City of Hope physician addresses grief in powerful new paper

October 26, 2018 | by Robert Young

banerjee-chandana-300x300 Chandana Banerjee, M.D., M.P.A.
Chandana Banerjee, M.D., M.P.A., had a childhood dream to become a writer or poet, and she planned on making it a career. But after getting an undergrad degree in literature, she decided to take a year or two off before going for her Ph.D. It was a decision that would change her life.
During the break, Banerjee became fascinated with health policy and marketing, so she abruptly switched course and earned a Masters in Public Administration. Soon afterward, the future physician became director of marketing for a Medicaid company in Connecticut.
That’s when an unexpected tragedy struck that rocked her personal and professional life, eventually leading her to City of Hope’s Department of Supportive Care Medicine.

A New Direction

“Shortly after finishing my first year in marketing, my father, who was visiting India at the time, had an emergency hernia operation,” Banerjee said. “Inadequate care by his medical team led to him being septic and he died from cardiac arrest. His death made me realize that to really make a difference, I needed to become a clinician and work with patients directly. Palliative care was in its early phase of conception at the time, so initially, given my interest in children and underserved communities, I decided on pediatrics.”
Banerjee’s experience dealing with grief shaped her career and inspired her recent article in the Journal of Pain and Symptom Management, titled “Grieving to Grieve.” It’s a deep dive into what she calls "anticipatory grief," a grief reaction among people who are facing the eventual death of a loved one during a terminal illness.
“Even in its silent form, grief is a powerful emotion that often plays a powerful role in shaping people’s lives,” she said. “My personal belief is that anticipatory grief has its various stages, much like conventional grief, and to truly address someone’s feelings and help them heal, one needs to recognize the impending loss that is to occur and address a person’s grief around that impending loss.
“By addressing both pre- and post-loss phases of grief, we can better understand grief in its entire spectrum, which then allows us to guide people through their healing process.”
In her article, she explains how anticipatory grief affects not only families and friends of afflicted patients, but also caregivers and physicians. It is, she says, a tragically overlooked aspect of practicing medicine that needs to be addressed.
“It’s well known among physicians that we are not taught the art of grieving,” Banerjee said. “Only recently have medical schools started teaching medical students how to cope with emotions we face in our careers that might ultimately drain us or impact our professional and personal lives.”

Healing the healers

City of Hope provides a support system with the Schwartz Center Rounds program, a series of workshops created for physicians and all employees of the medical center, clinical and nonclinical alike. They provide a safe space to explore and elaborate on issues and emotions related to daily patient care, Banerjee said.
The rounds are part of the Schwartz Center for Compassionate Healthcare, founded and named in memory of Kenneth Schwartz, a cancer patient who died from lung cancer at a very young age. He served as an inspiration for the medical center staff.
In his writings, he described that it was his caregivers’ kindness that often ‘made the unbearable bearable,'” said Banerjee, physician lead for Schwartz Center Rounds. “He believed that caregivers also needed to be supported and listened to as they selflessly cared for their patients.”
Supporting the emotional needs of patients and their loved ones has long been an important mission at City of Hope, which recently launched the Hospice & Palliative Care Medicine Fellowship Program, a one-year fellowship intended to train physicians to specialize in hospice and palliative care — an increasingly essential complement to existing care teams.
“What is unique about the HPM program is that it’s the only standalone NCI-designated cancer center fellowship on the West Coast,” Banerjee said.

Grappling with grief

Banerjee’s work in hospice and palliative care, as well as her personal struggle with grief, have given the doctor a deep insight into the grieving process, a process universal to the human experience that nevertheless remains a rather taboo subject.
Being mindful of how the process works can be invaluable in charting a path to healing, she said. And it’s essential that physicians recognize anticipatory grief in patients and their loved ones and connect them with the wide range of resources at City of Hope.
"Our spiritual care  team, social workers, palliative care workers, psychiatrists, psychologists and Child Life specialists will guide our families through the reality of losing someone they love.”
Healing from loss is a deeply personal process that takes many forms, she says, and expressing grief through a creative outlet can be a powerful tool in finding closure. After dealing with the shocking loss of her father, Banerjee found comfort through her love of writing.
“While someone will take comfort in prayer or participate in grief and bereavement sessions, others may express it in forms of meditation, writing, song or paintings,” she said. “Poetry was the form I chose to express my grief when I was finally ready. I’ve written poetry from a very young age, so writing about my father’s death and my emotions in the form of verse seemed appropriate.”
Regardless of which path to healing one chooses, dealing with this powerful emotion is inevitable. It is, after all, one common experience shared by all people.    
“Every human being, when lost, is grieved, even the vile ones, and hence grief is what unites us, no matter how different we are as people — and how differently we choose to grieve.”

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