Several years ago, on a beautiful and sunny day in Mammoth, I was skiing with a friend.  Gone were our days racing down the black diamonds; we now cruised the blue, intermediate runs.  Wistfully, we acknowledged that we had changed.  We had lost something through the years.  Our joints were less forgiving and our bones more fragile; the risks of falling had become greater.  The thrill of speeding down the mountain had been replaced by caution and we felt sad about our loss.

In a recent medical school class, we discussed our experiences of grief and loss.  We each experience many losses, and so do our patients.  In fact, sometimes it feels as if much of medical care involves dealing with loss of one sort or another.  Until we are comfortable with our own grief, it’s difficult to witness and be present for our patients when they feel this deep emotion.  So in this class, we share our stories in order to learn from and come to terms with our feelings.  I was struck by one very insightful student who shared her own perspective of loss. As her grandmother developed increasingly severe dementia, the student focused only on what was no longer there. Early on, while grandma remembered who she was, the student was frustrated by the repeated questions and inability to remember her answers. Later, although they could still carry on a meaningful conversation, she felt hurt that grandma could no longer remember who she was. In the latter stages, she was saddened that grandma was no longer able to converse, although they could still sit and hold hands. In each stage, she focused only on what was gone – and not on what was present. How different could the experience have felt, she wondered, if she were able to accept that something had been lost, but still appreciate what remained?

Losses are usually painful because of the joy we once felt.  If the ability, freedom or relationship weren’t satisfying or important to us, it wouldn’t feel so painful to lose it.  And yet, there are times when we feel an even greater loss because we didn’t allow ourselves to feel the joy.  Those are the most difficult losses of all, because we are left with unresolvable remorse and without the warm memories that might sustain us through our grief.

After my mother died, I could not recall what she was like before she became ill.  The sadness and anxiety of her last months eclipsed any happy memories.  So as my father was dying, I took note of several happy times with him.  Brief, loving interactions, moments of closeness – I engraved them in my memory.  When I miss my father, I can instantly transport myself back to those wonderful memories and it’s as if he is here again.  As a physician coach, I frequently stop my clients as they want to rush through those precious moments of their lives – stay for a a minute more, I ask.  What’s here to appreciate or learn about you, your work, your life?

With the holidays approaching and the blizzards in the east, ski season is upon us again.  While black diamonds belong to the past and my days on the mountain have shortened to a few hours each, I intend to marvel at the exquisite vistas from the top of the mountain,  enjoy the crisp air rushing by my cheeks as I cruise down those blue runs, and laugh with friends over a glass of wine at the end of each day.  There’s always something here to appreciate.

So I wonder, what is here that you want to appreciate today?