Grief waits in silence. Grief waits in silence.
I have written those seven words twice because they appear twice in the source text, and when I noticed that repetition, I understood it was not an error. It is the description of grief’s nature. Grief waits, and then it waits again.
My mother passed when I was still becoming who I am. Not at the beginning and not at the end, but in a middle that I was not ready to have marked. I was practicing medicine in Kenya when I received the call, and I was, in the way of physicians, in the middle of something clinical, and I completed the clinical task before I sat down. This is what training does. It does not eliminate the grief. It inserts a delay. A professional interval between the event and the feeling.
The feeling waited.
It waited through the administration of that loss, the paperwork and the planning and the ritual sequence that bereavement in a Kenyan family requires, which is complex and communal and, in its communal complexity, can be simultaneously deeply supportive and an effective mechanism for not sitting alone with what you are carrying. It waited through the resumption of clinical practice, which required my full attention because patients did not pause their illness for my grief. It waited through the years that followed, years of movement and accumulation and building, the residency in Kansas, the fellowship in Oklahoma, the arrival in Illinois, the building of a practice and a public voice and an institution.
The grief did not knock. It did not send a calendar invite. It waited in the room I walked past every morning, and I walked past it, and eventually I stopped noticing the door.
Katherine Shear and her colleagues at Columbia published important work in 2005 in JAMA on what was then called complicated grief: grief that does not resolve in the expected trajectory, that instead persists beyond the normative bereavement period with a particular set of features including yearning, intrusive thoughts, avoidance of grief-related material, and difficulty accepting the loss (Shear et al. 2005, JAMA, DOI: 10.1001/jama.293.21.2601). This construct has since been further refined and is now recognized in DSM-5-TR as Prolonged Grief Disorder, with specific diagnostic criteria and validated treatments. Solid rating on the foundational research.
What the research documents is something that many people who have experienced significant loss already know from the inside: grief does not follow a schedule. The Kübler-Ross stage model, which has been enormously useful as a cultural shorthand for the phases of bereavement, is rated Early on the Honesty Scale as a prescriptive description of actual grief trajectories: the empirical support for fixed ordered stages is not strong, and real grief is more idiosyncratic, less linear, and frequently more delayed than the model implies. What is supported, more robustly, is the observation that unprocessed grief does not resolve on its own. It settles into the body and the behavior. It emerges in unexpected places. It attaches to apparently unrelated situations and gives them a weight that the situation itself does not account for.
I have seen this in clinic in a form that is easy to miss if you are not looking for it. The patient who presents with insomnia and fatigue and general malaise, whose physical workup is unremarkable, who, when you take the time to ask about what else has been happening, mentions a loss that occurred eighteen months ago and that they thought they had “gotten past.” The getting-past is often not the getting-through. The person has resumed function. They have returned to work, to routine, to the surface-level performances of a life continuing forward. The grief has not followed them into the resumption. It is still in the house they left.
My son Jeremiah was born during one of the hardest years of my personal and professional life. His arrival was the arrival of something that required me to be present in a way that a grieving person who is also a high-achieving cardiologist does not naturally default to. You cannot half-attend a newborn. The newborn requires your whole face. And in being required to offer my whole face, regularly, in the undeniable presence of a new life, I found that some of the postponed grief was given its first real space.
I am not saying parenthood cures grief. I am saying that the state of full presence, any genuine encounter with a reality that demands you as you actually are rather than as you professionally appear, can open a door that has been closed for a long time. Jeremiah did not heal my grief. He sat beside me in the room where I finally walked in.
Grief does not knock. It sits down quietly in a room you walk past. The healing begins the day you walk in.
I want to say something about ambiguous grief, because it is underrepresented in the popular conversation about loss, which tends to focus on death. Ambiguous grief is the grief of the thing that was never quite there: the parent who was physically present and emotionally absent, the relationship that was technically intact but spiritually evacuated, the career that looked like arrival and felt like nothing. The community that diminished quietly and left you unsure whether you lost something real. These losses are more difficult to mourn in some ways, because they lack the formal occasion of death. There is no funeral for a father who was present but unreachable. There is no ceremony for the version of yourself you put down at thirty-two to sustain a career that required it. And yet the absence of ceremony does not mean the absence of loss. These things happened. They cost something. They are sitting in the room.
The difficulty with ambiguous grief is that the mourner often does not feel entitled to it. You cannot be sure the loss was real. The person is still alive. The relationship technically continues. The career is still proceeding. And so you carry a grief you cannot fully name, which is the heaviest kind, because grief that cannot be named cannot be moved through.
If this chapter has found you there, I want to say plainly: the loss was real enough to grieve. The grief is entitled. You do not need the loss to be certified by a death certificate or a formal ending to claim the right to mourn it. Walk into the room.
The clinical treatment for prolonged grief is not the instruction to feel more. It is a structured engagement with the grief that the avoidance has postponed: specific techniques for confronting avoided situations and memories, narrative work on the meaning of the loss, attention to the relationship with the person lost that is ongoing even in their absence. The therapeutic approach that has the strongest evidence base for prolonged grief disorder at this writing involves exposure-based elements combined with what is called restorative work: gently attending both to the loss and to the future the survivor is trying to build (Shear 2015, Current Psychiatry Reports, DOI: 10.1007/s11920-015-0554-4). Solid rating for the clinical treatment research.
For those of us without a prolonged grief diagnosis but with a grief we have been walking past, the work is simpler and less clinical. The work is: walk into the room. Sit down. Give the grief a moment of undivided attention. You do not have to stay forever. You do not have to resolve it in a single sitting. Grief is patient. It waited this long. It will settle for a brief, honest visit.
In the Kenyan tradition I was raised in, grief has communal forms. The extended mourning period, the gathering of relatives, the specific rituals of remembrance that mark the one-year anniversary. These structures exist for a reason. They build in the returns. They require you, periodically, to walk back into the room. Modern life in the diaspora, and modern professional life in general, has stripped out most of these structures without replacing them. We mourn in the allowable window and then resume. The grief is then left to manage itself, which it is not designed to do.
There is a grief you have been walking past. I do not know its name or the shape of it. Only you do. But I can say, with the confidence of someone who has spent years helping people negotiate the relationship between their bodies and their histories: the grief is not neutral. It is exerting a weight, somewhere. In the inexplicable sadness that descends on Sunday evenings. In the difficulty being fully present in the most important relationships. In the low-level reluctance that meets the morning. In the tenderness that surfaces, surprising and unwelcome, when a film ends or a song appears on the radio.
The grief has been patient. You may now make some room for it.
A Mirror
Is there a loss, a death, a relationship ending, a departure, a version of yourself that you have left behind, that you have not fully grieved? Can you name it? (Listening for: the reader’s capacity to identify postponed grief, the specific loss that has been residing in the walked-past room.)
How have you been avoiding the grief? Not in judgment but as information. What is the mechanism of the walking past? (Listening for: the specific avoidance strategy: busyness, productivity, premature meaning-making, emotional numbing.)
What does the grief feel like in your body when it surfaces unexpectedly? Where does it live? (Listening for: somatic grief awareness, the reader’s relationship to grief as a physical rather than purely narrative experience.)
Is there a ritual, a practice, a form of remembrance that would give the grief its rightful space without requiring you to collapse into it? (Listening for: the sustainable container for grief work, the practice that is possible within a real life.)
Who is one person you could be with in the grief without needing to explain or defend it? (Listening for: relational resources for grief, the existing safety in the reader’s life where the grief might be held.)
Letter from Dr. Job
Subject: The room with the grief in it
I walked past a room for years. I could feel it as I walked past. There was a weight in the door, a slight resistance in the morning, a particular quality to certain silences that told me something was in there waiting. I had learned, as doctors learn, to schedule my life around the rooms I was not ready to enter.
The room was not going anywhere.
One day I walked in. Not because I was ready, not because I had found the courage, but because life arranged a moment of presence that made the door too close to avoid. What I found in the room was not what I had feared. It was quieter than that. It was old. It asked for very little. It mostly just wanted to be acknowledged.
Grief is not the worst thing. The carrying of unacknowledged grief is worse.
You do not have to stay in the room long. Walk in. Nod at what is there. You will know what it is. Then, if you need to, you may walk back out. But walk in once this week. Just once.
— Job