We Were Trained to Save Lives, Not How to Grieve Them

You brace yourself for a casualty. You think you're ready. But nothing prepares you for the moment you walk into a morgue and see the face of someone you know. a brother in arms, someone you trained alongside, now gone. 

In healthcare, we are taught to be strong. To put the mission first. But what happens when grief catches up to you, and you have nowhere to put it? 

In this deeply personal episode, Fred opens up about his time as a Hospital Corpsman in Afghanistan and the specific day, August 11, 2011, that changed his understanding of loss forever. 

We explore the concept of "Cumulative Grief," the danger of the "stay strong" culture, and the practical tools you can use to process the heavy weight of this profession without breaking under it. 

In this episode, you will learn: 

• The "Debt" of Grief: Why suppressing your emotions works in the short term but costs you everything in the long term. 
• Survivor’s Guilt: How to distinguish between "I am responsible for the care" and "I am responsible for the outcome". 
• The Power of "The Pause": A simple, 60-second ritual teams can use after a code to honor the life lost and reset before the next patient. 
• How to Support a Teammate: Why saying "I'm here" is infinitely better than saying "Let me know if you need anything". 

Dedicated in Memory of: HN Riley Gallinger-Long KIA Aug 11, 2011 

Your grief is proof that you cared. And caring is what makes you a healer. 

 Mental Health Resources:  

If you or a colleague are struggling, please reach out. You are not alone. 

• 988 Suicide & Crisis Lifeline: Call or Text 988 (24/7, Free & Confidential)  
• Crisis Text Line: Text HOME to 741741  
• HSE Mental Health Services: hse.ie/grief  

Additional Reading: 

• HSE Mental Health Services: hse.ie/grief 
• Elisabeth Kübler-Ross Foundation: ekrfoundation.org 

Your grief is proof that you cared. And caring is what makes you a healer. 

My Recommended Stethoscope
I still use my Littmann from 2011 because it lasts. This is the modern version of the one I carry.

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Transcript

Frederick Nazario-alvarado: 0:00

Picture this. You're thousands of miles from home. The phone rings, and you're told the casualty is coming in. You brace yourself. You think you're ready. nothing prepares you for the moment you walk into that morgue and see the face of someone you know. A brother in arms. Someone you trained alongside. Now. Gone. In healthcare, we're taught to be strong, to keep moving, to put the mission first. But what happens when grief catches up with you and you have nowhere to put it? Today, we're talking about something every healthcare worker faces, but few of us are ever fully prepared for. Dealing with death and grief in medicine. you Welcome back to MAP, Medical Pathways for Success. The podcast where we talk about the real journey of becoming a healthcare professional. Your growth, your challenges, and the moments that shape who you are. I'm your host, Fred Nazario Alvarado. And today, we're diving deep into a topic that touches every one of us in this field. grief. This episode is personal, it's honest, and it's for anyone who's ever had to keep moving forward when their heart was breaking. Whether you're a student just starting out, a new grad finding your footing, or you've been in this field for years. I want you to know right now. You're not alone in this. Now let's get into this discussion. Let's start with the truth that nobody really prepares you for. If you work in healthcare, you will face loss. It's not a question of if, but when. We're trained to save lives. We're trained to do everything we can for our patients. but we're rarely taught how to process what happens. when we can't. And every loss leaves a mark. Maybe it's a patient you cared for over weeks. Someone whose name you knew. Whose family you met. Whose story became part of yours. Maybe it's someone you just met in the emergency room. A stranger whose life you fought for even though you never got to know them. Maybe it's a colleague, a mentor, or even someone who worked beside you day after day. Or maybe, like in my story, it's someone who wore the same uniform. carried the same mission. and believed in the same purpose you did. Here's what I need you to hear. No matter how much training you have, nothing fully prepares you for that moment. And it's okay to admit that. It's okay to say I wasn't ready. Because honestly? None of us ever truly are. When you enter healthcare, you know, at least intellectually, that death is part of the job. You read about it in textbooks. You practice scenarios and simulations. You've heard stories from your instructors and mentors. But knowing something in your head and experiencing in your heart? Those are two completely different things. In school, they teach you the clinical side, how to recognize the signs, how to perform CPR, how to call a code, how to document a time of death. But they don't always teach you what it feels like to walk out of that room knowing you couldn't save them. They don't teach you how to carry that weight. They don't teach you. What to do with the grief that sits heavy in your chest? Unspoken. while you move on to the next patient, the next shift, and the next day. There's this unspoken rule in healthcare. Stay strong, keep moving. Don't let it get to you. And I get it. We have to be able to function. We have the responsibilities. The mission doesn't just stop. But here's what happens when we internalize that message too deeply. We start to believe that feeling grief means we're weak. That crying means... we're not cut out for this. that needing support means we're failing. So we push it down, we compartmentalize it, and we tell ourselves, I'll deal with it later. but later never comes. or comes at 2 a.m. when you can't sleep, or on a random Tuesday when a song plays and suddenly you're back in that room, reliving that moment. Grief doesn't disappear just because we ignore it. It waits. And when it finally surfaces, it can feel like everything is hitting you all at once. So why am I starting here instead of just telling you my story? Because I need you to know that whatever you're feeling or whatever you felt, it's valid. whether you cry in the break room or held it together until you got to your car. whether you talked about it with your team or kept it locked inside. whether it happened yesterday or ten years ago, and you're still carrying it. Your grief matters. And more than that, your grief is not a sign that you aren't strong enough for this work. It's a sign that you're human. It's a sign that you cared. And caring. I mean truly caring is what makes you a great healthcare professional. So as we move forward in this episode, I want you to give yourself permission. Permission to feel. Permission to remember. Permission. to grieve. even if you've never got the chance to do it before. Because healing doesn't start with forgetting. It starts with acknowledging. Now, before I take you back to that day, I need to be honest with you about something. I've held this story inside for 15 years. I haven't shared it on social media. I haven't spoken about it publicly. It's something I've kept locked away. But if I'm going to ask you to be vulnerable, I have to go first. However, The story isn't just mine to tell. So before I even considered turning on this microphone, I reached out to Riley's wife to ask for her blessing. She knows exactly why I'm doing this. She knows that sharing Riley's story might save one of you from carrying this weight alone. And she gave us her permission. So, with her blessing, and in honor of HN Riley Gallinger-Long, let me take you back to August 11th, 2011. I was deployed to Afghanistan, serving as the patient tracker for my battalion. My job was to keep track of every injury, every casualty. and report back to our battalion surgeon, who would then report it to the battalion commander. It was a role I took seriously. Every update I gave mattered to the Marines and corpsmen out there. It was just about as much about morale as it was about connection. That day, I got a call. We had a casualty coming in. I'd only just arrived at Camp Leatherneck, still learning the ropes. But I felt ready. Honestly, I was a little eager because I was finally doing something that mattered. I made my way to the field hospital at Camp Bastion, the British base next door. It was a joint field hospital and I was told the casualty was a KIA, killed in action. That meant I had to go to the morgue, verify the casualty, and confirm the cause of death with the staff. I thought I was prepared. I truly did. But when I walked into that morgue, everything changed. casualty, it wasn't a Marine. oh It was a fellow corpsman. A brother. HN Riley Gallinger Long. 19 years old. Just married before deploying. And here's the part that hits me the hardest. We just graduated from Field Medical Training Battalion together. Same class, same dreams, same sense of purpose. The staff told me who it was. And I hesitated for a sec. I couldn't believe it one of us. I walked over to the table. I knew I had pale just from hearing the name. And I was a little shaky. I know that. I tried to keep my voice steady as I asked for the cause of death. They told me he'd been shot in the right hip. Massive internal bleeding. I don't even remember what I said next. I just remember thinking, this can't be real. Not him. Not someone I just trained with. Not someone who was just starting his life. I went back to my office and I called my surgeon to give a report. My HM2 answered. And as he answered, he could tell in my voice something was wrong. They must have already gotten word that Riley had gone in. but he still gave me the time and he didn't rush me. He just listened. I need to get my words together and I'll never forget that support. Just having that little bit of time. But here's the thing. The mission didn't stop. Not for me. Not for anyone. We had to keep going. There was no time to grieve. We continued to sustain more losses after that. We lost nine total, the entire time I was deployed. but I couldn't stop and grieve them. That's the reality for so many of us in healthcare. The world keeps turning. The world keeps moving. and we're expected to keep up. no matter what we're carrying inside. It wasn't until New Year's Eve, still deployed, that it all cut up to me. I had gotten some alcohol from some marine friends. and so I decided to bring in the new gear by myself. And that night... Everything I had been holding just came out. Every stage of grief. All at once. Alone in my room. I remember sitting on my bed drinking. And I remember the extreme depression I was feeling because of everything that had been happening. The ones we had lost. And of course, most definitely the biggest one was Riley because he was the first one I had to see. I remember being so angry with the whole situation. The tears were just coming out. the bargaining? Praying to God. saying why couldn't it have been me instead of him? If only there was a way things could have been different. it. uh It was definitely hard. Once the tears just didn't want to come out anymore. I turned to writing. Grab the notebook. and just wrote everything I was feeling. And. Yeah. So that was New Year's 2012. And I thought I was done after that. But then New Year's 2013 came around. I was home, surrounded by family and loved ones. And just after midnight, again. I broke down. myself in the bathroom and just just hide. was hard. knowing that. He wasn't gonna... It was... It's a pain. And even to this day, it still hurts. we move forward. because life doesn't stop. but we just don't forget. And since then, I don't really drink much on New Years. But every year I do raise a toast to the ones I lost while deployed. It's my way of honoring them. Of remembering the grief. remembering that grief doesn't follow a schedule. It comes when it comes. oh So why does grief hit us so hard in healthcare? Why does it feel like it comes out of nowhere? Even when we know loss was possible. And why? Why does it sometimes feel like we're the only ones struggling? Understanding why grief affects us the way it does can actually help us process it better. So let me break this down. One of the biggest reasons grief hits so hard is the weight of the responsibility we carry. When someone dies under our care, or when we're present for their death. There's often a voice in the back of our minds asking, could I have done more? even when you know logically that you did everything right. even when the outcome was inevitable. and even when the family thanks you for your care. That voice is still there. This is what we call survivor's guilt. And it's incredibly common among healthcare workers. We feel responsible not just for the care we gave, but for the outcome. And when the outcome is death? can feel like failure. even when it wasn't. Here's the truth. You are not responsible for every outcome. You're responsible for showing up. For doing your best. and for providing compassionate care. But you can't control everything. Medicine has limits. The human body has limits. And sometimes, despite our best efforts. People die. That doesn't mean you failed. It means you're human, working within a system that doesn't always have the answers. Here's something that doesn't get talked about enough. Grief in healthcare is cumulative. It builds over time. One loss is hard. Two losses are harder. But when you experience loss after loss... when it becomes part of your routine. It starts to wear on you in ways you might not even realize. Research calls this bereavement overload. It's when you experience so many losses in such a short period of time that you don't have the emotional capacity to process them all. So you just keep going. You keep showing up. and you keep doing your job. I lived this. Like I said earlier, in my 7 months in Afghanistan, our battalion lost 9 service members. and I tracked and verified every single one. Nine names. Nine moments I had to push aside to keep moving. And here's the dangerous part. You might not realize just how much that weight is affecting you until something breaks. until you can't get out of bed. or until you realize you've been running on empty for months. or even years. That's what happened to me. I didn't grieve Riley when he died. I didn't grieve the others who came after. I just kept moving. And I kept telling myself I was fine. And then, months later, it all came crashing out. Every loss, every moment I'd pushed aside. Everything I told myself I didn't have time to feel. And that's when I learned the truth about cumulative grief. It's a debt. You can put off paying it for a while. You can push it down and focus on the mission. the interest accrues. And eventually... The bill comes due. And if you haven't been paying in small installments along the way... You're gonna have to pay it all at once. And that. That's what breaks us. One of the hardest parts of grief in healthcare is how isolating it can feel. you might be surrounded by people. Your team. your patience. but you still feel alone in what you're carrying. Why? Because everyone's processing grief differently. Some people talk openly about it. Mother shut it down. Some people cry, while others get angry. Some throw themselves into work. others can barely function. And when you look around and see colleagues moving on, laughing at lunch, going on about their day. It can make you feel like you're the only one who's struggling. Like maybe you're too sensitive. Or maybe you're just not cut out for this. But honestly, you don't get to see the heavy stuff. You didn't see the coworker who had to sit in their car and cry for 10 minutes just to pull it together before their shift. You don't see the nurse staring at the ceiling at 2 a.m., replaying that code over and over. and you don't see the tech who goes home and hugs their kids a little tighter just because they need to feel something. Good again. Grief is often invisible, and that invisibility makes it even harder to carry. So why does grief hit so hard? Because you care. because you carry responsibility? Because the losses add up. And because this work is so deeply tied to who you are. But here's what I need you to hear. It's okay to grieve. It's okay to feel the weight of what you've experienced. And it's okay to admit that it's hard. You don't have to be strong all the time. You don't have to have it all together. You don't even have to pretend death doesn't affect you. Because the truth is, if it didn't affect you, you wouldn't be the kind of healthcare professional we need in this world. Your grief is proof that you're doing this work for the right reason. And that's something to honor, not to hide. So what do you do with all that grief? How do you keep going without losing yourself? I'm going to walk you through some practical strategies, things that have helped me. things that have helped other healthcare professionals, and approaches backed by research. But remember, there's no one right way to grieve. What worked for one person might not work for another. Your grief is yours and yours alone. Your healing is yours. And you get to choose what that looks like. first and most important step is to acknowledge what you're feeling. Don't bottle it up. Don't push it down. Don't tell yourself, I shouldn't feel this way. Your feelings are valid, period. You might feel sad, angry, numb, guilty. Like you should have done more. or even like you don't have the right to grieve because you weren't family. Let me tell you something. You have every right to grieve. It doesn't matter if you knew the person for years or for five minutes. If their death affected you, Your grief is real. Say it out loud if you need to. I'm grieving. And that's okay. One of the most healing things you can do is talk about what you're feeling. But here's the key. Find a safe place to do so. A space where you won't be judged or told to get over it. Research shows that healthcare workers often find the most comfort talking to peers, people who truly understand the work. That might be a trusted colleague, a mentor who's been through it, or even a peer support program at your facility. If you're not ready for face-to-face conversation, that's okay too. Talk to yourself. Talk to the person you lost, even if they're not there to hear you. The point is, don't keep it all inside. You can even just write it down. This is actually something I did that night I spent New Year's in Afghanistan. And look, I'll be honest, reading it back the next morning, it wasn't pretty. It was dark. But it got those feelings out of my head. And it really forced me to really dig into that loss and feel it. Instead of just bottling it up. And listen, you don't have to show what you wrote to a soul. That's for you. I'm pretty sure I destroyed the page that I wrote the very next morning. It wasn't meant for anyone else. It was just one of the ways I was using to get those feelings out when my tears kept me from speaking anymore. Let's talk about honoring the loss. Rituals are powerful. They give us a way to honor what we've lost while creating a sense of acknowledgement. Even when closure feels impossible. For me, it's that New Year's Eve toast. Every year, I raise a glass to those I lost while deployed. It's a way of saying, you're not forgotten, and you mattered. Your ritual doesn't have to be elaborate. It just has to be meaningful to you. Light a candle, play a song that reminds you of them, visit a place that was significant, say a prayer, donate to a cause they cared about. Write their name somewhere you'll see it. Rituals don't erase the pain, but they give you a way to carry it with intention. And then there's taking care of your body. Grief is exhausting. Physically, mentally, and emotionally. And when you're exhausted? Everything feels harder. So take care of yourself. Sleep when you can. Eat food that nourishes you. Move your body, even if it's just a walk around the block. And breathe. When everything feels overwhelming, take a few deep breaths in through your nose. through your mouth. It sounds simple, but it tells your nervous system you're safe. Taking care of your body isn't selfish. It's necessary. You can patch a wound, but you can't repair the damage while you're still taking fire. And then we have the power of pause. Here's something that hospitals have started doing, and I think it's powerful. After a code or an intense resuscitation effort, instead of immediately moving to the next task, the team takes a brief moment of silence. No prayer, no hand holding required, just 30 to 60 seconds to acknowledge what just happened. To recognize that this was someone's mother, someone's child, or someone's spouse. to honor the effort everyone gave. Then they move forward. It's called the pause. And it's a small thing that makes a big difference. If your facility doesn't do this, maybe you can start it on your own. Even if it's just a quiet moment in your head before you walk into your next room. And lastly, know when you need more help. Seriously. Sometimes, grief is more than we can handle alone. And that's okay. That's not a failure. That's being human. Watch for these signs. Feeling stuck. The sadness just won't lift no matter what you do. Trouble functioning. Having trouble getting out of bed, going to work, and basic self-care. Feeling completely numb or disconnected. Intrusive thoughts. Like replaying the moment over and over. Turning to unhealthy coping. Drinking too much. or completely isolating yourself from others. Physical symptoms that won't go away. Chest pain, headaches, exhaustion. If any of these sound familiar, please reach out. Talk to a counselor. Call your employee assistance program. Use the crisis line if you have to. There's no shame in asking for help. In fact, it's one of the bravest things you can do. I've provided a list of resources in the show notes if you need any further assistance and don't know where to go. But there's one big thing you really need to realize. And here's something I'd wished I'd known back in 2011. Healing takes time. And it doesn't happen in a straight line. Some days you feel okay, and others you feel like you're right back where you were. And that's normal. That's part of the process. Grief doesn't follow a schedule. It doesn't care if you think you should be over it by now. So give yourself grace. Give yourself permission to have a bad day. and give yourself permission to still be healing even a year later or even 15. And remember, healing doesn't mean forgetting. It doesn't mean the pain disappears completely. It just means you learn how to carry it in a way that doesn't break you. Now I want to talk about something just as important as taking care of yourself. And that's how we take care of each other. Grief isn't just an individual experience. It's a collective one. And the way we support each other can make all the difference. If you're working with someone who's grieving, the best thing you can do is just to be there. You don't need the perfect words. You don't need to fix anything. You don't even need to make the pain go away. You just need to be present. Sometimes the most powerful thing you can say is, I'm here if you need me. Not, let me know if you need anything. That puts the burden on them. just a solid. I'm here. And I'm not going anywhere. Presence doesn't have to be loud or dramatic. Sometimes it's sitting next to someone in silence. A hand on their shoulder. text that says, Thinking of you today. Those small moments of connection mean more than you'll ever know. If someone opens up to you, listen. I mean, really listen. Don't interrupt. Don't rush to relate it to your own experience. And don't offer advice unless they ask. Let them talk about the person they lost. Let them share memories. Let them cry. Let them be angry. Let them say the things that don't make sense. and let them repeat themselves. m And whatever you do, don't judge how they're Grief is not a competition. There's no right way to do it. Another way to be present is to offer practical help. Grief is exhausting. Even small tasks can feel overwhelming. So instead of vague offers, be specific. Be forward and say things like, I'm covering your shift tomorrow. No arguments. I'm dropping off dinner tonight. I'm checking on you next week and the week after. And if you say you're going to do something, follow through on what you offer. Don't make empty promises. And if you're a leader, or in any kind of leadership role, even informal, you have the power to set the tone. Acknowledge losses when they happen. Don't pretend they didn't occur. Give people time when they need it. Create a space for conversation. And if you can, model vulnerability yourself. Let your team see that you're human too. When grief is normalized, people don't have to hide it. And that makes all the difference. Now let's take a breath, because it's time for your map moment. you It's time for your little push to keep you going stay focused keep strong your pathway to success is on it's time for your map moment. A moment to pause, reflect, and take a real step toward healing. This week's challenge is about honoring someone you've lost. Whether it's a patient who had a profound impact on you, a colleague, a mentor, or a loved one. Here are your four steps. Step one, write their name down. On a sticky note, in your journal, On your phone, say their name out loud. Let yourself remember them. Not just how they died, but how they lived. What did they teach you? What do you miss about them? Step two, share memory. If you feel comfortable, tell someone a story about them, a friend, a coworker, or send it to me at madpodcastsatoutlook.com. Stories keep people alive in our hearts, and sometimes sharing helps you process what you're carrying. Step three, create a ritual. Light a candle, play a song, Take a walk somewhere meaningful. Raise a toast. Just do something that feels right to you. Something that says you mattered and you're not forgotten. Step four, reach out. If you're struggling, don't do it alone. Text a friend, call a counselor, and if you're in a good place right now, look around. Is there someone on your team who might need support? Sometimes just knowing someone cares makes all the difference. By doing this, you're not just honoring the person you lost, You're honoring yourself. You're giving yourself permission to grieve. You're acknowledging that what you experienced was real and that it mattered. and you're taking a tangible step forward, towards healing. Grief is not a weakness. It's a sign of love. And love is what makes us healers. You know, as I sit here thinking about everything we've talked about today, the losses, the weight we carry, the moments that shape us, I'm reminded of something important. This work that we do, it's not easy. It never has been, and it never will be. but it is also some of the most meaningful work in the world. We get to be there for people during the most vulnerable moments of their lives. We get to hold their hands when they're scared. get to fight for them when they can't fight for themselves. And yes, sometimes we're there when they take their last breath. That's a privilege. A heavy one. But a privilege. If you're carrying grief right now, whether it's from yesterday, last year, or a decade ago, I want you to know. Your grief is not a burden. It's not a weakness. It's proof that you cared. That you showed up. And that you gave a damn about the people you were caring for. And in a world that can sometimes feel cold and disconnected, that matters more than you know. Every healthcare worker who's ever cared deeply about their work has experienced loss. Every single one of us has had moments where we questioned whether we could keep going. But we do. We keep going. Not because we're superhuman, but because we are human. Because we care. Because we know that the work we do matters. Even when it's hard. So if you're struggling, reach out, talk to someone. You don't have to carry this alone. And you don't have to have it all figured out. Just take the next step and then the next one. That's how healing happens. Take care of yourself. Take care of each other. And remember, you are not alone. Keep learning, keep growing, and keep following your map, your medical pathway for success.