Finding Meaning After Loss

“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

In 1969, Elisabeth Kübler-Ross identified the five stages of dying in her book, On Death and Dying. Her work has radically transformed the way we think and talk about grief and loss, giving us a shared vocabulary for and understanding of a previously murky, yet universal, human experience.

Towards the end of her life, Kübler-Ross worked closely with David Kessler, with whom she co-authored several books and formally adapted the stages of dying into the stages of grief. Today, Kessler is the world’s foremost expert on grief and has taught healthcare workers, counselors, and first responders on facing death and loss. His writings and his website Grief.com have reached millions of people.

In this episode, David joins co-hosts Henry Bair and Tyler Johnson, MD, to share his personal experiences with loss and what his decades of helping those on the edge of death have taught him about finding meaning amid suffering, and happiness after tragedy.

In this episode, you will hear about:

• 2:10 Thanatology — the study of death and dying — and what drew Kessler to this field
• 6:06 Kessler’s friendship with Kübler-Ross, the psychiatrist best known for developing the five stages of dying
• 11:22 How physicians are often ill-equipped to face death and how they might better engage with dying patients
• 19:05 Kessler’s advice to physicians on finding meaning amid loss and tragedy
• 28:58 A review of the five stages of dying/grief
• 33:38 On “Meaning,” the sixth stage of grief that Kessler developed
• 38:04 How the COVID-19 pandemic saw a renewed interest in grief management, and how his interview with the Harvard Business Review entitled “That Discomfort You’re Feeling Is Grief” went viral
• 43:54 How Kessler manages the overwhelming sadness he sometimes experiences in his line of work
• 48:31 Kessler’s advice to physicians on comforting grieving patients

Following is a partial transcript (note errors are possible):

Kessler: I’m so glad to be with you. Thank you both for doing this.

Bair: So, David, you are often referred to as a modern-day thanatologist. Now, that’s not really a word that we hear often. So can you tell us what that means and what some of the big-picture issues you address are?

Kessler: So think about the Greek word “Thanos,” which means death. You know, people often know it from the action movies. The enemy is always Thanos — so not unlike our world that Thanos is our enemy. Many people perceive it that way. So I study death and dying, grief and loss. You know, it’s interesting. People sometimes want to think of me more as end of life or more as grief, and I perceive them as going hand in hand. I very much think about how death shapes the grief.

Bair: I see. So this is a very peculiar and unique line of work. Can you tell us what first led you to this career?

Kessler: Sure. I had a mother who was in and out of hospitals when I was growing up, so hospitals to me were like, just the place you go. I knew hospitals from such a young age. And one day she got really sick and had to be transferred to the hospital in the big city, which was a few hours away, for this new procedure called dialysis, which you could only get at a few hospitals.

And these committees had to vote if you could get dialysis because there wasn’t that many machines at the time. And they voted she could get one treatment, which we know now would not have done a lot. And so there she was in the ICU hours away. And my father and I went there to be with her and, you know, here I was 13 years old, I had been taught to lie about beer. No one had taught me to lie about my age for getting into a hospital in a big city. So when they asked me how old you are, I said 13. I never thought to say, oh, I’m 14, so I could make the cut. Some nurses let me in, some didn’t. So sometimes I could see her and sometimes I couldn’t.

I spent a lot of a time in the lobby, and at the hotel across the street where we were. One day, a fire broke out and everyone was evacuated. And we’re here on the street and we see the fire trucks pull up for this fire in the hotel. And as the fire trucks pull up and begin to extend their ladder, shooting starts and they realize they have an active shooter. It turned out it was one of the first mass shootings in the U.S. Racially motivated. And it went on for 13 hours. My father eventually got us back, but I saw first responders being killed, hotel guests. Even the chief of police.

Then we got back to the hospital and had a couple of days and I wasn’t able to see my mother when she died. So that really shaped a lot of my early life. And there just wasn’t anyone there. There wasn’t anyone to really say, perhaps this child should be allowed to say goodbye to his mother, you know, or we should have a plan to give him some help with the grief after. There was none of that. So in some ways, I often think about how I became the person that maybe could have helped me.

Bair: And now you are the world’s foremost expert on grief. And for a very long time, you worked with Dr. Elisabeth Kübler-Ross, who’s a psychiatrist best known for introducing the five stages of grief. Can you tell us briefly how you came to know her and work with her and, dare I say, eventually befriend her?

Kessler: Sure. We were supposed to be both speaking at a conference in Egypt on death and dying. And, of course, she was the keynote and I was wallpaper. That’s when she had her first stroke and wasn’t able to go. So I reached out to her son afterwards to ask how she was. And surprisingly, he said, here’s her number. And I called her up and we had a wonderful conversation. And, you know, I was someone who I said to her at the end of the conversation, I hope someday, somehow we get to meet. And she said, how about Tuesday? I mean, that’s the person she was. We met. We became really good friends. She was brilliant. More honest than you meet people. You know, she had an honesty that I would either say you respected or it pissed you off.

She said to me early on, if you’re here for anything professional, I’m done. And I said, no, I’m not. And at the time I was working on my first book, The Needs of the Dying. And the joke was she couldn’t keep her hands off of it. Like, she would say what chapter are you on now? Did you put this in? Did you put that in? And she really helped the book become so much of a better book because of her and her involvement.

For the full transcript, visit The Doctor’s Art.

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