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Editor's Commentary on "Hair Clips for Esma"

 , March 01, 2020

In “Hairclips for Esma,” Lila Flavin discusses something many of us in health care are accustomed to seeing on a regular basis, but few of us have found a comfortable way to discuss – death.

In vulnerable and vivid prose, Flavin recounts the experience of her first patient death – as a third-year medical student on a pediatrics rotation. While not dramatic per se (no code, no chest compressions, no distraught family), it was traumatic, as most of our first deaths are. Flavin describes herself going through the normal stages of grief and second-hand trauma, as well as her uncomfortable feeling that perhaps her emotions are inappropriate and unprofessional. Like many medical students, Flavin lacked the senior mentorship or the peer support to help her process what is a near-universal experience in medical training.

The strength of this essay is not only in its intimate description of a difficult experience, however; it is also in Flavin’s suggested remedy: processing led by a group facilitator, on a regular basis, for third-year medical students for whom their patients’ death may be the first they’ve seen up close and personal. When Flavin describes the ability to compartmentalize that she has developed by the beginning of her residency, we, the readers, recognize ourselves with painful clarity.

But what if we made a place for grief in the hospital? What if we had the time and space in our workday to process before moving on to the next patient? It sounds like a pipe dream in this age of fee-for-service medicine and 80-hour residency workweeks. But maybe by providing such opportunities for medical students we could begin to change the current culture of health care. Perhaps we could train the next generation of doctors to be as aware of their emotions as they are of their list of notes to be written. Flavin provides practical suggestions for this, but her essay itself is a suggestion, too. Reflective writing might be a way out of burnout and into deeper relationships with our patients and ourselves.

Irène Mathieu