How to heal trauma with meaning: A case study in emotional evolution | BJ Miller | Big Think

Steve Shire, whom I've come to know very well over the years. And technically, it was his wife who was my patient. This was when I was doing hospital-based work, acute care hospital work. This was years ago.

And Steve's wife, Amy, was dying of biliary tree cancer and was in the hospital, in our hospital, and died in the hospital. I, as part of the palliative care team, was called in to help tend to her comfort in the final days. I actually never met Amy in a conscious state. When I got to the bedside, she was alive, but unaware, as far as we could tell.

But I, at the same time, met Steve, her doting husband. And as often happens in this work, your work—the patient can often end up being the family member. And that's what happened here. So Steve was deep, deep in grief. I mean, he loved Amy to the moon and back. And it showed. You can feel this man's pain down the hall.

And as happens, in this acute care setting, especially—it's a heck of a foil. There's so much that's possible in a hospital. The impossible often is possible in a hospital. The tag line where I did my internship at the Medical College of Wisconsin was, “where miracles happen every day.” I hated that tag line. It felt like way too much pressure.

But the point is crazy things—I shouldn't say that—impossible sounding things, in the hospital, are possible. And so it's extra charged. I was watching Steve say, “Well, what about this? Why can't we do—” almost like an engineer's mind. “Like if we just get the math right, we'll have a different outcome, right?” That had always been the case with her illness to this moment.

But this moment was different. There was nothing more we could do to save her life. And so I was working with Steve coming to terms with all this, and watching him try to do this very quickly, because she was in the matter of hours to live. And he was really trying hard.

And he wanted to find a world view where he felt OK. But that world view wasn't accessible yet. He felt just horrible. And there was no way through it. There was no explaining it away. So we just sat together. We just had to be together, and just had to kind of wade through the emotions.

And sometimes, the trick for us in this world is to just not run away. There's so much we're not going to fix. But abandoning someone in those moments, that starts feeling almost like a sin. So as it goes, Steve and I stayed in touch through his grief.

And what ended up happening with Steve—he did this very beautiful thing. I think, for a lot of us, even the most horrible experiences in our lives, some of the most difficult, say, one of the ways to make meaning from them is to learn something from those experiences, to take something away, to be changed by the experience, and to affect the future.

In a way, that's like the legacy of the thing you lost. So for Steve, he came up with what they call prognostic, prognostication tool. And it's in our book. And we actually wrote an article recently about it, because when he was reflecting on how beautifully his wife Amy had handled the medical maze and her own death and preparing Steve for it, he hit on this idea that Amy had wished to have a hand on the spigot of information.

She was interested to know her prognosis. She was interested to know all sorts of details. She was a very analytical person. But she was smart enough to know that some information was just going to bury her. It wasn't going to help her. It was just going to—it would flood her in a way that wasn't helpful.

And so she and Steve talked this out. And then Steve came up with this tool as a way to sort of declare how you want to receive information. It was a beautiful notion. So Steve came up with this tool. And now, we're trying to get it around the world, where, as a patient, you can say to your doctor, “Hey, tell me everything there is to know. I want to know it all. Don't spare me any detail.”

Or you can say, “Hey, don't tell me anything. Tell my husband or tell someone else.” Or you can say, “Let's play it in the middle.” And over time, tell me what I need to know now, and answer my questions as we go kind of thing.

And that tool has already helped a gazillion people. And that's part of what Steve has honored in Amy's memory. And it's a way he's made meaning from her death. And I look at him smile every time he talks about this thing. And what a beautiful sort of alchemy he's done with his grief.

And he's now helping a gazillion people with this thing.