After the Loss of a Patient: Reflection and Connection Through Prose

By Hedy S. Wald

Lean machine of prose, stripped down to the essence, and a power-packed way to care for the caregiver… this was my experience of the 55-word story genre1 at a writing seminar. While I had some experience writing haiku, I was generally accustomed to reflective narratives3 as “story” so was nothing short of surprised when a compact 55-word prose “small jewel”2 about a patient who touched my heart and soul spontaneously emerged onto the paper.  It chilled me to the bone and warmed my heart. I was asked to read it aloud for the attendees – the hush afterward was a moment of sacred silence…

“Honoring Alan” I titled it…Alan I., MD was my patient on the rehab unit, the unit with the “vent” patients where I was the psychology consultant, where I provided supportive counseling.  Was my patient. Yes, he passed. But before that, despite the indignities and ravages of disease, he managed to muster the strength, both mental and physical, to undertake rehab exercises, vent and all.  And sometimes his devoted wife would be singing show tunes as he did so and I was in awe.  On tougher days, amidst the pop and swish sounds of the vent machine, I’d read poetry and see a flicker of brighter light in his eyes.  I may have imagined that, but I don’t think so – his wife told me he liked poetry.  Now, in another space, another time, he still liked poetry – sometimes. Before starting our sessions, I’d pause at his door to collect myself, to be able to enter the room intentionally4 as the combination of serious illness and ventilator posed challenges for a caring practitioner. And spurred my reflecting on the nobility of the human spirit and there but for the grace of G-d go I.  A caring physician he was, I was told, and now physician friends would come visit the physician-patient who got smacked with a one-two punch of Guillain-Barre and Myasthenia Gravis and never fully got up from the mat.

He passed on a holiday.  Afterward, I entered his room on the unit feeling so displaced. “Passed” is the word I have chosen to use here -writers do make choices – perhaps then easier to tolerate than “died.”  It wasn’t his room of course, it was a hospital room, but it felt like his after so many months.  The cards from friends and relatives were gone, so was my postcard of the Wailing Wall I had brought back from Jerusalem and which his wife had tacked onto the corkboard.  He had mouthed how he had wanted to visit there; the card serving as his vicarious trip.  Attending a writing seminar months later, “Honoring Alan” emerged – a means of reflection, emotional processing, caring for the caregiver, perhaps even fostering resiliency,5 honoring a valiant life:

Honoring Alan

Wounded Healer
With intimate knowledge of a body that betrays
Double whammy myasthenia, guillain-barre
Doc on a vent, I’m called to help
To counsel, to share.
To poetry I turn.
So I read, offering
A mind vacation for trapped body.
He passed on Passover
From slavery to freedom
The salt water at seder
My tears.

I shared this with his widow, she wanted to read it.  The prose connected us on an even deeper plane.  She sent it along to family and wrote me: “I have thought of you so often since those terrible (but also amazing) days of Alan’s illness.   It was so hard; it was so blessed. And you helped to make it that way.”  She wrote some more, I wrote some more, and then it was done.  We each had work to do. Life work.

Yes I did let her know I was on leave from the hospital at that time because of my own husband’s diagnosis of brain cancer.  Truth can be stranger than fiction.  She sent words of strength and comfort. Reflection and connection – it goes both ways.

Hedy S. Wald, PhD
is a Clinical Associate Professor of Family Medicine at the Warren Alpert Medical School of Brown University where she directs the reflective writing curriculum in the Family Medicine Clerkship and was honored with Dean’s Excellence in Teaching Awards.



  1. Scheetz A, Fry ME. (2000). The Stories. JAMA. 283(15): 1934.
  2. Fogarty, CT. (2010). Fifty-five Word Stories: “Small Jewels” for Personal Reflection and Teaching. Fam. Med. 42(6):400-2.
  3. Wald HS, Reis SP. (2010). Beyond the Margins: Reflective Writing and Development of Reflective Capacity in Medical Education. J. Gen. Int. Med. 25(7): 746–749.
  4. Wald HS, Haramati A. (2015). Hineni – I am Here: On Presence and Sacred Space. Special section: Spirituality in Medicine – Creating Sacred Space. J. Altern. Complement. Med. 21(6): 247-250.
  5. Wald, HS. (2015). Professional Identity (Trans)Formation in Health Professions Education: Reflection, Relationship, Resilience. Acad. Med. 90(6): 701-706.

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