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.

Blogging 101: The obligatory ‘my story’

Here we are, the first of many a blog post. Excuse the informality but you are most likely here because we have one pretty shoddy thing in common or you’re my dad; so, either way, thought I’d skip the futility of being prim and proper.

So coming to write this, I sat staring at the blankness of my screen which aptly matched my brain. I have so much to say without a clue as to where to start, while also resisting the urge to narrate what I’m saying in my head as I’m typing as if I’m in some cringy coming of age film.

Anyways, I am known to waffle, so apologies in advance for the inevitability of a bit of a lengthy post (I’ll work on it). Here we go, I hope you’re mentally prepared for my chaotic-ness – buckle your seatbelts people:

I remember so vividly being told that my mum was ill. I say ill, I mean riddled with metastatic disease. Anywho, I’d gotten in from school on a Friday, fuming to the sight of a maccies paper bag on the dining room table. Mum and Dad had been without me. The absolute cheek of it. In my entitled-ness I made a sly comment to my Mum about the audacity of the entire situation. I looked up at her into her glassy eyes and she just gave a little chuckle. At this point I’m confused and a bit worried, but mostly in a deep depression about missing out on a big mac.

My beautiful mum was diagnosed with metastatic breast cancer on 31st January 2014. Not to get the violins out but I’m fairly certain that’s when my childhood ended.

Complete honesty, I’ve always been an annoying, overbearing (person) older sister to my little brother and daughter to my mum and dad. I have to give my annoying little self credit where credit is due.

But, with mum’s diagnosis, I felt an overwhelming sense of duty. I think this was mostly a want to protect my little brother, who was only 9 at the time. My just about 13 year old self felt obligated to enter this adult world of trying to be a crutch to my (genuinely amazing) dad (fan girl post incoming) and to the rest of my family. It is something that no child should have to go though, however it has made me the person I am today and has massively shaped pretty much every aspect of my life. All of that malarkey for another time though.

Aside from the initial shock of the situation, and I know a lot was obscured from my view in an effort to protect me, but aside from the chemo and radiotherapy leading to my mum’s mastectomy, life was fairly normal. Of course there was always underlying worry, but my parents did an amazing job at making that as quiet as possible amongst the extreme volume of the severity of the situation. Now I’ve typed that into black and white I understand how completely ridiculous that may seem, but honestly that is pure credit to my parents – it was our normal, and that was okay.

Due to the malignant nature of mum’s breast cancer, that it had spread to her sternum and liver, her prognosis was never great realistically. Rightly or wrongly I never really knew or came to terms with this until my first year of uni, and I’m not gonna lie – I’m not mad that this was the case. So time went on, mum didn’t go into remission, but her cancer was managed, and we were all pretty satisfied with that. Beginning of 2018, a few months after my Grandad’s passing, it came to light that mum’s cancer had metastasised to the brain. This entire situation was cruel, but thats a lengthy story for another time. Mum had brain surgery, the resected segment the size of an egg, and she had more radiotherapy. Things seemed to be stabilise and she continued her regular treatment, her trusty Herceptin – as mum called it: magic medicine. Things went pear shaped when mum stopped responding to Herceptin, and instead switched to Kadcyla. Things were okay for a little while, but in the meantime my mum lost a second parent and the family dog passed. It did seem like one thing was constantly happening after the other.

March 2020. Need I say more? Everyone’s lives had changed there is no getting away from that. My family’s however, was already changed beyond my comprehension – and I only realised this when it had already happened, I don’t know whether this was the better or the worse eventuality honestly. My dad said he had noticed significant changes in my mum and her manner starting around December 2019. When I say that I returned home to a different person, I wish I was being my usual overly dramatic self. With this I entered what I now understand as anticipatory grief, and it is fair to say that March to September of 2020 was the worst 6 months of my life. Unless we are hit my another pandemic (me: isn’t superstitious – *still touches wood*), I know I will never experience that extent of turmoil and emotional pain again. I feel angry that I could say at age 19 that I knew that was the worst my life would ever get. I hate to tempt fate but how I lived in that period of time was my version of a hell. Personally, watching one of the people I love the most become someone I could barely recognise, leading to their death is something that will always stick with me. I would never wish that on my worst enemy.

No word of a lie, 2 weeks after my mum’s funeral our dog died. She was old bless her… like she was past her sell by date kind of old… but the timing was impeccable.

That was that. By this point I had already technically started my second year of medical school… that decision was an interesting one which we will cover another time.

Okay – sob story over, violins can be put away and I’ll have my golden buzzer now please. Jokes aside, thats me – that part of my life even. Everyone who has a story like this knows theres so much more to them, but whether I accept it or not this is a big, significant part of who I am. I spent so long worrying about people knowing about this part of me and it being some big deal. People have their own stuff going on to worry about unfortunately, life can be so cruel. I wanted to tell my story and share advice because, honestly, I really needed it and the resources just weren’t there.

If you’ve got this far, you deserve a medal… and thank you 🙂