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A Piece of My Mind
November 8, 2016

The Things We Have Lost

Author Affiliations
  • 1Office of Graduate Medical Education, University of Washington School of Medicine, Seattle
JAMA. 2016;316(18):1871-1872. doi:10.1001/jama.2016.9954

Before you know kindness as the deepest thing inside,

you must know sorrow as the other deepest thing.

Naomi Shihab Nye

When most people consider the grief endured by physicians in training, they look first to the devastating narratives of patient care—sudden illness, agonizing decline, putrid decay, untimely death, haunting errors, and crushing uncertainty. Even more than a decade from residency, I am pierced by these tragic moments and faces—each still heart-shatteringly vivid. Recognizing the direct emotional toll of patient care, medical educators in some training programs have earmarked time for death rounds,1 Schwartz rounds,2 or narrative medicine3 sessions. Many of these interventions are deployed in high-intensity settings within the clinical learning environment where residents wrestle daily with ethical dilemmas or end-of-life dynamics.

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