Learning, which is an ed-tech company that builds engaging mobile tools that teach health, civics, and science to K-12 and professionals. I’m also a medical educator. For over 25 years, I have been teaching at the medical school level. I have been teaching at a California school of medicine since about 2007.

Either at the bedside or in the classroom, my mission has always been the same: to lead with empathy, to empower others, and to make learning and healing indelible. You asked why I wrote this article. That article came from a very raw and real place. Being a physician, we have all these experiences. It was that one single morning, which was a deeply emotional morning, and as you said in the title, a moment when the grief hit from multiple directions all at once. That morning, I learned about the death of two people, which I shared in the article.

The first was Mariana, an extraordinary woman. She was a fearless human rights leader. She was a devoted wife and the wife of my drama professor from my childhood, also a mother to wonderful daughters, a young grandmother, and a dear friend whose life left a very lasting impact on many people.

I knew that she was ill. She shared her diagnosis with me, so my scientific mind was aware of her poor prognosis. But she was still very lively. She was still doing things, involved in a lot of different things, and her loss at the time was very unexpected and it shook me.

Interestingly, just moments later, I saw another post, believe it or not, on Facebook. Both of those posts I saw on Facebook were about the death of someone else I knew. He was a fellow parent from our kids’ school. He and his family moved away after his daughter graduated from high school, but we still kept in touch. He was always supportive. He was curious about my medical work and gaming. He was always tagging me on social media platforms. He was sending me articles about medical simulations and health care, and he was our age and shockingly, all of a sudden, he was gone too. Both of them died of cancer.

As I was observing and absorbing that news, in real life, my phone surfaced a memory, as phones often do: two years to the day of the time I took my own mother to see her oncologist. She unfortunately died of cancer too, just eight months after that. I am still grieving that loss. I am not over it.

Interestingly, that very date, which was March 29, also marked a day when my great-grandmother died and when my grandfather was born. I experienced all those memories and events, everything colliding that one morning. I found myself asking the question: How do we process all this? How do we carry on when we feel the loss and when the loss is relentless? How do we stay grounded? That morning reminded me how fragile life is and how it can change in a moment.

I didn’t really plan to write an article that day, but I think the emotions demanded space. I just wrote, and I wrote it in the middle of these emotions. I just sat down and poured all this out: grief, shock, reflections, everything. I didn’t share all the details about those people because I was still processing it. But perhaps, in all of this, one of the very striking and sad things was that the sad news came to me not through a phone call but through social media, through Facebook. We have an algorithm, and those algorithms somehow, all of a sudden, just served those two obituaries and the memory on a day which was already filled with meaning.

Kevin Pho: Let me ask, even with your background in palliative care, you said that it didn’t necessarily teach you to process all the emotions that accompany a tragic event and accompany all the grief that you described. So tell me, how did you move forward? Tell me the process by which you processed all these emotions that were going through your head during this time.

Jasminka Vukanovic-Criley: I think it is very hard. It’s not easy. I think emotions are the most powerful thing that we experience in life. I know nowadays we talk so much about mental health, but emotions are at the core of that mental health, and taking time to slow down to think about it, to acknowledge our emotions, whatever they are. Is it shock? Is it sadness? Whatever it is, it’s extremely important.

We experience emotions as physicians at the bedside constantly, and we are, I think, very good at compartmentalizing them. Sometimes we are going at a rapid speed, making rapid, life-and-death decisions, doing the best for our patients, but it does affect us.

On the other side, we are human beings who have a life outside of our work, and that life outside of our work has its own demands. Not only physical; physical is easy, but emotional demands. How often do you find yourself being bombarded or asked by friends and family when problems come up, and all this drains your emotional bank account?

I think it’s just really important to stop and think about how you can take care of yourself better. How can you recharge? If you are sad, do not just push it away. Stop and do whatever helps. Go for a run. For me, it was writing it down and putting it all on paper or maybe just do something that we physicians are often deprived of: sleep, rest. You need to have your emotional bank account full because it affects how you deal with things.

Kevin Pho: You wrote in your article that grief was an ocean with unpredictable tides. Tell us the type of strategies or anchors that you found helpful in learning to swim against the waves of sorrow, as you put it.

Jasminka Vukanovic-Criley: I don’t think that I have the answer yet. I think some people say grief has stages, that there are only five stages, and you go through the stages and then at the end you’re going to feel better. I don’t think that grief necessarily has very clearly defined stages. I think it is a journey. It is a very transformative journey, especially if you live your life with emotions, with empathy and compassion. I think that that change, that journey, changes us deeply.

When I talk about those waves and tides, this is what happens in life sometimes. You just work and you’re busy, and you are fixing things and helping and creating, or all these things that you’re doing, and maybe you don’t even have time to grieve. Then something happens, like you see those announcements about somebody dying, and it just reminds you. You have all these memories and it triggers something in you.

When it triggers, I personally am still trying to search for answers because I do not understand. Even as a physician, I don’t understand all the mysteries of life and death yet. The strategy that you’re asking me about… I really don’t have a strategy except to slow down and to acknowledge your emotions. Another strategy as a scientist, and I don’t know if you want me to share that part, is probably to be open to experiences that cannot necessarily be explained by pure science and scientific data that we currently have at our disposal to measure things.

Kevin Pho: That’s one of the questions I wanted to ask you. Sometimes, we need to find reassurance in things that cannot be scientifically explained. In your article, you have a specific number that you attribute meaning to. How important is it to find messages or meaning in the grieving process, even though the origin is inexplicable and not based in science?

Jasminka Vukanovic-Criley: I don’t know. I think everybody’s different. Everybody has a different way how they grieve. I think this is also a heavy question because in all this process since my mother died, the biggest surprise to me has been how much that particular loss—and I had lots of losses in the last several years—but that particular loss still continues to shape me.

This includes my interpretation of how the universe maybe sent me some kind of quiet signs. Then it’s up to me to either disregard them or try to be really emotionally in tune and figure out if it really means something or not.

Speaking about this, some physician-scientists might find it unacceptable. As a physician and a scientist, I spent over 30 years grounded in data, clinical judgment, empathy, compassion, and evidence-based care. But really, nothing prepared me to think even deeper about those questions about life and death.

After losing my mother, what happened… I don’t know if you would like me to share, but when she died, and I took care of her to the very last minute, I witnessed something real. I witnessed her soul leaving her body. I felt her presence shift. Since then, I have somehow interpreted that she continued to send me signs: some small but undeniable moments of synchronicity or quiet reminders like the number you mentioned. Did that number really mean something or not?

I was questioning, and I still question many times, my mind. Am I filling in the blanks? Do I just want to attribute meaning to something? But I also realized over time that assigning meaning to some of these things is very deeply comforting but also deeply meaningful. Thinking as a scientist, this is something that we cannot measure. We cannot publish it, but still, that is very real to me.

Trying to reconcile those two ends—from the scientific perspective and having something that we feel but cannot measure—makes me realize how much we know in medicine, but also how much we do not know when it comes to the mysteries of life and death using our current scientific instruments. Maybe in fifty to a hundred years, who knows? Maybe things are going to change.

That transformative journey has opened me personally to wonder. I expanded my thinking and I expanded my perceptions. I still believe in science. I’m still teaching scientifically, and I build tools that are grounded in data, but I believe that what I felt and what I saw was real.

There is a tension and also a beauty in holding both truths: that medicine and science are powerful, but so is the mystery in life. The evidence that we have matters, but it also cannot explain some of those experiences. I think that those two truths are not mutually exclusive. I think that they can coexist.

That dual perspective as I’m going through this grief journey did not make me less scientific, but I think it made me more human. I think it made me a better doctor. It made me an even more empathetic educator, and it made me a more grounded innovator, too. I think that was probably the most surprising and transformative part of this journey, both as a doctor and as a daughter and someone who is navigating grief personally.

Kevin Pho: We’re talking to Jasminka Vukanovic-Criley. She’s a hospitalist. Today’s KevinMD article is “When grief hits all at once: A morning of heartbreak and love.” Jasminka, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Jasminka Vukanovic-Criley: There are lots of lessons. First, make time to grieve and be open-minded. Even if you take care of others, do not forget to grieve your own losses because your emotional bank account needs to be full before you can take care of others. Our emotional fluency, in addition to our scientific mind, is probably one of the greatest tools that we can use when we take care of others.

Second, I would also say be very mindful of how you start your own day. We live in this age of amazing technology, but also in a world that is driven by constant alerts and scrolling. What we let into our minds first thing in the morning can shape our mood, our decisions, our energy, and our emotional bandwidth in ways that we don’t even realize. Social media is powerful. I think it can connect us and it can keep us informed, which is all really great, but it can also deliver news at a time when we’re not ready for it. I think we just need to be mindful of when we allow ourselves to look at things, to scroll, and to learn about stuff.

Another thing, as I mentioned in my article, is that life is fragile, and we never know when it is going to be our last day. Death is inevitable for all of us. Grief can also be very disorienting, especially when we lose somebody very close to us. I would just say remember to cherish the people in your life that matter a lot to you. While you can, follow your heart. Do not wait for the right time because sometimes that right time might never come.

As I mentioned earlier, be open-minded because science has so many answers, but it still does not hold all the answers. Those are some of the things.

Kevin Pho: Thank you so much for sharing your story, time, and insight. Thanks again for coming on the show.

Jasminka Vukanovic-Criley: Thank you very much, Kevin.