Pain that's not on the Leave schedule.

The phone rang in the early morning. A voice said: The doctor was hit by a motorcycle; the driver was high on cocaine. He's currently at [the hospital]. ICU, coma condition. For a moment, the doctor didn't know what to do. Standing in the middle of the room with his phone in hand, he put it down, then picked it up again to check the news because people were starting to post on social media. It was as if, if he picked it up and reread the message, the text on the screen might change. We are doctors; we are taught to deal with the pain of others as part of our profession. But that day, our own pain made everything more difficult than ever before.

This article is written from the doctor's direct experience and scientific explanations of why loss can render even professionals unable to work, and how we can take care of ourselves when we still have to work.

An unanswered loss: Ambiguous Loss

There are many types of loss, and one of the most painful is what psychologists describe as... Pauline Boss From the University of Minnesota, it's called... Ambiguous Loss หรือ "A loss that remains unclear." Boss coined the term in 1999 after studying the families of soldiers who went missing in the Vietnam War. However, it has since been used to describe many other real-life situations, including when a loved one is in a coma, which Boss classifies as a type of loss where the loved one is in a coma. "Existing but without." (Physically Present, Psychologically Absent)

What makes Ambiguous Loss particularly painful is the lack of clear boundaries, confirmation, rituals, and a point where society says, "Okay, you have the right to grieve." We hang between hope and fear, between praying for the teacher's recovery and preparing ourselves for all possibilities.

The boss emphasized that this is not a pathology, but a normal response to an unusual situation. The feeling of being unable to work, numbness, or anger without knowing who you're angry at are all perfectly reasonable reactions.

What happens in the brain and the body.

When we hear upsetting news, the part of the brain that... amygdala The system, which is responsible for detecting threats, will immediately release stress hormones, including... Cortisol (Cortisol) Adrenaline (Adrenaline Research published in Brain Sciences and Applications (2025) titled “Unraveling the Neurobiology of Grief” found that the amygdala in a constant state of alert will “compete” for resources from… Prefrontal Cortex Which is responsible for decision-making, concentration, and information management.

The practical consequence is that our brains are performing two tasks simultaneously: processing pain and maintaining daily life functions, all from the same energy source. Neuroscientists call this resulting phenomenon... Grief Brain This manifests in familiar forms, including loss of concentration, slow decision-making, forgetting what was just said, needing to reread a text three times, and feeling unusually exhausted even without doing much.

In addition, persistently high cortisol levels suppress bodily functions. hippocampus This area, which is central to memory, can experience dysfunction in short-term memory, as well as suppress the immune system, increase inflammation in the body, disrupt sleep, and increase blood pressure. Research published in… The Lancet Public Health (2024) Studies indicate that untreated loss of health significantly increases the long-term risk of autoimmune diseases, metabolic disorders, and depression.

Even doctors aren't immune to pain.

This may be the most important part of this article. Many may be surprised that many of my fellow doctors are unable to work all day. In a society that often views doctors as “strong,” “accustomed” to loss, or “able to control their emotions,” research says something completely different. A study in Palliative & Supportive Care found that medical personnel have very complex patterns of grief and coping, and often what is called… Disenfranchised Grief It is a sadness that is “not permitted” by society because no one expects a doctor to be sad. The Annals of Family Medicine (2017) found that this disenfranchised grief is a major accelerator of… Physician Burnout Or, in medicine, burnout.

The truth that doctors want to tell you is that loss doesn't care what field you're in, how many years you've worked, or how many psychology books you've read. When a loved one is in the ICU, a doctor's brain responds to pain using the same mechanisms as everyone else's brain.

Coping strategy: You don't need to be strong; you just need to be honest with yourself.

• I admit that I am sad. – Suppressing feelings doesn't make them go away; it only causes them to shift to the body, resulting in symptoms such as headaches, neck pain, stomach upset, or insomnia.
• Allow yourself to live with uncertainty. – My boss suggested that the goal isn't to "shut down" the pain, but to learn to "live with" it. We can have hope and fear at the same time.
• Lower your expectations at work. – Reduce your tasks to just what “needs to be done today” and delegate achievable tasks to others. Telling yourself, “I have to be able to do the same work as usual” on days like this is setting unfair expectations for yourself.
• Tell someone you trust at work. – You don't need to announce it to the whole office. Just briefly telling your boss or a trusted friend, "There's something at home, sorry if I'm a little late today," can help you lose a lot of weight.
• Maintain a consistent schedule. – Research on Behavioral Activation indicates that maintaining a consistent schedule of eating, sleeping, and waking up helps maintain circadian rhythm, preventing disruption even on days when you feel unmotivated. Getting up, brushing your teeth, eating breakfast, and getting some morning sunlight are signals to the brain that life can continue.
• ใช้เทคนิค Grounding 5-4-3-2-1 – Explore the five senses of sight, four of touch, three of hearing, two of smell, and one of taste. This technique effectively brings the brain back to the present moment and reduces amygdala activity.
• Take care of your body intentionally. – Taking a light walk for 20-30 minutes a day can help reduce cortisol and stimulate endorphins. If you have insomnia, consult a doctor; don't force yourself to endure it.
• Someone is listening. – BMC Psychiatry (2024) found that what people need most when they are grieving is “someone to listen without judgment,” not advice, not comforting words, just someone to be there.

When should you seek professional help?

Grief is normal, but there are signs that indicate it's time to see a doctor or psychologist. These include severe sadness that doesn't subside for more than 4-6 weeks, inability to perform basic functions, feelings of meaninglessness, dependence on alcohol or other substances, or a significant decline in physical health. The DSM-5-TR identifies these conditions as... Prolonged Grief Disorder It is a clear and treatable diagnosis, and the best evidence-based treatment is... Cognitive Behavioral Therapy (CBT) Asking for help is not a sign of weakness, but one of the smartest decisions you can make right now.

As I write this article, my professor is still in the ICU, and no one knows what the future holds. The uncertainty is immense, and no words can truly lessen it. But what I do know for sure is that getting up today, continuing to work, and caring for patients, even while mentally following the news, isn't a betrayal of my feelings. It's what we can do today, and it's enough. Pauline Boss says the goal of dealing with ambiguous loss isn't to "close the lid," but to learn to cope.Holding both hope and pain in the same hand. And move forward with both of those things.

Our teachers have taught us many things throughout the years. Perhaps this is another lesson they taught us unintentionally.

refer (References)

1. Boss, P. (1999). Ambiguous Loss: Learning to Live with Unresolved Grief. Harvard University Press.
2. Boss, P. & Carnes, D. (2012). The Myth of Closure. Family Process, 51(4), 456–469.
3. Stroebe, M. & Schut, H. (1999). The Dual Process Model of Coping with Bereavement: Rationale and Description. Death Studies, 23(3), 197–224.
4. Statharakos, N. et al. (2025). Unraveling the Neurobiology of Grief: Insights into Brain and Behavior — Narrative Review. Brain Sciences and Applications. doi:10.26599/BSA.2025.905001
5. Lytje, M. et al. (2024). Investing in bereavement care as a public health priority. The Lancet Public Health. doi:10.1016/S2468-2667(24)00030-6
6. Granek, L. et al. (2017). Disenfranchised Grief and Physician Burnout. Annals of Family Medicine, 15(4), 375–378.
7. PMC / NCBI. (2025). ICD-11 Prolonged Grief Disorder, Physical Health, and Somatic Problems: A Systematic Review. PMC11960567.

Dr. Kobkarn Chunhasawatdikun

• Specialist in preventive medicine with 22 years of experience in integrative medicine, health promotion, and lifestyle modification. Expert in many disciplines of alternative medicine working with multidisciplinary specialists including Chinese medicine, Thai medicine, homeopathy, massage therapy, art therapy, music therapy, sports science, and physical therapy, as well as a lecturer in food as medicine, nutrition and wellness, teaching chefs how to make healthy food.

Work Experience

• Currently the Director of Well-Healing by MedPark.
• 2566-2568 Head of Wellness Business Development, Vimut Hospital Holdings Co., Ltd., Specialist in Preventive Medicine.
  Founder of BALAVI, an integrated medical and lifestyle modification center, specializing in the care of cancer and chronic disease patients.

Training

• Training in advanced life support operations Faculty of Medicine Siriraj Hospital
• Training from Boromarajonani National Institute for Drug Addiction Treatment and Rehabilitation
• Course for Senior Executives in Public Health (NSS), Mahidol
• THON's Executive Program THG SASIN Chulalongkorn University
• Completed hospital management course CEO48, Mahidol University.
• Micro MBA, Chula Business Administration & Faculty of Commerce and Accountancy, Chulalongkorn University
• Advance training course in Acupuncture and Traditional Chinese Medicine, China, 2006 The American Board Certified in Nutrition Wellness, (CNW), USA, 2017
• Training in Anthroposophy Training (IPMT program) course from Switzerland, 2010-2019
• Pressel Massage training, 2014
• Regenerative medicine: new approach in hormonal treatment Symposium (WOSAAM), 2016
• Advanced Nutrition for wellness, IFNW, Thailand, 2017
• Integrative Functional Nutrition/Functional Foods for Chronic Disease Module 2, USA
• Integrative Functional Nutrition/Functional Foods for Chronic Disease Module 1, USA, 2018
• Thai Traditional Therapeutic Massage and Thai Traditional Pharmacy Accredited and Certified by The Union of
• Thai Traditional Medicine Society, Ministry of Public Health