Opinion

A PIECE OF MY
MINDNolan N. Jones, MD
Otolaryngology–Headand Neck Surgery,
Department of Surgery,
Tripler Army Medical
Center, Honolulu,Hawaii.

Corresponding
Author: Nolan N.
Jones, MD,
Otolaryngology–Headand Neck Surgery,
Department of Surgery,
Tripler Army Medical
Center, One Jarrett
White Rd, Honolulu, HI
96859 (nolan.n.jones.
mil@health.mil).
Section Editor: Preeti
Malani, MD, MSJ,
Deputy Editor.

A Daughter’s Impact
dealing with it altogether. For me, this meant avoiding
conversations, events, people, and places.
Whenweleftthehospitalthatnight,Iwantedsobadly
to never go back. The iconic “Pink Palace” that can be seenfrom nearly any location on the south side of Oahu had
transformed from an exciting, dynamic place of learning
to a constant reminder of the hardest day of my life. Everything seemed to become a trigger—the drive to the hospital, the hallways connecting the operating rooms to thelabor and delivery unit, the call pager I was holding when
we heard the words, “I’m sorry. There is no heartbeat.” Allaround me, there were inescapable reminders that ourbaby was dead. I genuinely questioned how I would everbe able to go on for another 3 years at this institution.
Due to an upcoming outside hospital rotation, I felt
relieved that I didn’t have to return to work at TAMC on
a consistent basis. In retrospect, this situation was perfect for avoiding my grief, but not for walking with it. WhenI started at the new hospital, I chose not to divulge what
had just happened in my family to anyone I was workingwith. I didn’t know any of them prior to starting at the hospital, and I was afraid sharing this information might negatively influence how I would be perceived or trained. I wasworriedthattalkingaboutHazelmayinvokeemotionsthat
could be perceived as weak or ill-equipped to deal with
the intrinsic stressors of surgical residency. Because of these fears, I chose to
avoid the subject altogether.
From hearing the testimony of theseThis pattern of suppression continother families, I gained a deeper
ued, and I thought I was doing a good job
coping with the stress. There were days
understanding that the presence of grief
when the grief seemed to be more overis only made possible by the initialwhelming than others, but I was always
presence of profound love.
able to pull myself together, tuck away
the emotions, and carry forward. SevOn May 19 during what would become the final vi- eral weeks into the rotation, I received feedback thatability check, Hazel’s heart was no longer beating. After clinically, I was doing well, but that I needed to come out
induction of labor, Hazel was born silent on May 20 at of my shell, engage more with others, talk more, andjust 19 weeks 6 days’ gestation at Tripler Army Medical show a little more personality. In hearing this, I recogCenter (TAMC) in Honolulu, Hawaii, the same hospital nized that my outward demeanor was a true reflection
where I had completed my clinical clerkship in obstet- of how poorly I had been dealing with the grief interrics and gynecology during my third year of medical nally. I had been in survival mode, using all of my emoschool and where I am currently a resident physician in tional bandwidth to get through work, but I hadn’t beenotolaryngology. That day, we spent 8 hours with Hazel’s managing the grief. Rather, I was using work to try andbody before making the impossible decision that it was stamp it out. Clearly, this wasn’t working.
This experience served as a wake-up call for needtime to part ways. Traditionally, “Twinkle, Twinkle LittleStar” plays over the loudspeaker at TAMC when a fam- ing to change how I was dealing with my grief. I started
ily and their new baby leave the labor and delivery unit. to read grief management books and pray more often,
But that night, we walked out in silence, no baby in our which helped, but one of my regrets during this time isthat I did not seek any form of formal counseling. I thinkarms to hold.
Everything about losing a child is painful. The grief doing so may have provided an outlet to better processthat comes with such an experience is immeasurable my emotions, so I wasn’t dealing with them in the isoand frankly unimaginable to those who have not gone lation of my own mind. Despite not seeking counseling,
through it. This grief could be so physically and men- I did continue to feel noticeable improvement by contally painful to endure that it was often easier to avoid sciously acknowledging these emotions.
It was a familiar walk back to labor and delivery room
number 7. This room sits tucked away in a corner with
the intent to shield grieving parents from the sights andsounds of new life. That day, the door was marked witha picture of a leaf harboring a single rain drop on a purple
back drop, awaiting our arrival. For my wife and I, there
was no escaping this new reality. Our baby had died.
In the weeks leading up to this day, our world had
been turned upside down. On April 16, 2022, we had goneto a private clinic for a gender reveal ultrasound when
the technician discovered the presence of several abnormalities and advised us to seek medical care. Subsequently, our daughter Hazel was diagnosed with Turner
syndrome in utero. Due to the degree of fetal hydrops
fetalis, presence of large cystic hygromas, and cardiac
abnormalities, Hazel was given a terminal prognosis. At
the time, there was no telling how much longer we hadwith her, but it was undoubtedly limited. For 4 agonizing weeks, we did our best to cherish this fleeting timewith Hazel while simultaneously grieving the loss of her
future knowing that every day with her could become
our last. Each week, we were afforded an opportunity
to see her on an ultrasound. Medically, this was to assess viability of the pregnancy, but to us, it was a righteous opportunity to see her while she was still alive.

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Opinion A Piece of My Mind

A major turning point for me arose shortly after Hazel’s originaldue date in October when TAMC hosted an event titled “A Walk toRemember.” We were invited to this event as a family who had experienced pregnancy, infant, or child loss. My wife, son, and I attended
this event. Here, we heard the names and stories of dozens of otherfamilies with similar circumstances. The lives of those lost were remembered and celebrated. This event struck me so deeply because
all around me were parents who were brave enough to reenter thebuilding where so many bad memories were formed. They weren’t
forced back here due to work obligations; they voluntarily attended
to celebrate the life of their loved one. I know it must have been challenging to return to that building, yet here they were, creating positive memories and reframing the relationships with their children.
Seeing these other families and finding comfort in our common experiences served to highlight to me the importance of community
while processing grief. From hearing the testimony of these otherfamilies, I gained a deeper understanding that the presence of grief
is only made possible by the initial presence of profound love. This not
only helped to change the way I thought about my own grief, but reinforced to me that grief is not an emotion that we should deal within solitude, but instead in shared reflection. In life’s grand irony, I had
triedsohardtocompartmentalizemygrief,onlytoendupfindingcomfort and solace by sharing Hazel’s story in the very place to which
I initially never had wanted to return.
I have thought a lot about whether there is some greater lesson in this story. Sometimes, I feel guilty thinking this way, as if thePublished Online: June 23, 2023.
doi:10.1001/jama.2023.9981
Conflict of Interest Disclosures: None reported.

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value of Hazel’s life is somehow reliant on whether or not I can articulate a specific impact. The truth is that although I am grateful to
be Hazel’s father, there will always be a part of me that hurts for her.
I think this is something to which everyone can relate. Although individual stories of loss are unique, grief is the most universal of human experiences and each of us is touched at one point or another.
Furthermore, physicians are privileged to play a role in some of thebrightest but also darkest periods of patients’ lives. Knowing pain
and learning from my own experience with grief has improved theability to empathize and to have difficult conversations. It has
strengthened my desire to deliver the highest-quality care. It empowers me to take the extra step in developing a genuine humanconnection. It has given me an added tool to achieve what I desired
most from a career in medicine—to help other people.
Because of Hazel, my heart is softer, my tone is gentler, and mypatience is longer. I understand the power of holding a loved one’s
hand just 5 minutes longer because I know what it’s like to never
be able to get that back. I know the gravity words can hold because
I’ve been suffocated by their weight. Although by no stretch has
this road been easy, I can honestly say I am a better man, husband,
father, and physician because of our journey with Hazel. Although
I will miss her for the rest of my life, I cherish the opportunity to continue working at the place where she was born because it is now
a place where I feel deeply connected to her. It is my hope that although she was born silent, as time moves forward, by keeping her
memory alive, Hazel’s impact will continue to speak loudly.

Disclaimer: The views expressed are those of
the author and do not reflect the official policyof the Department of the Army, US Army Medical
Department, the Department of Defense,or the US government.

Additional Contributions: I thank my wife, Katie,
for encouraging me to share our family’s story.

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