By Andrew Durham

Most people on my course lamented over our cancelled graduation ceremony in 2020. After the six-year slog that we’d all been through, they felt like COVID had robbed us of a crowning moment. I was secretly relieved however; I didn’t have to go through another important day without my dad.

Medical school had taught us a lot about pathology and anatomy, but we certainly weren’t prepared for grief on such a large scale. Death is a subject that makes people feel uncomfortable, particularly if you’ve never experienced it. Unfortunately, I’m well accustomed with loss.

A little bit about me. I studied medicine at Leeds and was graduated early with all the other final year medical students across the country, so we could help with the pandemic. Graduating as a doctor is daunting in of itself because suddenly you go from being “just a medical student” to the first person nurses call when a patient deteriorates. And when that’s you at three in the morning and you’re on your own, it’s bloody scary. Now we were being asked to step up to help fight a disease that (at the time) we didn’t know much about and which would be the biggest challenge that we and our senior colleagues would ever face. Medical school had taught us a lot about pathology and anatomy, but we certainly weren’t prepared for grief on such a large scale. Death is a subject that makes people feel uncomfortable, particularly if you’ve never experienced it. Unfortunately, I’m well accustomed with loss.

8 years before, while the country was celebrating Team GB’s success at the London Olympics, I was sat in intensive care hoping that my dad would wake up. On the day that we won our first gold medal, he had a brain haemorrhage while cycling to work. Someone found him collapsed in a bush and he was air-lifted for emergency surgery. My mother and I sat with him for a week, holding his hand and hoping that every twitch and jerk was a sign that he was coming around, but he was too badly brain damaged. This generous man, who had loved his family unconditionally, who had supported us in all of our endeavours and my best friend was pronounced brain-dead on 7th August 2012. He became an organ donor just after midnight.

I am well versed in grief and have a lot to say on the subject, which was a problem when I began writing this article because I wasn’t entirely sure what to focus on. My initial drafts were an uncoordinated effort of literacy mania, jumping from one topic to the next without any cohesion. So I’ve split this essay it into sections. Readers may find certain bits more helpful than others because grief after all is a journey, and depending how far along the timeline you are, you may find some bits relatable, and others will hopefully interest you as an insight into where loss can take you. This is my account of the rollercoaster that is grief.

The immediate aftermath, back to school and the first year

Dad’s death wasn’t a long drawn out process where we had some forewarning, it was shocking and sudden; in the space of a week our world was shattered. The initial feeling was disbelief that something like this could happen to us. Two weeks beforehand we were living a very normal and steady family life. That had been turned on its head. I wasn’t in denial about it, but it didn’t feel real, like a bad dream. Something like this could never have happened to us.

With it came a sense of numbness. I was upset but nothing could touch me, make me laugh, cry; I didn’t feel anything initially. With this however came a clarity of thought as I wasn’t making decisions based on my emotions and one of the most important things that I had to choose was whether to go back to school or not. Dad’s passing came in the summer before my final year, which was particularly inconvenient being right before my A-Levels and I still wanted to apply to medical school; or did I? I didn’t know how I was going to react once the numbness had disseminated and rushing off to uni was probably not the best idea after only a year of grieving. Did I still want to be a doctor after such a traumatic week in hospital?

I decided that the most important thing for me was to return to some sort of normality but remove any unnecessary pressure. I’d go back to school to do my exams and play rugby, but I wouldn’t put myself through the stress of UCAS (which is particularly strenuous when applying to medical school because of all the extra exams and the earlier application deadline.) I’d ride out the emotional roller-coaster and once over the worst of it then I’d see if I still wanted to apply.

That’s the thing that people on the outside looking in don’t seem to understand; just because the funeral is out the way doesn’t mean that the grief stops. We still had to get used to an empty place at dinner and not having dad come home from work every night

The numbness wore off after about a month. In the days before the funeral everyone had offered their condolences in a large outpouring but after they had rescinded back to their normal lives, mum, my brother and I were left alone to pick up the pieces and get on with it. That’s the thing that people on the outside looking in don’t seem to understand; just because the funeral is out the way doesn’t mean that the grief stops. We still had to get used to an empty place at dinner and not having dad come home from work every night. The only evidence of dad having ever lived in the house was his clothes, occupying space awkwardly in the drawers.

Then came anger. I was angry about this “new normal” without dad that we had to get acquainted with, that it was he that had died and not another arsehole, perhaps someone who wouldn’t be missed as much. This then extended to other areas. I was pissed off when people complained about the most insignificant of things like a reality TV show or a schoolfriend being bitchy. I was disproportionately infuriated when a bus made me late getting home once and absolutely raging when the younger kids at school tried to wind me up. I was fucked off with the everyone and everything and all the time.

I also felt incredibly isolated. One thing that I noticed when I went back to school was that people seemed to be avoiding me. In hindsight I recognise that it was probably because they didn’t know what to say. What do you say to someone who has suddenly lost a parent when you’ve never been through it yourself? It was awkward for them. Part of this may have been self-inflicted though; like I said I was pissed off all the time and it certainly showed in my behaviour – I’m not known for my poker face. Who would want to talk to someone who’s always grumpy, no matter how justifiable? Once or twice I tried to bring it up with a couple of people, but they would either change the subject or say “we don’t have to talk about it if you don’t want to.” (but maybe I do, that’s why I’m bringing it up), or simply walk away. And this wasn’t just my classmates, but teachers as well. It was like I’d done something awful and people wanted to disassociate themselves from me. I found this odd because in the immediate aftermath of my father’s death I had had a flood of messages from people offering condolences and saying that if I ever needed to talk to someone they’d be around.

t felt like I had been abandoned on an island of sadness and distress, and everybody else could see the beacon but kept sailing by.

But when I actually needed this nobody stepped up. It felt like I had been abandoned on an island of sadness and distress, and everybody else could see the beacon but kept sailing by. This was upsetting, but what really hurt was that in the leavers book I was voted the person most likely to make a situation awkward. I was furious about that! A very close friend of mine who lost her husband had a similar experience when a neighbour saw her on the street, and actually crossed the road to avoid talking to her. Losing someone you love turns you into the elephant in the room and it really compounds the sense of isolation. It’s also quite hurtful. It’s been nearly a decade and I still feel uneasy when I see my old classmates at reunions. I find that I’m less trusting of people these days, which is probably a defence mechanism.

My attitude to my peers changed because of this. People who I had previously considered friends, who I thought that I could talk to, I began to distance myself from. The qualities that I sought after were authenticity and genuineness, and my circle grew a lot smaller as a result. It took a few years to realise that this wasn’t necessarily a bad thing though and this lack of insight was detrimental when I started university. You see for a long time I felt like the problem at school had been with me, that I was an arsehole who nobody liked. I’d had one of the worst experiences a person can go through and nobody was there for me. In freshers, I didn’t tell anyone about my dad. I had a fresh start and didn’t want people avoid me as they had at school. I suppose I felt almost ashamed that my father had died (which was wrong). I also tried to compensate for the insecurity of being perceived as an arsehole as I didn’t want to feel that loneliness again, and that’s the worst thing I could have possibly done because it’s off-putting; it’s needy.

Realising that grief makes people feel uncomfortable took a while to understand. When I started looking for people with the qualities that I value in friends, everything fell into place. It didn’t matter if they’d been through grief or not, they could sympathise, and they made the effort to do this. Grief can feel like you are trying to survive day to day. It’s a lot easier when you surround yourself with the right people.

The lifeboat of a goal and the role of stoicism

I was in a pretty dark place in that last year of school, but I knew deep down that I still wanted to study medicine. It had been an all-consuming goal for several years and I wasn’t willing to give up on it. My father had supported me right up until he’d died, and he and mum had both made a big financial sacrifice in sending my brother and I to a private school. If I had stopped studying, it would have been a waste of their money, my time and effort, and to be honest I don’t know what else I would have done.

Up until this point I’d done very well academically, but I hadn’t been ready for the step up to A-Levels. They’re a completely different ball game. I left revision too late and the last month leading up to the penultimate AS exams was awful for my mental health. I was so stressed that I wasn’t sleeping properly, and I would wake up panicking about how much revision I hadn’t done the night before and how much I had to get done that day. Dad had brought everything into perspective; my grades came back the day after his funeral so in the grand scheme of things they didn’t really matter that much. AABB; not a total disaster but I needed straight As.

It was going to take time, effort and focused concentration and as such it pulled my attention away from the grief. This may sound unhealthy, but you have to remember that I had decided that I was still determined to go to medical school, and the effort needed to get the grades was something constructive that I could do, rather than picking fights or getting drunk.

As I mentioned earlier, I was emotionally numb and this came with a clarity of thought. I realised that I hadn’t approached the exams in the right way, It was going to take time, effort and focused concentration and as such it pulled my attention away from the grief. This may sound unhealthy, but you have to remember that I had decided that I was still determined to go to medical school, and the effort needed to get the grades was something constructive that I could do, rather than picking fights or getting drunk. It was particularly important when I broke my thumb and couldn’t play rugby, the only real physical outlet that I had. Becoming a doctor was a goal I could work towards that was the only positive aspect in my life at the time.

Grief made me angry, and anger is a fantastic motivating tool. I felt energised by it. I couldn’t do anything about my Dad, but I could about my grades and I committed to worked my damned hardest. The sadness was always there but it was in the background. If I became too upset or allowed myself to fall into depression, then I wouldn’t get the As.

Results day came with on the anniversary of dad’s funeral. I was successful at getting into medical school. It was a mix of deep sadness with serene relief.

For me, having a goal was like a lifeboat; it gave me a productive focus away from the grief. Some may read this and consider it unhealthy or that I was trying to ignore how I felt, but I was worried that if I decided that I wasn’t bothered, then I’d slip into a deep depression and throw away the wonderful opportunity that I had at that school. In the long run that option would not have benefitted me. It would have made my life financially harder and I would have certainly regretted not striving for my potential. The horrible question of “what if?” would have hung over me. The world didn’t give a fuck about how I felt and in spite of what had happened, the world didn’t owe me anything either. If you want something you have to go and get it. I made a choice to continue to chase a goal and there is a power in choosing to go on. Others do the same but not necessarily academically. People may want to raise money for charity (which is common following a loss) or become an entrepreneur. Getting fitter is another good use of your time, and I know a lot of people who turned into gym monkeys when they lost a parent. If you can harness the anger that comes with grief and direct it appropriately you can do something very positive.

This is where I should probably talk a little about stoicism, which I feel is unfairly labelled as toxic and a major cause of mental health issues among young men – I don’t think it is. Stoicism is defined by the oxford dictionary as the ability to experience pain or trouble without the display of feelings or complaint, and the American Psychological Association labelled this in their clinical guidelines as one of the “many toxic traits” that make masculinity apparently bad. I will phrase this delicately and in the most PC way I can – I disagree. Stoicism, while not always appropriate, is sometimes very necessary.

Stoicism, in the right circumstances, can help people keep their emotions under control and help them to move forward in the world productively. This is frankly something that everyone should be looking to develop. I’m sure we all have someone at work who we don’t like, but it may be a case that we have to work with them on a project. Every doctor or nurse will at some point have to work with other clinicians who they don’t like but are obliged to put that to one side because ultimately, they’re all there for the patients’ benefit.

Having the emotional intelligence to recognise when I needed space and to take a step back, combined with stoicism was an incredibly important factor to my exam success, and to maintaining good mental health. It was just a case of getting the balance right

Under the circumstances that I was in, stoicism was appropriate in helping me go back to school and continue chasing a dream. I was able to control my emotions when I needed to and to carry the heavy weight of my loss while still doing the bare minimum to make the grade. Of course, there were times when I had to allow myself space to be upset and to feel that horrible pain. I remember having an invitation to an 18th but recognising that I’d had an emotionally difficult week and so didn’t go. I even ruled myself out of selection for a rugby tournament, which for me was unheard of. The coaches were surprised when I told them that I didn’t want to go, and although they pressed the issue, I was blunt. “No sir, I’m not in the right headspace and I wouldn’t be much use to you.” I saved what little fuel in the tank I had for the important stuff. It would have been a disaster if I’d had a breakdown in an exam or during an interview, so I saved my reserves for these. Having the emotional intelligence to recognise when I needed space and to take a step back, combined with stoicism was an incredibly important factor to my exam success, and to maintaining good mental health. It was just a case of getting the balance right, and sometimes you need to be selfish.

University

A year had passed since dad had died. I finished school on what felt like a triumph with my A-Levels and then came a gap year, which I spent mostly doing odd jobs in the local care home. I’d made the smart choice in taking the pressure off myself but in spite of my results, I felt a bit like a failure. You see all of my peers had gone off to university and photos of them having the time of their lives kept appearing on my Facebook feed. In comparison, I felt I wasn’t really making a dent in the universe and I didn’t have a definite plan going forward. It was a frustrating time, but looking back, I can appreciate that this was actually when the dust of the previous year settled. I had dealt with the major stress of exams on top of my grief and now I could relax, process my emotions and recover from that year. It was bliss not having to worry about any sort of academic pressure. I wasn’t completely idle though and put an application together, which thankfully was well received by Leeds who offered me a place.

Studying medicine is not like a normal degree and I’m not saying that because of a superiority complex, it’s the truth. The standard of behaviour expected of us is high because we are considered professionals from our first day. We are there for at least 5 years, the placement hours we have to put in are long and we see and do things other students may never experience, like working with cadavers.

Studying anatomy is best done with a body, and for two years, Tuesday afternoons were spent in the dissection room. Our first time in there was just to get used to being in the presence of a corpse and I couldn’t help thinking, “Is this what my dad looks like now?” Is his skin all yellow, are his muscles all stiff, or has he decomposed in the coffin? Is he rotting?” It was a horrible thought and my distress obviously showed because several people kept asking me “Are you okay?” in that first lesson. I must have looked like a ghost.

As time went on, I was able to put this to the back of my mind and I became more comfortable working with the donors, which was lucky because one day we were presented with half a head on the dissection table. It had been removed from its body, and then cut down the middle to split the nose into two (the sagittal plane). A few people fainted in this session.

I would also think about the donor’s families and how they must be feeling. As I mentioned earlier, dad became an organ donor and had been a perfect candidate. At 49 he was relatively young, he was healthy, he was fit and the circumstances around his death meant his organs could be retrieved while they were still functioning. (He was considered braindead; his heart was still beating, meaning his organs were still perfused and therefore in excellent condition for transplantation). While several people benefited it felt like we had abandoned him to the mercy of the surgeons, and it didn’t feel right; leaving him with strangers to be harvested like an animal. The last time I saw my father was at the theatre doors when he went for the retrieval op. I held his hand, gave him a kiss and then they took him away. I stood there after the doors had closed stuck where I stood; I just wanted to take him home.

I saw first-hand how donation can change a patient’s life when I sat in on a transplant clinic, an unhappy accident that the staff organising placements were oblivious to. Every patient who came in was so joyful at being given a second chance and we got some lovely letters from the recipients of dad’s organs saying how grateful they were, but it didn’t change the fact that my dad was dead.

I saw first-hand how donation can change a patient’s life when I sat in on a transplant clinic, an unhappy accident that the staff organising placements were oblivious to. Every patient who came in was so joyful at being given a second chance and we got some lovely letters from the recipients of dad’s organs saying how grateful they were, but it didn’t change the fact that my dad was dead. He wasn’t at my 18th, he wasn’t there when I got into medical school and he didn’t see me qualify as a doctor. He didn’t meet my first girlfriend, he won’t be at my wedding and he will never know his grandchildren. Someone else’s health and happiness does not provide any comfort or sense of justice for the distraught anguish that I endured, the suffering that my father went through or the unfairness of the situation.

During that placement, I wondered if the donor’s families felt the same, as if their loved ones had been taken away from them to be butchered. If they felt anything like I had then it would have been awful for them.

After we had completed our dissections, the donors were then cremated and returned to their families. Accompanying this was a “Ceremony of Thanks” that we had to facilitate, which was an opportunity for us to show our gratitude and that the donors had been treated with respect. Hopefully it helped the families but for me, a few strangers giving a speech and a live music performance would have meant very little. It wouldn’t have changed the fact that I was never going to see my father again.

We started going into hospital in our third year. All of the time we had spent in the library doing the theory was finally being put to practical use by seeing patients and making diagnoses. This was the fun part of studying medicine; there’s a real beauty to it. When you ask the right questions and work out what’s going on it’s like everything flows. Of course, there were a few obstacles to overcome, one of them being a weeks placement in intensive care. After my own experiences I was naturally very apprehensive about this.

Before going to medical school, I’d done some work experience in the same hospital where dad had died. At one point the doctor who I was shadowing had to go back to THAT intensive care department to see the same consultant that had looked after him, and unfortunately we had to go and discuss a patient in the very room where dad had been.

That was very unnerving. On the walk up there, I could feel my heartrate go up, my palms start to sweat, and I felt sick seeing that same room after only 8 months. This memory came back vividly during the induction talk we had as students. I felt the same reaction I’d had on work experience brewing inside me and when she went on to talk about organ donation, I had to turn my head away. I knew I would have to tell them that I wasn’t feeling comfortable about going.

The consultant was lovely and very understanding, and actually agreed to come with me on the ward rounds in case it became too much, but strangely I didn’t feel like I needed any pastoral support when the time came. None of those old emotions surfaced and I had a really good time during that week, so much so that it made me think about whether this was the speciality for me.

Why did I not have such a strong response to being back in intensive care this time?

Probably because I talked about it. This may seem like an oxymoron after what I’ve said about stoicism, but stoicism does not advocate bottling up your emotions. Sometimes talking is very important.

by having to verbally articulate how I was feeling, it helped me to comprehend better not only my emotions, but also why I was feeling the way I was and how I could move forward with them.

4 months into grieving things became very difficult emotionally. All three of us struggled, but none more so than my brother who would not go to school or engage in any of his hobbies. We both needed help. One of the best things my mother did was get us all counselling. Initially I was sceptical about whether this would be helpful, but it was actually quite cathartic. You see for an hour a week I could go and talk to someone who I’d built a relationship with over several weeks about anything that had been on my mind. We could offload to them about a shit week, the stress of exams and our anger as well. All I really did was complain to someone in a non-judgemental environment and get it out of my system. Every time I left, I felt better because I’d offloaded something. Obviously the comment about “just complaining” is me being facetious, but by talking it got my thoughts out of my head and into the open air, and by having to verbally articulate how I was feeling, it helped me to comprehend better not only my emotions, but also why I was feeling the way I was and how I could move forward with them. It was an important development for my emotional intelligence and helped me to get through the worst of the grief.

Counselling isn’t easy though. It took a couple of sessions before I really started to feel comfortable and see the benefits. I told mum I didn’t see the point initially but she encouraged me to stick with it and by week 4 I actually started looking forward to the sessions, because I knew that by going I could get more understanding as to how I was feeling. Grief can make people very volatile. In a day I could go through all 5 of the stages Kubler Ross speaks of, and not in any particular order. Being depressed in the morning and then going through anger, bargaining, denial and then feeling happy in the evening, I suppose this is what it feels like to suffer from mania. The counselling helped me to find some clarity and grounding in this emotional storm and it has been very beneficial for me years down the line.

Fast forward to third year at medical school, when Grandma, the matriarch of our family was diagnosed with cancer, I was able to better process the emotions that arose with this.

They didn’t come on as strongly as they had done with dad, but rather than let them affect me I could just acknowledge that they were there. Loosing Grandma wasn’t nice and of course I was upset about it, but at her funeral I was fine. The rest of my cousins were very tearful and needed consoling, but my brother and I just looked at each other, shrugged and said “Yeah, this again.” “Shit isn’t it.”

In fact, when mum called me to say that grandma had died, I was walking to a seminar. When I saw the caller ID, I knew what was coming. My body’s physical response was nowhere near as strong as it had been with dad and although I was slightly mentally detached, I was able to go to the seminar and participate in the roleplay, without crying or displaying any obvious signs that I’d just received some bad news. I told my close friends who knew that grandma had been unwell and they seemed surprised that I wasn’t breaking down and stayed for the day. My attitude was one of “Ah well, here we go again.”

I’d experienced grief on such an intense level previously and had processed the loss quite well in hindsight, that when bereavement turned its ugly head again I was able to better recognise the emotions and acknowledge them but not be overwhelmed by them.

While upsetting, losing grandma wasn’t a tragedy. She was 83, had lived a good life and her death seemed part of the natural cycle. When I spoke to my mum about this she agreed, but she also made the point that she didn’t have the energy to grieve for grandma. It had been 4 years after dad and we were still recovering from the aftermath of him, but I also think when you go through a major loss like that, it increases the threshold of what you can tolerate and completely changes your perspective on death and so many aspects of life. As I’ve mentioned previously, the qualities that I looked for in friends completely changed and now with grandma’s death, while upsetting my reaction wasn’t as strong as that of my cousins’. I’d experienced grief on such an intense level previously and had processed the loss quite well in hindsight, that when bereavement turned its ugly head again I was able to better recognise the emotions and acknowledge them but not be overwhelmed by them.

Grief changes you, there’s no real way of getting away from it. It can be for better in some ways and for worse in others and looking back I can see how the experience of losing dad has moulded me into the person I am today.