Self-care and Self-compassion: Suggestions for students

I am going to make a few suggestions which I hope will be helpful based on my own experience and with the conversations I have had with students over the years. These suggestions are not compulsory nor evidence based as such. They have not been researched as far as I know. They are experienced based and you may find that trying out one or two make sense for you and help you to understand your experience. Therefore these suggestions are based on principles of self-care and self-compassion.

My experiences of bereavement include my parents as well as my two brothers. Perhaps the most pertinent here is the bereavement I experienced whilst at university. During my final year of my physiotherapy undergraduate degree, my stepmother died at home from a heart attack, over the christmas break. She had been in hospital previously from the same cause, so it was not entirely unexpected, but it was still a shock. The police visited that night because it was a death at home. That was unpleasant to deal with on top of the shock of death. I kept busy with making arrangements for the funeral and sorting all the things that needed to be sorted out in the time following someone’s death. All sorts of things come up that you have to deal with that you had no idea about before. At the time I was very task focused and got through it. It wasn’t until I returned to university and was sitting in a lecture about cardiology that I felt the upwelling of tears and sadness. I felt embarrassed at the time and thought that there was something wrong with me that I could not control my reactions. I did not talk to anyone about this. Over time, the emotional reactions faded and I no longer felt so raw about the experience.

Looking back, I can only encourage people to make contact with a personal tutor or the year lead to let them know what is happening and to see if there are any adjustments to the course that can be provided to help accommodate your grief. Whilst medicine is an intense and relatively inflexible schedule of study, there are ways to work around meeting the requirements. Do reach out to someone you can connect with at the university and your GP if you feel that is necessary. There are many university supports in place such as counselling that will help you process your grief and manage the workload. That is if you still want to continue at the same pace.

Do consider taking time out to grieve your parent or loved one. Many students find this hard to contemplate as they have worked so hard to be at medical school and often it is the loved one’s wishes that they continue their studies and become a doctor. Some students prefer to be in medical school while they are grieving because medicine gives them a sense of purpose and feeling worthwhile. Such students can feel that they would be needlessly languishing at home. However, taking time out may be important for your mental health and your decision is yours alone in the end.

Understand that making a decision in a time of bereavement is not always easy though. Anecdotally some people say not to make a major decision in the year or two following bereavement. However, if your health suffers because of the bereavement you may find yourself in a place where the consideration of taking time out is taken out of your hands due to your own mental health and suffering. This is not a failing and you have not made a mistake anywhere along the line. Taking a break can be seen as a part of your journey through medical school too.

The journey through grief is not linear nor a straight upward progression. Instead, you are required to become larger than you were before to accommodate these feelings and experiences. You may find yourself revisiting issues and memories in a more circular or spiral fashion. It is therefore important that you manage your expectations about the grieving process and your recovery. You may also need to manage the expectations of those around you.

The revisiting of the grieving process may also be complicated if you had a complicated relationship with your loved one before they died. In these sorts of situations, the difficulties that were present during your lifetime together do not tend to go away. In fact, they can be exacerbated by the normal tensions and stresses of going through the dying process. If you had a complicated relationship with your loved one, then you may benefit from talking with a grief counsellor or a therapist. It may sometimes seem like you are taking three steps forward and two steps back in your grieving.

Sometimes activities such as writing a letter to the one who has gone, or drawing a picture, or making a collage of photos of your time together, or writing a poem or choosing an already written one that speaks to you, may help you understand more about yourself and what has happened. Lighting a candle and saying your version of a prayer may help with acknowledging what you are going through. Talking through these with an understanding person may help greatly. Perhaps you have an old friend who knows you that you can talk these things through with or perhaps another student will be able to help you.

Above all, treat yourself with the same kind of care and compassion that you would treat a dear friend. Mary-Frances O’Connor talks about the distinction between grief ‘the intense emotion that crashes over you like a wave’ and grieving ‘as a process with a trajectory rather than a moment’ to show how we manage both. We are re-making the map in our brains about the loved one and now their absence. This takes time and can be exhausting. Both the crash and trajectory change how we see ourselves in the wake of this loss so we are involved in re-making ourselves too at the same time. Feelings of yearning, panic/grief at the loss as well as the full range of emotions are all part of the grieving trajectory. With such an intense experience, nothing less than full compassion towards ourselves will do.

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