This question – whether or not it is appropriate to say “I’m sorry for your loss” to a grieving family member — is one I’ve heard explicitly raised by a variety of professionals. For example, a resident tasked with providing a family with autopsy results was simply unsure of how to begin the conversation; and if it was “ok” to empathize. Another worried whether extending condolences was too much of an invitation to deal with a family’s difficult feelings of grief. A funeral director caught off guard by a family’s sharp response (“No you’re not! You just want my money!”) questioned her willingness to do what had come naturally and switched over — forevermore — to “you have my condolences.”

The latter examples are more complex, so, for now, let’s talk about the first. We’ll come back to the others in a later post.

My view on the general issue is as follows:

In my line of work — as an autopsy pathologist who works closely with families — I always let the family know that I’m sorry for their loss. And I say this right away the first time we speak. I do this because I am sorry for their loss. It’s that simple. The human connection is the most important part of the interaction.

Holding back the words has more to do with the speaker’s own discomfort or unfamiliarity with death and grief than any rule about “how grief works” for the family.

Here’s a bit of context from my world.

Families who call me for an autopsy (the same ones speaking with you for whatever reason) have often spent weeks or months advocating or fighting within the health care system. And, of course, their loved one has died despite their and everyone’s efforts. When they call me, they may be expecting the fight to continue — I am (another) doctor. By saying “I’m sorry for your loss,” I also let them know right away that I’m on their side. It’s because I actually am.

Even separate from any difficult relationships they may have had within the health care system, the family will also have many feelings surrounding their loved one. They may be feeling angry because of perceived missteps in the treatment; guilty that they were unable to care for a headstrong or even self-destructive loved one; or feeling lost if the death was sudden. The quest for answers through an autopsy is always part of an effort to fill in emotional pieces of a story. Did that uncaring physician miss a diagnosis as I suspected? Should I have pushed harder for that x-ray? Did my husband suffer before I found him?

Given the often problematic relationships, the self-doubts, and the huge personal hole that can be left by a loss, families in grief welcome kindness. There is so much room among grieving families for simple, undemanding kindness. “I’m sorry for your loss” dropped into the well of grief splashes deep, soothing and welcome ripples. There’s so much power in the small gesture.

To the uncertain resident, I would say give yourself credit for wanting to reach out. Go ahead and say the words. You’ll find the family will really appreciate it.

The other two examples — the resident who worried about getting “too much family” by reaching out and the funeral director who got “too much family” in the form of a rejection — are really exceptions. The solution there has to do with believing it when you say “I’m sorry for your loss.” But stay tuned for for that discussion at a later point.

In the mean time, if you know a family or individual in grief, don’t hesitate. “I’m sorry for your loss” can be ice cream to the sore throat of grief. Even a small scoop can soothe.