We are never very good at predicting what we are going to feel in the future. In 2016, during an Open Door women's retreat, I spoke about wanting to make a bigger impact on the heart-rending tragedy of Veteran suicide. Less than a year later, through a string of miraculous events, I now have the opportunity to do just that, to serve as the suicide prevention senior advisor for the Tragedy Assistance Program for Survivors (TAPS), an organization I have held in very high respect from a distance for a long time.
As I made the departure announcement to colleagues at the VA (in a Veterans behavioral health clinic), I was initially focused on what I was going to be doing next, filled with hope and excitement for what the next chapter would bring. What I didn't expect was to feel such an impact of grief – the direct result of severing ties with the hundreds of Veteran patients I have worked with for the past eight years at the VA. This grief has been profound.
I have lived in nearly every time zone and whenever I have severed an attachment in the past, I have always been able to find solace in the idea that “true friends easily pick up where they left off.” My husband and I are blessed to have friends like this, including two very dear friends we hadn’t seen in 8 years that we recently stayed with in Australia with my remaining vacation leave balance. Even with very little contact, I’ve felt able to hold attachments to dear friends like these because there's always the hope of the future reunion.
But it isn't the same with my former patients - in the vast majority of cases, I will never see them again. I have walked alongside them in their most sacred pain, and known them through critical times of transition in their lives – marriages, births, and deaths of family members and friends. In most cases, that very private, safe place in my office was the only touch point we ever had or could expect to have in the future. And no matter what they tell you about “clinical reserve” in graduate school training, if your heart is really in the work, it creates an attachment. It's certainly a unique kind of attachment in that my patients know very little about me and they are not there to serve my needs, but my heart has been fully invested in their growth and recovery. So, there is a strong attachment nonetheless and one that could not translate into the way I have been able to hold other disrupted attachments.
As I began to sever ties with them, some of them went into crisis and it was a very scary, turbulent time for them and for me. I had nightmares that about them, thought about them all the time, worried over them, prayed for them, and struggled with how to let them go.
In the context of this time of suffering, I developed a spiritual practice that gave me a good way through. This practice was an adaptation of how I have helped people grieve other types of losses. First, I had to realize that this was indeed grief. Second, I had to acknowledge that grief was the appropriate emotion to feel. Essentially, I needed to get comfortable with the fact that I was experiencing attachment loss as an extension of doing the work with my whole heart, and this is not pathological.
Once these two connections were made, I was able to rely on what I know about healthy grieving. As I have told my patients, a healthy grief journey is one that allows us to remain connected with the one we have lost, rather than making it our goal to forget about them and move on. So, in those final poignant sessions with my patients, I locked the memory of their faces and voices in my mind. I strained to listen to everything they said in the context of terminating our therapeutic relationship.
As Veterans generally are, they were extremely generous in spirit. Some of them acknowledged that it “really sucked” but without exception, they thanked me and gave me words of encouragement. They told me that they believe in me and that they would always have my back if I ever needed them. So that is where I have placed them in my mind. They are standing right behind me. I can almost hear them because I know what they would say. For example, I was recently traveling to the reunion of some Marines in a Unit that has seen an especially high suicide rate. I had a terrible sinus infection and the descent in the plane was excruciatingly painful - so much that it brought tears to my eyes from the sheer physical pain. I felt like my head was going to explode or maybe that I would have a stroke or something. But then I heard the faint echo of the voice of one of my patients behind me, saying "embrace the suck doc" (which is how Marines effectively say, "just lean into the pain and you will get through it").
When I assemble them as an invisible mental force, I can easily call them to mind. I can continue to hold and carry their stories. I can pray for them as a group and I do. I can honor them in the next chapter of my life. I can draw from their strength to be bold as I work on their behalf.
God has said that his power is manifest in our weakness. In my new role, I have already had several experiences that remind me of this truth, and they are often mediated by the collective strength of the invisible force at my back that I am now working to serve. I still miss my patients, sometimes acutely, but as in any healthy grief journey, I also can access the happy memories of our conversations, recall some hilarious stories they shared, and I know that I have a way to hold them close as I move forward in this new chapter of my life. This has been a good way through for me.