A 23 year old girl is roomed with abdominal pain. It is a busy Friday evening in the emergency department and on my mind is my patient that I just told is having a heart attack and am having sent to the cardiac procedure center where they can determine where the blockage is and hopefully open up the blockage before any more of his heart tissue is damaged.

I walk in to see my 23 year old patient, and see her near hysterics, writhing in pain on the hospital bed. She grabs the railings and thrashes back and forth yelling out in pain. I ask her quickly where her pain is, and she yells, “My stomach! My stomach! Please! Help! My stomach!” I try to get more of a story, but she is in so much pain. I find out that she thinks she may be pregnant but she doesn’t know how far along she is. She appears to be having contractions, lower back pain, maybe she is in labor, but she seems early along in her possible pregnancy. I tell her I am going to find her nurse so we can start an IV and get her some pain medication while I try to figure out what else is going on . So, I step into the hallway and look up and down, and see no one in sight. I step out further and see that all my nurses are in patients’ rooms taking care of other people.   I step back into the room, and see my patient sitting slightly up against the incline of the bed with her legs bent at the knees. She is calm. I also see under the edge of her hospital gown, an image I will never forget.  She has miscarried her baby.

I look up again at my patient. I’m not sure if she knows what has happened. I sit down next to her and rest my hand on her arm. “I am so sorry, but you have miscarried your baby.” I stare intently at her face, trying to read her expression. She stares at the warm glow of her smart phone. I want to throw my arms around her, comfort her, talk to her. She says, “Ok.” I tell her I am going to have to deliver the rest of her pregnancy, that I’ll need to deliver the placenta. She responds monotonously, “Ok. But please. I don’t want to see. Please don’t tell me how far along I was.” She never looks up from her phone. I finish taking care of her and sit back down next to her. I explain what I have done, but am sure to honor her wishes. I explain the next steps and what to expect. She nods, she is void of any expression. I ask her what questions she has, what concerns she has, how I can help, what resources she needs. She needs nothing. She has no questions. No concerns. How long until she can leave. Please don’t tell her boyfriend who is waiting in the lobby. I say again, “I am so sorry.” I linger. She nods again. I have so much empathy and support to give. She would rather not have any.

I think about her often. I wonder what I could have done differently. I wonder if she had questions or concerns. I wonder what thoughts were spinning through her head.

What I have learned over the years, is that everyone grieves differently. Some cry. Some panic. Some act brave. Some become frustrated and angry. Some are in denial. Some use humor to get them through. Some ask questions repetitively and talk in circles, as they are slowly processing this big moment in their lives. And some are like her. Expressionless. Detached. Dealing with whatever it may be in their own ways. And that’s the exact thing about grief. It presents in different ways. No two people grieve the exact same way. I may have wanted to throw my arms around her and I may have expected tears, but that is not what she needed. She needed space. She needed me to stop talking. And that is okay. Her grief and my grief and your grief are not the same. We need to respect that of one another and let each person take the lead on how they need to react and how they need to heal. No quick judgments that because there were no tears or outbursts, that she is not in pain. There is no need for her to explain her reaction.

I still wonder what more I could have done. But I was there. And I will be there again and again for my patients. And that is the best I can do and what I will promise to continue to do. I will wonder and ask what more I can do and be there however they need me to be there.