On my desk at work, there are a few photographs. There’s me and hubby, and Babyboy, and even our cats. Soon there will be photos of Babygirl, too. But there are two special photos that stand apart:

 

One is of my fresh-faced, smiling cousin, in a moment of honest adolescent bliss, hugging her big ol’ dog, a Great Dane with crooked ears. That day was a special family get-together, one of those rare gatherings where just about everybody manages to be there, and a genuine family celebration just happens, for no real reason whatsoever. As I recall, there were plenty of jokes and ribbing, guitar-playing and singing, and stuffing our faces with good barbecue. Months later, she was the passenger in a car crash; she was killed. She was age 15.

 

Another is of our niece holding her toddler daughter in her lap; she’s hugging her little girl in a way that you know that baby was her whole life. She’s in our living room, sitting on the couch, wearing a flannel print shirt, comfy and happy and healthy. She was on a short vacation from her job, or her calling, rather, as an ICU nurse, and she was visiting us to meet Babyboy for the first time. The next year, she was the victim of a domestic abuse homicide; she was 29. Her daughter is fine, and now lives with my brother-in-law and his wife.

 

When I’m caught up in the grind of my office day, I look up at these photos. Sometimes I take a moment and pray; I even have conversations with these girls. Their presence helps me to remember what is important in life… I need that reminder over and over and over again.

 

But one of my great sources of shame is that while I keep these girls in my mind and heart every day, I am not very good at reaching out to the living, the ones left behind, the ones who are still feeling these losses the most. I actually am very bad at this. I just don’t know what to say.

 

At the moment of the tragedies, of course, there were tearful conversations, hugs, and meaningful silence. Afterwards I sent copies of photos I had of them. But now, I am at a loss.

 

A few weeks ago I got an email request from a friend of our niece, who wanted a copy of a photo I have of them together. We emailed back and forth a bit, and I confessed that I felt bad that I hadn’t spoken with my brother-in-law and his wife for awhile, that I hoped they were doing OK, but I just didn’t know what to say, that I was afraid of saying the wrong thing and making it worse for them. She wrote back: “I know what you mean… Even though I see them often, I am also ashamed to say that I find myself avoiding them, for the same reasons.”

 

I was surprised to read her confession, because I thought I was the only one who was such as awkward jerk. There was some comfort in knowing that I’m not the only one; on the other hand, I wondered how many people have trouble reaching out… And it made me feel worse.

 

I think of this now as we are recovering from Hubby’s illness; we are aware how lucky we are that he didn’t need surgery; and we are jolted with the reality that yes, perfectly healthy people can get really, really sick, really fast, and we need to acknowledge and think about the possibility of death. God can call up anyone, at anytime.

 

Also, January and February are the birthday months of both girls. We don’t live close enough to either branch of our families to say anything in person; sending a card feels weird; a phone call would be nice, but I couldn’t imagine what to say.

 

This is embarrassing. It’s my job as a physician to manage awkward moments and direct the light of honesty and purpose to difficult topics, like discussing end-of-life issues, biopsy results and cancer diagnoses, or even the pros and cons of cancer screening or genetic testing, with my patients. In the exam room, I have confidence in this, in using well-picked words to discuss powerful and potentially devastating information/ results/ statistics in a firm and yet gentle manner, to impart understanding and hone a plan.

 

But I can’t do this at home, perhaps because in these early deaths, there is no sense to be made, and no plan. It’s going to mean sitting in the pain of it. It means bearing witness to emotion, or enduring my own.

 

And I’m not very good at sitting in pain with patients, either. Yes, there is a box of Kleenex on my desk, and it gets used often. But in the office, I can sit with someone in grief for a short while and then get up and leave– kindly offering, of course, to let them stay in the room in private a little longer. If someone is very hysterical, my goal is usually a clinical one: treat this stress, alleviate this anxiety. Write a referral to therapy, recommend meditation, write a prescription for Ativan, make a followup appointment.

 

Some people are inherently good at managing these emotions, at sitting in grief, in pain, with others, even their own family. Or is this a learned skill?

 

How do we learn this? How do we acknowledge, and then speak of the unspeakable, what do we say? How do we reach out to those who hurt the most, to remember and memorialize, in a way that won’t inflict fresh pain and grief?