Have you ever struggled with your emotional reactions after losing a patient?

There are rituals and practices frequently associated with loss of a loved one that may be absent in the case of loss of a patient. Reliving happy memories, sharing stories with other loved ones, attending some sort of ceremony, receiving sympathy cards or other expressions of support, and so on. But not having these things does not mean not having anything. There are other ways to help you with grief and loss.

1) Name your feelings. “Bad” is a descriptor, but it isn’t a feeling. Sad, devastated, angry, regretful, and anxious are some examples of feelings. You may, and probably do, feel a combination of feelings. That’s normal and healthy. It is also normal and healthy for emotions to ebb and flow and change, often in a short period of time. Naming your feelings is a first step to managing them adaptively.

2) And feel the feelings. When we have distressing feelings, it’s natural to want to shy away from them. It would be so much easier if we could put the feelings in a box and set them aside. But the longer we avoid feeling our natural feelings, the more distressed we become. I’m not talking here about temporarily compartmentalizing so you can get through your shift, your day, your exam week, or other external stressor. It is an important skill to be able to put a pin in our emotions and continue to function. The trouble comes when we find we never get around to processing those feelings and we keep stuffing them and stuffing them and stuffing them until we simply can’t manage anymore.

Think about a 2-liter soda bottle that has been vigorously shaken. Yanking the top off will cause soda to spray everywhere. But if you slowly open the top just a bit, close it again, and do that repeatedly, the fizz will dissipate. We can expect a similar process with our emotions. We will not experience high-intensity emotion on and on without ceasing. If acknowledged and processed, our emotional tension will also dissipate.

3) Give yourself tools to help contain your emotions. You do want to feel your feelings but you do not want to be overwhelmed by them. Some things to consider:

• Pay attention to the basics. To the extent that you are able, get enough rest, ensure proper hydration and nutrition, and engage in regular exercise.
• If you begin to feel overwhelmed, change your physical state. Stand up if you are sitting. Drink a glass of cold water or hot tea. Splash water on your face. Put a cool cloth over your eyes. Rub the back of your neck. Do the small things that physically soothe you.

4) Write it down. Journaling, poetry, and other written forms of expression are powerful tools for processing and managing emotions. If you worry that writing will feel like too much, set a timer for yourself before you start. When the timer goes off, it will not switch off your emotions but will bring you back to the present so you can ground yourself.

5) And speaking of grounding, I invite you to try this exercise that you can do anytime, anywhere to help you collect yourself and restore emotional equilibrium. Gently focus your attention on yourself and your environment and identify:

• 5 things you can see;
• 4 things you can touch;
• 3 things you can hear;
• 2 things you can smell; and
• 1 thing you can taste.

If you are unable or prefer not to do one of these steps, simply leave it out. The overarching structure is one of established effectiveness, but this isn’t a skill that requires strict adherence to a formula in order to gain benefit.

Another grounding exercise is point-look-name. When you feel yourself becoming carried away, take the time to notice your surroundings. Point at something, look at it, and name it. For example, “chair-table-lamp-area rug-window” etc. This technique brings you firmly back to the present moment in your present circumstances. In this present moment, the distressing or traumatic situation is not occurring. Center yourself.

Practice self-compassion as you experience and process your emotions. It may be a quick process for you or it may move more slowly than you would like. You may believe that you have moved past your distress only to find yourself immersed in it again at a future point. All of these are normal; offer yourself kindness and understanding.