EP. 34: FINDING MEANING AFTER LOSS

WITH DAVID KESSLER

Oct 25

WITH DAVID KESSLER

The world’s foremost expert on grief shares his own experiences with grieving and discusses how we can find meaning through loss and happiness after tragedy.

Listen Now

Episode Summary

In 1969, Elisabeth Kübler-Ross identified the five stages of dying in her book On Death and Dying. Her work has radically transformed the way we think and talk about grief and loss, giving us a shared vocabulary and understanding of a previously murky, yet universal, human experience. Towards the end of her life, Kübler-Ross worked closely with David Kessler, with whom she co-authored several books and formally adapted the stages of dying into the stages of grief. Today, David is the world’s foremost expert on grief and has taught health care workers, counselors, and first responders on facing death and loss. His writings and his website Grief.com have reached millions of people. In this episode, David joins us to share his personal experiences with loss and what his decades of helping those on the edge of death have taught him about finding meaning amid suffering, and happiness after tragedy.

David Kessler is one of the world’s foremost experts on grief and loss. His experience with thousands of people on the edge of life and death has taught him the secrets to living a happy and fulfilled life, even after life’s tragedies. He is the author of six books, including the new bestselling book, Finding Meaning: The Sixth Stage of Grief. He co-authored two books with Elisabeth Kubler-Ross, including On Grief and Grieving. His first book, The Needs of The Dying, received praise from Saint (Mother) Teresa.
David’s personal experience as a child witnessing a mass shooting while his mother was dying in a hospital helped him begin his journey. For most of his life, David has taught physicians, nurses, counselors, police, and first responders about the end of life, trauma, and grief. He facilitates talks, workshops, and retreats for those experiencing grief. However, despite his vast knowledge on grief, his life was turned upside down by the sudden death of his twenty-one-year-old son. It inspired him to write his newest book, Finding Meaning.
David’s volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross’s disaster services team. He worked for over a decade in a three-hospital system. He is the founder of www.grief.com, which has over five million visits yearly from 167 countries.
In this episode, you will hear about:
• Thanatology — the study of death and dying — and what drew David to this field - 2:10
• Kessler’s friendship with Elisabeth Kübler-Ross, the psychiatrist best known for developing the five stages of dying - 6:06
• How physicians are often ill-equipped to face death and how hey might better engage with dying patients - 11:22
• David’s advice to physicians on finding meaning amid loss and tragedy - 19:05
• A review of the five stages of dying/grief - 28:58
• On Meaning, the sixth stage of grief that David developed - 33:38
• How the pandemic saw a renewed interest in grief management, and how his interview with the Harvard Business Review entitled “The Discomfort You Are Feeling is Grief” went viral - 38:04
• How David manages the overwhelming sadness he sometimes experiences in his line of work - 43:54
• David’s advice to physicians on comforting grieving patients - 48:31
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to the Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] In 1969, Elisabeth Kübler-Ross identified the five stages of dying in her book on Death and Dying. Her work has radically transformed the way we think and talk about grief and loss, giving us a shared vocabulary and understanding of a previously murky, yet universal human experience. Towards the end of her life, Kubler-Ross worked closely and authored several books with David Kessler, who today is the world's foremost expert on grief. David has taught health care workers, counselors and first responders on confronting the end of life and reached millions of people through his writings and his website Grief.com. In his 2019 book Finding Meaning, David introduced a sixth stage of grief meaning. In this episode, David joins us to share what his personal experience is with loss and how his decades of work helping people on the edge of life and death have taught him about finding meaning amid suffering and happiness after tragedy. David, welcome to the show and thanks for being here.
David Kessler: [00:02:07] I'm so glad to be with you. Thank you both for doing this.
Henry Bair: [00:02:10] So, David, you are often referred to as a modern day thanatologist. Now, that's not really a word that we hear often. So can you tell us what that means and what some of the big picture issues you address are?
David Kessler: [00:02:26] So think about the Greek word Thanos, which means death. You know, people often know it from the action movies. The enemy is always Thanos. So not unlike our world that Thanos is our enemy. Many people perceive it that way. So I study death and dying, grief and loss. You know, it's interesting. People sometimes want to think of me more as end of life or more as grief, and I perceive them as going hand in hand. I very much think about the death shapes the grief.
Henry Bair: [00:03:02] I see. So this is a very peculiar and unique line of work. Can you tell us what first led you to this career?
David Kessler: [00:03:10] Sure. I had a mother who was in and out of hospitals when I was growing up, so hospitals to me were like, just the place you go. I, I knew hospitals from such a young age. And one day she got really sick and had to be transferred to the hospital in the big city, which was a few hours away for this new procedure called dialysis, which you could only get at a few hospitals. And these committees had to vote if you could get dialysis because there wasn't that many machines at the time. And they they voted she could get one treatment, which we know now would not have done a lot. And so there she was in the ICU hours away. And my father and I went there to be with her and. You know, here I was 13 years old. I had been taught to lie about beer. No one had taught me to lie about my age for getting into a hospital in a big city. So when they asked me how old you are, I said, 13. I never thought to say, Oh, I'm 14 so I could make the cut. Some nurses let me in, some didn't. So sometimes I could see her and sometimes I couldn't.
David Kessler: [00:04:36] I spent a lot of a lot of time in the lobby. And at the hotel across the street where we were one day, a fire broke out and everyone was evacuated. And we're here on the street and we see the fire trucks pull up for this fire in the hotel. And as the fire trucks pull up and begin to extend their ladder. Shooting starts and they realize they have an active shooter. It turned out it was one of the first mass shootings in the US. Racially motivated. And it went on for 13 hours. My father eventually got us back, but I saw first responders being killed, hotel guests. Even the chief of police. Then we got back to the hospital and had a couple of days and wasn't able to see my mother when she died. So that really shaped a lot of my early life. And there just wasn't anyone there. There wasn't anyone to really say, Perhaps this child should be allowed to say goodbye to his mother, you know, or we should have a plan to give him some help with the grief after. There was none of that. So in some ways, I often think about I became the person that maybe could have helped me.
Henry Bair: [00:06:06] And you know, you are now you are the world's foremost expert on grief. And for a very long time, you worked with Dr. Elisabeth Kübler-Ross, who's a psychiatrist, best known for introducing the five stages of Grief. Can you tell us briefly how you came to know her and work with her and, dare I say, eventually befriend her?
David Kessler: [00:06:30] Sure. We were supposed to be both speaking at a conference in Egypt on death and dying. And of course, she was the keynote and I was wallpaper. That's when she had her first stroke and wasn't able to go. So I reached out to her son afterwards to ask how she was. And surprisingly, he said, Here's her number. And I called her up and we had a wonderful conversation. And, you know, I was someone who I said to her at the end of the conversation. I hope someday, somehow we get to meet. And she said, How about Tuesday? I mean, that's that's the person she was. We met. We became really good friends. She was brilliant. More honest than you meet people. You know, she had an honesty that I would either say you respected or it pissed you off. She said to me early on, If you're here for anything professional, I'm done. And I said, No, I'm not. And at the time I was working on my first book, The Needs of the Dying. And the joke was she couldn't keep her hands off of it. Like, she would say what chapter you are now? Did you put this in? Did you put that in? And she really helped the book become so much of a better book because of her and her involvement.
David Kessler: [00:08:03] Despite her, I'm not doing anything professionally. After that, we wrote a book together called Life Lessons. The book still holds up well, and it's getting a little renaissance right now because two members of the band were photographed reading it. So it's getting a little surge right now, even though it's many years old. We would talk about her stages because remember, her stages were stages of dying, and she had written about them in her book on death and dying. That really changed medicine. You know, people don't realize back then how the person who was dying was very isolated and not really cared for as much in the hospital. And it was like once there was nothing we could do. There wasn't a lot of interaction. She really changed that and brought dying patients out to. Actually attend grand rounds and talk to doctors about their experience. And that was considered tasteless at the time and really crazy. And we look back now and we think about how, my goodness, how many doctors have had cancer and share what that's like. And it helps us understand the patient's experience. So she really changed things with that book. But over the years, the Stages of dying informally got adapted for grief and they got adapted many times, not very well.
David Kessler: [00:09:46] And we would talk about that. And then I think it was like probably a 98, 99. She said, okay, let's do a book and adapt the stages. And we formally adapted the stages for grief. And it's interesting, so many of the concerns people have with the stages we literally addressed on page one. If you look at page one of the book on grief and grieving, it talks about the stages aren't linear. There's no one right way to do grief. There is no model one right model for grief, and that our grief is as unique as our fingerprint. And to really, if they're helpful, as some scaffolding for some people who are thrown into this unknown world of grief. That's great. And if it doesn't resonate with people, that's fine to. It's interesting. Elisabeth's all her early work now is and research is at Stanford. So it's really interesting that that's where it's housed now. And we also talked about in there and she had talked about it earlier, called preparatory grief. We talked about it as anticipatory grief. And that's the grief that comes up before someone dies for them, the patient and the family. So that was really our work together with those two books and adapting her amazing stages.
Tyler Johnson: [00:11:22] Let me cut in here and ask for doctors. I feel like most doctors have a very conflicted relationship with perhaps with grief as well, but especially with death, because on the one hand, of course, nobody else except for maybe nurses. But in any case, all health care professionals, no one else has as much exposure to or is as close to death and dying as doctors are. Right. And particularly in our society, we've done a pretty good job of, for the most part, walling death off for most of polite society. And so a lot of people may go through their entire lives and never really see a person die or almost never even think about it so much. They think about what comes before and what comes after. But the actual direct death is just something that most people don't have much experience with except for doctors.
David Kessler: [00:12:13] But can I jump in real quick? My best friend is an oncologist. And it was so startling. I mean, if you said to him, have you been around death, he would say, absolutely my whole life. And then when someone in his life was dying and he was actually present for that, that time, in those moments, he was like, oh, my gosh, I never I never saw this part. You know, he was used to walking in glimpsing death and walking out, but not being present for that before, during and after. So I just wanted to throw that in there because I think sometimes many physicians don't get that whole experience.
Tyler Johnson: [00:13:04] Right. Well, and that was yeah. So when I when I mentioned that, I think that relationship is really conflicted. That's what I was going to get to, is that I think that for the most part, with the exception, notable exception of palliative care doctors, most doctors think of death as the enemy or they think of it as failure, or they feel a great degree of, at best, ambivalence and at worst, guilt and even anger. Because when patients die, it means that what we have done as doctors hasn't worked. We haven't done enough. We failed. And so all of that is just to say that I think that even though on the surface it would seem like we have more exposure to death and dying than almost anybody else, I totally agree with you that in reality, we often keep it as much at arm's length as just about anybody else does. I'm always struck, I don't know if you've seen the play or the movie wit, but wit is this beautiful play about a woman who's an English professor at college, English professor who dies of ovarian cancer. And the point of bringing it up in this context is just to say that towards the end of the play, the woman is in the hospital. She's obviously dying. Everyone knows that, although not everyone admits it. The doctor's last two interactions with her are one to come in and examine her vital signs, which is just this very perfunctory. He sort of stops in, looks at a couple of numbers, and then goes back out and then is very last interaction with her is after she has already died.
Tyler Johnson: [00:14:37] He doesn't even recognize that at first. And then when he finally does recognize it, even though she had stated that she didn't want CPR, he starts doing CPR on the body. Right. In contrast, the nurse's last two interactions with the patient are one when she's very close to dying and she's just sort of there on the bed in agony. The nurse takes lotion and massages the patient's feet. And then after the patient has died in, the doctor wrongly starts to do CPR. When she had said that that's not what she wanted, the nurse rushes into the room and makes him stop and then tries to afford the body a measure of dignity and allow the patient to pass in peace. And so I guess all of that is by way of saying that I feel like even though it might seem like doctors should be really good at this, in many cases, I think we're actually not. And I wonder, as someone who, though not a medical doctor yourself, someone who studies this and who worked with someone who was a medical doctor who sort of pioneered this way of thinking about death and dying, what what I guess message could you bring to doctors about how we might more productively and meaningfully engage with the dying process and the death of our patients than maybe what we do right now?
David Kessler: [00:15:56] Sure. You know, I always say, despite not being a physician myself, I have been training them for years and I am so grateful that more and more physicians are open to understanding this part of life. You know, because I do talk to them about what the end looks like, how to deliver bad news, CPR or DNR, all of those things, you know, going back to my friend. One of the things that he experienced in that process that I think gets missed, that he said to me is, oh my gosh, the end of life is just as profound. As the beginning of life. And I don't think people who haven't seen that would think about it as profound and ranking up there with the birth of watching a child being born, I don't think we would think those things connect. And yet if you've been there, when your loved one takes that last breath, it feels very sacred. So in terms of wit, I know it well. Judith Light, who is a friend of mine, started it on Broadway, and I got to do talkbacks with the audience afterwards because such a good learning moment for everyone who was in the audience after that. And they wanted to talk about it right after they saw it, like they wanted to have this talk back and.
David Kessler: [00:17:27] You know, I think it's a language we're often not taught. And there's so many things, I think. Physicians are taught many times. How to do and what to do. And sometimes, especially around end of life, missed the full understanding. Like I think about resuscitation and I talk about how often resuscitation fails in the hospital. And people are so surprised at the statistics of resuscitation failing in the hospital. And I often will do a chart where I'll have them multiple choice out reasons. They think resuscitation fails in the hospital and they'll say it's because we're too late or we're not doing it right, or this is the patient's complicated and I'll go, No, it's always done on the dead. And they're like, What? And even physicians, I go, What do you mean it's done on the dead? I'm like, Yeah, we're trying to raise the dead. And then think about here's this wonderful life saving tool resuscitation we have. Designed for sudden death and trauma, heart events. And it was never designed for the end of life. And yet that's when we do it the most at the end of life. And I see that changing more and more and realizing to tease out when things are futile and when they're not.
Tyler Johnson: [00:19:05] I'm curious. So I'm also, as we've mentioned before, an oncologist and three or four times a year, I'll work on the cancer floor in the hospital taking care of cancer patients, but also working with a team of trainees. Right. So these could be medical students or early residents who have just finished medical school. And what I recognized so that service can be very challenging for multiple reasons. But one of the reasons is because a lot of patients die. And unlike in most of the hospital, if somebody comes into the hospital, they come in because they have a pneumonia or they took a fall or whatever, and they come in and you give them antibiotics and oftentimes they get better and then they go home. But on the cancer service, because of the underlying cancer and the progressive nature of how it sets people up for multiple other kinds of illness, these patients are often in the hospital over and over and over and over again, and then eventually are come into the hospital and die there because of some complication of their cancer. Whereas on other services, it would be very unusual to have someone die while you're taking care of them. On the cancer service, we almost always have at least one person die and sometimes we have two, three, four, five, six, seven, eight, depending on sort of what what's going on that week.
Tyler Johnson: [00:20:18] And one thing that I have realized as the doctor who is training the doctors who are learning their doctoring skills, is that one thing that I think is really important but hard to do right, is to think about after a patient has died. How can I, as a teacher, a professor, how can I try to use that moment as a teaching moment? And how can I try to make it meaningful for my trainees? Because I've recognized that even as somebody who thinks about these things a lot, my inclination often is to just sort of pass by it, right? It's to try to move on to the next thing, the next solvable medical problem, because there's something uncomfortable about sitting with the reality of what's happened and trying to make some kind of meaning out of it. And so I guess I'm just curious if you were there in our team room with us and we had had a patient, let's say, who we'd taken care of for a couple of weeks and gotten to know pretty well and the patient had just had just passed. What might you say to us in that moment? How might you help us to try to make some meaning from that difficult experience?
David Kessler: [00:21:32] Well, the first thing would be to go back to where you started from, which is to understand. I tell people the death rate is 100%. Like literally all of us are going to die. It's 100%. And to not hold that experience as a failure, I can tell you. After my mother died, she had had a primary physician who wasn't there, wasn't able to be involved. And I remember even I was probably 15 or 16. He said to me, you know, I wonder if your mother had kept better in touch with the physicians who knew her better if she'd still be alive. Not helpful. And, you know, one of the things is in that moment. Families. I will see families and oncology units who have done 150% of everything that could be done. They have gotten every treatment. Their loved one's body has just gone through so much. And the physician holds such a sacred role to say to that family. You did enough. You did enough. You fought the good fight. Your loved one did enough because families are so left with so many. Oh, if only we had gone to that other hospital. What about the other doctor? What about that doctor? What? You know or you know, the day before, you know, the physician came in and said the GI test looked good. I mean, OC their GI system looked good, and the rest of their body has cancer. So, you know, things like that are so confusing it just to help the family know they and their loved one did this. Well, you know, we all want to finish life well.
Tyler Johnson: [00:23:47] That really resonates with me. I've watched with great interest sometimes as patients are nearing death, particularly those who are religious, but even sometimes those who aren't. It's clear that if, say, for a Catholic patient, when a priest comes in to administer last rites, there is an enormous spiritual authority, a spiritual presence that enters the room with that person who has been sort of set apart to do that religious right in that moment. And that's obvious, right, because the priest usually comes in with priestly vestments and has a certain specific prayer that they say and whatever. What it took me much longer to recognize, though, is that towards the end of life, the white coat and stethoscope that doctors wear become their own sort of priestly vestments, if you will, in the sense that, of course, we do everything we can medically and technologically to keep the person alive as appropriate. But as you say, everyone is going to die. And once a person dies often or in the time around, a person's death, including just before, often our most important role, I think, is actually a spiritual one, as much as it is a medical or a physiological one. Right. And part of that, as you mention, is helping the person, the person's family, to the degree that we can to come to peace with what's happening, because we have a sort of a vested authority that nobody else has. Right. Nobody else in the room can say, you need to understand you've done everything that's medically possible. Right. And when we say those things, I think it carries with it an authority and an impact that nobody else can can really capture. And so I, I really resonate with that idea that there is a great deal of meaning. And paradoxically, actually, many of my most meaningful moments as a doctor have come in the time around Death, which I agree with you, is is I think, a really a sacred time.
David Kessler: [00:25:50] Yeah. And it is that sense of families are looking to physicians many times to let them know. It would be wonderful if you're not Catholic, if there could be some sort of symbolism that the fight has been fought and it's been done well and it's now sacred time to be with one another. And I think that's such a confusing time. And as you mention, I think physicians hold more power in that than they do to say this is the moment to ride the horse in the direction it's going. And everything in our society. We're taught, you know, rage against the dying of the light. You know, even that poem wasn't about death. It was about blindness. But we we have this fight mentality. And I tell people, could you imagine ever walking out to a sunset, the most beautiful sunset you could think of and yelling at it? I mean, who wants to rage against the ending of a day? And yet this is the ending of our loved one's life. And it's a moment for people to gather and say goodbye. And, you know, so many people are in the hallway discussing what else could be done because no one's told them No, no, no. That this is the moment of goodbye. This is the goodbye moment. And, you know, I want to make sure physicians understand that this isn't just them.
David Kessler: [00:27:26] This is society. I mean, we have a society that has sanitized death. You know, when I was a kid, we would just be driving somewhere and I'd be on my way to school and we'd end up behind a hearse that was picking up a body from the hospital. Someone who had died that night just behind a hearse. When was the last time in your normal day you were behind a hearse? It doesn't happen anymore. The dead move around our cities in white, unmarked vans. We've sanitized all this. I tell people if you live in a home. That was built before the forties. It's got a wide door for the casket to come in. The casket used to be in the home. Your loved one died at home. Their body was in the parlor. What happened to the parlor with the funeral industry? It became the funeral parlor. And your grandparents parlor got moved to the funeral home. And what did we do? It was actually in Ladies Home Journal that they said your parlor should not be a room to display the dying. Your parlor should not be a dining room. It should be a living room. Literally, our living room comes from that sense of let's whitewash dying. Let's have a living room. Let's sweep death away from us.
Henry Bair: [00:28:58] This conversation on the evolving notions of death is a good segue way to the next thing I'd like to explore. As we have previously discussed. Dr. Elisabeth Kübler-Ross developed the Five Stages of Dying, which was later adapted into the five stages of Grief. I'd wager that most of our listeners here are familiar with the five stages. But I think it would still be helpful if we briefly went over them. So the first we have denial, which is the shock and disbelief that the loss has occurred at all.
David Kessler: [00:29:34] Can we just add after you say them? I'd love to add what they sound like. That sounds like I can't believe this is happening. I can't believe they're dying. I can't believe they're died. This it's that denial of reality and it's a positive coping mechanism.
Henry Bair: [00:29:55] And in the second stage, we have anger. Anger that someone we love and cherish is not there anymore.
David Kessler: [00:30:02] And we can be angry at the person that died. We might be angry at the medical system. We might be angry at God, the unfairness of the universe at ourselves. And I always tell people, anger is pain's bodyguard. You know, whenever you see anger. It means someone's in pain. My go to emotion as a man is anger. If someone walks in here and gives me bad news and there's someone else in the room, someone else's go to emotion might be sadness. They sit down and cry. I get angry. The person who cries gets all the sympathy. The angry person gets told, Hey, hey, that's inappropriate. Step out of the room. And yet they're both the same pain.
Henry Bair: [00:30:55] In the third stage, we have bargaining, which is a reflection of all the what ifs and all the regrets in life. David, can you elaborate on what that sounds like?
David Kessler: [00:31:05] Sure. Bargaining before death is. Please, God, let me let me have more time with her. Let her live another year, another five years. I'm going to be a better husband. I'm going to be a better man. I'm going to attend church. I'm going to volunteer. I'm going to be generous with my money. It's that deal making with God after death. It becomes the. What ifs and if onlys. What if we would have tried more? One more treatment. If only we had gotten a second opinion. All those what ifs and if onlys.
Henry Bair: [00:31:40] And then we have depression.
David Kessler: [00:31:43] Right. When Kubler-Ross talked about depression, it was actually sadness. In our modern world, we don't use the word sadness anymore. Oh, my gosh. We were at lunch. We were all so depressed. And, you know, by the time we had dessert, we were better. And I'm like, wow, You went into a whole clinical depression at lunch and you were better by dessert. That's great. No, we were actually sad.
Henry Bair: [00:32:12] And then last we have acceptance, which is acknowledging the reality of the loss.
David Kessler: [00:32:20] Yeah. I think one of the big myths about acceptance is that there's one big acceptance you find. No, there is a little acceptance. When you hear the diagnosis, you have to accept it. Finally, just to agree to treatment. Then maybe you have to accept that the treatment isn't working. Then you might have to accept that death is coming and you have to accept the death. And then after the death, there is a little acceptance. You have to find just to plan the funeral. There's a little acceptance you have to go to to be at the funeral. Then there's a million other acceptances. And I think we think there's one big one. You're going to find a million little ones. And I think one of the myths that we dealt with so much is that acceptance took on a finality that we never intended it to. You know, when people ask me how long will I grieve? My answer is always like, well, how long is your loved one going to be dead? Because if they're going to be dead a long time, you're going to grieve a long time. That doesn't mean you'll always grieve with pain. Hopefully, you can begin to grieve with more love than pain.
Henry Bair: [00:33:38] And that brings us to the next stage. I wanted to go through these stages because you recently added a sixth stage, which is finding meaning, which you wrote in your book, Finding Meaning, the Sixth Stage of Grief. So I'm wondering if you can tell us first, what do you mean by meaning, and then what led you to formulate the sixth stage?
David Kessler: [00:34:02] Sure. So. After decades of doing this work and working with many bereaved parents. Five years ago, my younger son David died. It's as brutal as anyone would think it would be. In fact, I was. Surprised at how intense the pain was. Of course, I knew a child dying would be the probably the most intense pain you would have, but it was so intense. I wanted to write a letter to every bereaved parent I had counseled, saying I didn't know how bad the pain was. You know, as I was going through those early months, there was a part of me that was the father, and I had to do everything that I had told everyone else to do. I had to go to grief counseling. I had to go to a grief group. I literally took my contacts out, put glasses on, put a baseball cap on, went to a bereavement group, a grief group, and sat in a chair five feet from a table with my books. And I couldn't tell anyone that was me. I couldn't be the expert. I had to be the father who had to bury a child. But in that experience, there was always the grief, death and dying expert in my mind who would go, Yup, you can't believe he's gone. You're in denial. Yep. You're angry at God? Yep, yep. There you go. Bargaining there, There's depression. And when I got to acceptance, I was like, Yeah, no. It can't just be acceptance and I'm done. I wasn't willing to stop at acceptance. And I had read Viktor Frankl's work Man's Search for Meaning, and I had even written a few chapters on Meaning and Grief, and I saw them when I was in this very spot here that we're talking from at my desk.
David Kessler: [00:36:09] I literally found these chapters I had written, and I threw them down and went, Yeah, like, that's going to help. And I went back and read them. And what I found is meaning did not take the pain away, but it became a cushion. And I began writing and interviewing people. Who would their family members dealt with? Cancer and death by suicide and addiction. And just a million physical illnesses and mental illnesses and tragedies in the world and how they found meaning afterwards. And I began to write about that. And, you know, and I knew at a certain point it would become a book and people suddenly kept going. That's the six stage meaning. And I went, Yeah, it's what I wanted with acceptance was to find meaning. And I think we're a society now that doesn't want to just stop at acceptance. We want more. We want meaning. Now, here's the confusion about me and I. By the way, I was so honored that the Kubler-Ross family and Foundation gave me permission to actually add a sixth stage to her iconic stages and. One of the things I tell people and caution them was when people first hear meaning, they will go, there's no meaning in a horrific death. There's no meaning and a sudden heart attack. There's no meaning in a death from cancer or death by suicide or the car accident or the pandemic. There's no meaning in that. And I'll go "Correct. Meaning is not in the horrific event. Meaning is in us. It's what we do after our loved ones die."
Tyler Johnson: [00:38:04] You know, I'm I'm struck by two things there. One is that listening to your experience with the death of your son, there's a beautiful play called Shadowlands, which is about the experience that C.S. Lewis had. So C.S. Lewis had spent a good part of his adult life writing and sort of preaching or whatever you want to call it. Giving talks about the meaning of suffering and why God gives us grief and all of these kinds of things. Only to then when he was confronted by the death of his wife, which happened very soon after they were married, to find that the visceral experience of grief was totally different from the theoretical experience of grief. Right?
David Kessler: [00:38:43] Very.
Tyler Johnson: [00:38:45] And then he writes this just absolutely heartbreaking book called A Grief Observed, where he talks about how for all of the writing and theorizing and philosophizing he had done, when it actually came time to experience that bone deep grief, he was just left helpless, powerless in, you know, in front of that kind of suffering. That's one thing. And then the second thing is that this idea, you know, I it's been such a destabilizing time over the last couple of years with the pandemics. You mentioned the experience of of driving your car following a hearse down the street. But I, I still can't get from my mind those early days of the pandemic where there were so many people dying in Manhattan hospitals that they couldn't line the freezer trucks up fast enough to take the dead bodies out of the hospitals because there were just so many of them coming so quickly. Right. And that sticks in my mind, I think, as a sort of a potent I mean, just image in and of itself, of course, is terrible. But it also sticks in my mind as this sort of potent symbol of the fact that all of us as a society have been grappling with this incredible weight of grief that is unusual in that it's been shared and it's been so raw and so out in the open, which is just to say that I think we're still very much trying to move from those first five stages to the sixth stage in the sense that, you know, even talking to a lot of very smart people and reading things that a lot of very reflective people have written, I think that we as a society are still sort of stumbling in the dark, trying to grapple with what's happened and trying to find some meaning in the midst of what has been such an enormous weight of shared suffering.
David Kessler: [00:40:35] I have I have an interesting thing about that that. When the book Finding Meaning: The Sixth Stage of Grief came out. I was speaking at a national conference for therapists and I ran into a friend of mine who's a happiness expert and has a book on happiness Awestruck, Jonah Paquette, And it's fascinating. I was like, How are you doing? And he said, Oh my gosh, it's so, so busy. Everyone wants to know about happiness. And he said, How are things with you? And I said, Oh, it's really slow. No one wants to know about grief. And then the pandemic hit. And one of the things I was surprised about is I did this little article. Just this little article that was about how in early in the pandemic, I think it was in March, you know, people were saying, why am I waking up crying? Why am I so sad? What's wrong with this? And the article I did was for the Harvard Business Review. And the the title was "The Discomfort You Are Feeling is Grief." And it went viral more than any books, anything I had ever written. It went crazy. And my my happiness expert friend and author, we met recently at that conference again that had gathered for the first time since the pandemic. And he's like I said, how are you doing? He goes, Oh, you know, it's a little slow. Happiness has been put to the back of the bus right now. He goes, How are things with you? I'm like, busier than ever. I mean, everyone wants to talk about grief.
Tyler Johnson: [00:42:11] Yeah, it really is. I feel like we've had to sort of I don't know. It's kind of shaken us from our stupor in a way, Right? Like so much of everyday life, most of the time is kind of iridescent and shallow and we sort of move from we're in the thick of thin things all the time. But in the pandemic especially stuck in our homes and with no ability to avert our eyes. Right. And then there's the racial reckoning in any way. All of these things. It was like we were sort of forced as a society to confront the deep suffering that is woven into every life, but that we often do such a good job, especially in the area of social media and self promotion and airbrushing our lives for each other. We usually do such a good job of keeping that suffering hidden, keeping it inside. But then in the midst of the pandemic, it was like it sort of burst open and we were forced to grapple with the fact that all of us are confronting those kinds of difficult, deep things all the time.
David Kessler: [00:43:08] And going back to that airbrushing. Think of the tragedies that have happened in our country, in this world. Almost 3000 people died. And 911. If you go back and look at, you know, the virus in 1917. No monuments, no monuments. We like to move on from illness when it's done. My fear is with COVID, a million people dying over a million. Probably not going to see any monuments to that. We so want to be the society like, oh, we're getting through the pandemic. Forward, onward. Off we go. No, no, no, no time for monuments. We're good.
Henry Bair: [00:43:54] The next thing I'd like to explore is in your line of work, you often counsel a lot of patients dealing with very painful moments in life, and you bear witness to moments of suffering. Now, I'm wondering if many people might think that that can seem like really hard work, that can seem just for you on your part personally, it can be overwhelming. Have you ever experienced moments when you felt like this is too much? And either way, like, what do you do about that? How do you manage that overwhelming sense of, Is this too sad for me? And then despite that, move on and continue comforting people.
David Kessler: [00:44:38] So a few things. You know, where we just were. My work during the pandemic and now has moved all online. I have online grief groups and certificate programs for people who want to be certified and grief training. And, you know, it works well. It works well. I was very lucky early in life. I had such a strange relationship with this work. And one of the things that happened is we have a hospital here in Los Angeles called Sinai. And I remember being in Cedars-Sinai, and I was probably in my twenties. And. I was at the the nursing station and I was just looking down and a social worker said to me, What's going on? And I said, Everyone's dying. Everyone's dying. And she said, Come with me. And she took my hand. And we walked across the bridge at Cedars Sinai, and she took me to the newborn nursery. And she goes, It's important to remember not everyone is dying. And I think when you do this work, you have to hold that work present. I even remember in my car once with my kids. You know, then being in the back seat at some point, I think they were probably preteens or something, and they had overheard a million conversations in my work. One of my sons said, Oh, it sounds like everyone's dying. And I said to my son, You have to remember, if your dad was an auto mechanic, it would feel like everyone's car's always broken. But no one calls their auto mechanic to say, Hey, car's running good. Just wanted you to know we call when something goes wrong.
David Kessler: [00:46:34] And I went. I'm the mechanic. Kind of. You might call after someone dies, and so no one's looking up grief dot com because things have gone well. So, you know, I think it's important that we find that balance in our life. And the other thing that was such an eye opening experience for me. Is before the pandemic, I would do these huge events in hotels and there'd be, you know, 2 to 300 people in the audience and. Afterwards, when maybe the day was over, the cleaning crew would be in there and maybe I'd be tearing down my equipment, my computer after I gave the talk and the cleaning crew. Now, remember, in this hotel in the next room had been nurses for something and the other room had been CPAs in the next room, real estate agents. The cleaning crew of the hotel would say, What were you talking about? And I go, Why do you ask? And they would say, Because your group was laughing the most. And I would go, We were talking about grief and they would go, What kind of grief? And I would go to that kind of grief when someone dies. And that experience was so strange for them. And I thought about it and I realized, you know, when a horrific things happen and we look at the end of life and grief, our bandwidth for pain gets expanded, but so does our bandwidth for joy. And we might cry a little more, but we also laugh a little harder. So I think it's really important to remember all of that is part of life.
Henry Bair: [00:48:31] David, with the last few moments here, I'd like to end with a question that we usually end our conversations with, which is some advice you might have for clinicians and medical trainees over the course of our conversation on grief and grieving. We have mostly focused on situations in which there is death and dying involved. But working in a clinical setting, one quickly realizes that grief and grieving can pop up in some of the most unexpected of circumstances. The other day I was working in the eye Clinic, which is not normally a place you would associate with death and dying. There I encountered a patient who had experienced a- essentially a stroke in her eye, and before going to see her, I had confirmed with my supervising physician that the resulting blindness was almost certainly going to be irreversible. So I go in to see the patient and tell her the news. And up until this point, she had been under the impression that this would be temporary and we would be able to give her some medications to let her see again. So I told her the news and she sits in silence for a while and the first thing she says is, Yes, but I have this vacation coming up this winter. I'm going to be able to see by then, Right. I take a little bit more time to explain the results of the tests we did and why this means that her vision loss was irreversible. And as I explain, she nods. But when I finish, she says, No, you don't understand. My daughter is due to give birth in a couple of months. I'm going to be able to see my grandson, right? So here you can already see the beginning of the stages of grief. David I tell you the story to illustrate the point that we in health care must always be prepared to address grief no matter the nature of the illness that we are treating. So what advice do you have for clinicians about being ready to deal with grief when it does come up?
David Kessler: [00:50:37] It's really important. It's a good story that illustrates it well. It's really important to know that grief is change. Grief is change. And it is a change we did not want. So if you think about delivering bad news and by the way, one of the things I hear so much is people want to know, how can I become good at bad giving bad news? And people actually don't want you to be good at it. They want you to have a little trouble saying it. They want you to stumble through it. It's hard news to give and it's okay to have a hard time giving it and. It's that idea of knowing you want to what I call witness their pain. You can't fix it. You try, you can't fix that eyesight or whatever the change in their body is that is irreversible. And so part of it is witnessing them, not blindsiding them, not giving them toxic positivity. Look on the bright side or always say never start a sentence with at least because at least is going to minimize it. At least you got your other eye. Or maybe at least you can do this or still do that to just be with them. And also, like in your case, to recognize. You can only witness that situation. You cannot fix it. You can be with them. And they are beginning a long road. And so I would release the expectation that anyone's going to make them feel better in that first. Hour of hearing about a diagnosis, they are going to have to work through it and the more they can know. They're going to need to talk about it. They're going to need to be seen to be witnessed. They're going to have a lot of feelings about this. And that's really normal in how heartbreaking it is that you don't have better news.
Henry Bair: [00:52:52] Well, this has been a lovely conversation. David, Thank you again for taking the time to join us. We really appreciate it. Your stories and.
Tyler Johnson: [00:52:59] Insights. It's been delightful to speak with you.
David Kessler: [00:53:01] Thank you so much. And for people who need more resources, they can find them at grief dot com.
Henry Bair: [00:53:06] We'll be sure to link, you know, your writings and everything in the show notes.
David Kessler: [00:53:10] Great. Thank you so much. Take care.
Henry Bair: [00:53:15] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program, notes and transcripts of all episodes at the Doctors Art. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:53:33] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.
Henry Bair: [00:53:48] I'm Henry Bair.
Tyler Johnson: [00:53:48] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.