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Dealing with Hardship

by Rob on October 30, 2008 · View Comments

in Best Of,General Medical

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My job involves being around people who are struggling.  Many people are dealing with personal illness, while others with loss.  Whatever the case, it is a very common occurrence to sit alongside of someone who is in significant hardship.

Here is my advice to them, and to you if you are dealing with difficulty:

  1. You can cry in front of me.  If there is anyone you can cry in front of, it is your doctor.  I have people crying in front of me all the time, so I don’t feel uncomfortable when you do.
  2. Most of the people around you don’t know what to do.  Since our culture doesn’t like dealing with our own suffering, we don’t know well how to deal with others’ suffering.  Some people around you will ask things like, “what do you want me to do?”  They want to fix your problem – which is not possible.  Others will just feel awkward in your presence.  They feel like there should be something they can say to help, but they don’t know what it is.  Be patient with them.  The people closest to you are often the most awkward.
  3. It’s OK to lie.  When people see you socially and say, “How are you doing?” they don’t really want to know; they are just being polite.  Even when your life is falling apart, it is not wrong to say “fine.”  It is not phony to put on a front, it is the polite thing to do (and much easier).  As a physician who has gone through hard times, I have dealt with this personally.  People always ask me how I am doing.  I found it good to make a true statement that avoided answering the question, like: “well, I’ve got three teenagers at home….”
  4. People will say really stupid things to you.  For some reason, some people feel it is their job to tell others when they aren’t grieving in the right way.  Either they will tell you that you should “get over it,” or make you feel like you are getting over things too quickly.  These people are idiots.  Ignore them.  They are not you and don’t really know what is going on.  Even if you feel like doing it, don’t hit them or call down fire from heaven.  Just tell yourself that they are idiots, and ignore what they say.
  5. Depression is irrational.  I am not saying that it is irrational to become depressed, but instead that the overwhelming emotions that you feel are not always going to “make sense.”  You don’t wake up in the morning and decide, “I think I am going to be depressed this morning;” so why should you be able to remove the emotion simply by deciding.  The nature of depression is to be out of control of your emotions, so don’t feel like you are crazy when this happens.
  6. Being happy does not mean you are not sad.  Some people feel that after they have lost a loved one, it is dishonoring to them to enjoy things in their lives.  They think that somehow you have to “grieve enough” to show how much you care for them.  But most of the time we have both happiness and sadness in our lives.  Good things don’t negate the bad.  There cannot be silver linings without dark clouds.
  7. Try not to isolate yourself.  It is very normal to feel lonely when you are depressed, and feel like nobody cares.  Yet it is also normal for depressed people to want to avoid social situations.  Yes, you will make some people feel awkward, but it is very important for you to not be isolated.  This doesn’t mean that you have to have a big talk with everyone who is around you (remember, I gave you permission to lie).  You just need to have social contact – however superficial it is.
  8. There are two kinds of depression.  People can have the emotion of depression and not be clinically depressed.  Feeling depressed is something that most people in grief or hardship do encounter.  Clinical depression, on the other hand, is when the feeling of depression becomes so dominant in your life that it interferes with your ability to function.  Clinical depression can harm you and your relationships, and often needs medication and/or counseling.  Becoming clinically depressed doesn’t mean you are weaker than others, it just means that you were hit harder.  Some people avoid clinical depression by escaping to addictions or living in denial.  This is no better – and may be worse.
  9. It is normal for depressed people to wish they are dead.  When life is hard, it is not uncommon to wonder if not being alive would be a better alternative.  There is a huge difference between this and making plans to kill yourself.  If you are feeling the latter, then you should talk to someone.  If you talk to me, I won’t lock you up in a mental institution (unless you are totally irrational and untrustworthy).  One of the big lies that depressed people believe is that their loved ones would be better if they were dead.  Suicide does not make the lives of those around you easier – it makes them much harder. There are very few things more devastating to people than for a loved one to commit suicide.  Don’t buy the lie that says that you are doing this for your loved ones.
  10. Time helps.  Life is full of hard things to lots of people.  I have lived through these things with a large number of patients, and no matter how dark things seem, they do get better.  Traumatic events cause a huge hurt in your life that you don’t know how to deal with.  Over time, you will re-learn how to live your day-to-day with the reality of your hardship factored in.  When you are in the depths, it is hard to see that this is only a season.  It almost always is.  Just take it “one day at a time.”  I know that sounds cliche, but it really is the only way to get through it.
  11. Don’t protect your loved ones.  People are too afraid to be a burden to their loved ones.  That is what family and friends do for each other – they carry the heavy loads, and allow themselves to be burdened.  It is an honor to be the person to stand at the side of someone in the dark hours of their lives.  You would expect them to come to you for help, so you can do the same.  Don’t let pride keep you from comfort.
  12. If you need me, please bug me.
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{ 9 comments }

Hilary October 30, 2008 at 1:17 pm

Thank you for writing this. These are really good reminders.

enrico October 30, 2008 at 1:35 pm

As someone who is going through one of the hardest times of his own life, I appreciate what you wrote. There is an extension to #2 that I feel I need to share to those who genuinely want to help a loved one/friend:

Offer what you feel might help, but the best help of all is simply being available for what the person needs and in their own time. Don’t turn your offer into an imposition because you want to feel you did something (worse, only when it’s convenient for you). Having said that, a “no, that’s OK” now doesn’t mean forever; a sincere, non-pushy offer for something again later might be accepted at a time when a need is more.

It’s a fine line between “being there” and being pushy, and the old adage “put yourself in their shoes” doesn’t always work b/c people are so different, particularly in times of great stress/hardship. Your post helps highlight those differences/pitfalls, and I thank you for sharing.

Bronnie October 30, 2008 at 3:31 pm

An excellent post – heartfelt.
and I have to agree with the extension to #2 by enrico, great idea. If you’re happy with this, I’d like to link to this post on my blog – it’s a really helpful set of ideas.
cheers
Bronnie

Dannette October 30, 2008 at 6:02 pm

I just finished a post on my blog about my inability to deal with stress, and the resulting detrimental affects it has had on my health. I suffer from Fibromyalgia, and depression is a common reality with the condition.

I love how life finds a way to steer you, and here I am at your blog for the first time. I know I could use more tools to help me communicate to my friends and family what I am feeling. This post of yours is very timely.

Thanks. I will be back soon.

MaryO October 31, 2008 at 12:49 am

Thanks, Dr Rob! So many, if not all, of these points are important to those of us in the Cushing’s community.

Thanks again for sharing your thoughts with all of us.

Zee October 31, 2008 at 11:42 am

All very insightful, especially #6 and #10. I know those from experience.

For some reason, though, I don’t think I would ever feel it’s OK to cry in front of the doctor. It would just get written down in my chart and follow me around for the rest of my life. :(

I wait until I get out to my car in the parking lot. Then I cry.

medstudentwife November 1, 2008 at 8:40 pm

Beautiful post, Dr. Rob. I’ll be carrying this close

Kim November 3, 2008 at 11:48 am

I have bookmarked this post and will keep it to share with those who will need it (including myself!)

Angel November 4, 2008 at 10:17 am

Finding this post couldn’t have come any sooner. My family is awaiting the verdict from our second opinion on what’s going on with our grandmother. So far, signs point to ALS, and yep, we’re all feeling a lot of things. This list will be shared with the rest of my family as a reminder of how to deal–and how to help out my grandfather. Thank you so much for the perspective that you add regarding medicine and health care!

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