Every day I encounter patients in the general hospital who are grieving some loss, both old and new. It’s never really just one kind of loss, though most often loss of health is the most obvious, most visible one. Many have lost limbs, some are blind, some are losing their lives. Some have lost homes and talk of their homelessness–a new thing for a few though I’ve met many who somehow learned a sort of skill set for surviving without a permanent roof to protect them from the rain. I listen to their painful stories because their doctors have called me–though frankly, they occasionally don’t tell their patients I’m coming to listen to them. A brief awkward moment and variations on the joke, “No, they didn’t tell me a psychiatrist was coming; I thought I was sane…”

First, I look around the room for a chair…which I often cannot find easily. It may be covered with dirty linen, or the old clothes and duffel bags filled with what this grieving person has left in the world. These bags are near empty, full of the gaping remnant. Emptiness seems a thing in the room I can feel.

Then the man or the woman speaks. They talk of having no place left to live–or to die. Not having a place to die creates a sorrowful space in the room where I’m a witness. And all the not-having, grandkids-not-here, and vivid dream of some rainy sky in Oklahoma, golden cloud Hawaii, unspeakable Heaven–spills down on the counterpane, patters on restless hands, raining hard on our shoulders. They speak. I listen and remember.

I remember a cold, sleety rain on the backs of a small gang of men hired to do what probably isn’t done anymore these days–fill in the grave of some stranger to us, the motley, the lost one trying to find the path back to innocence always blocked by bramble, and the drunks looking for a few dollars to buy a bottle of fresh dreams. We had shovels and a pile of dirt slowly turning into a thick, brown mud-mountain. And the sleety rain came down on our shoulders. We didn’t know the name of the man we were burying. We were hired for the day to cover him from the rain, which fell and fell and made the shovels greasy and the footing perilous, so close to the newly opened chasm in the cemetery whose name we didn’t know.

We stop for lunch at a nearby tavern because that’s where my older companions want to go to drink their lunch, though I’m not thirsty. I watch them but decline the offer to join them raising glasses of dirty brown rain falling down their throats to warm the bellies that probably had not seen real food for days. We had been paid already. This was where they were already losing their cash. After the rain of 7 and 7, it’s back out to the grave, where the sleety rain has been doing its work, gathering in puddles in the hole and in our shoes.

There’s a rhythm to shoveling. You plunge the blade in the mound. You press the back of the blade in. You swing more than lift, to save your back. We rained dirt into a stranger’s grave, covering another loss to humanity. Burying a man by hand, shovel-load by shovel-load, taught me something about loss–though I’m still not sure exactly what it is. These lessons may have names which are easily forgotten in the mind, though held in the heart.

So I listen to the stories of loss my patients tell, as their tears rain down, revealing and not covering our humanity.


Author: Jim Amos

Dr. James J. Amos is Clinical Professor of Psychiatry in the UI Carver College of Medicine at The University of Iowa in Iowa City, Iowa. Dr. Amos received a B. S. degree in Distributed Studies (Zoology, Chemistry, and Microbiology) in 1985 from Iowa State University and an M.D. from The University of Iowa in Iowa City, Iowa in 1992. He completed his psychiatry residency, including a year as Chief Resident, in 1996 at the Department of Psychiatry at The University of Iowa. He has co-edited a practical book about consultation psychiatry with Dr. Robert G. Robinson entitled Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry. As a clinician educator, among Dr. Amos’s most treasured achievements is the Leonard Tow Humanism in Medicine Award.