When I arrived, many more experienced medics were surrounding the elderly lady, and it rapidly became clear she had succumbed despite their best efforts. Standing at the edge of the action, one of the senior residents instructed me to inform the relatives. Terrified, I dutifully went to the small room where the husband, three strapping sons, and two daughters sat. I told them in the gentlest terms I could muster that their beloved wife and mother had passed peacefully, seemingly from heart failure. There was silence, then one lad asked in a strong Liverpool accent, “Was it cancer, Doc?” Strange question, thought I. “No, it was her heart; at 89 it just gave out.” And his response has stayed with me ever since “Thank goodness for that, Doc, she would have hated to have died from the cancer!”
Grief gets us all at some point and we never know how we will respond. What that Liverpool experience showed me was that any response is okay if it helps one process the unimaginable. Years ago, I wrote an article (“Impacts & Collisions,” AOPA Pilot, February 2016 page 28) about the loss of my friend Bill Gibbons on October 9, 2015, in a weather-related aircraft accident, and how I leveraged my grief by presenting on human factors to an NTSB hearing on the day of his memorial service. I have also recounted in the pages of our magazine, and in this online column, how one should defer flight on anniversaries of poignant days because grief can resurface, often when we least expect it, inspired by hearing a song on the radio, thinking about a flight we took. And if that memory appears on short final, while focused on airspeed and runway alignment, a tragic memory can cause emotional, and physical inversion. Please take this warning seriously, a terrain avoidance system for your life.
As pilots, we tend toward stoicism, maybe defaulting to emotional autopilot when grief strikes. We compartmentalize, isolate, and “soldier on.” But grief isn’t a minor mechanical squawk you can simply note and then ignore; it requires acknowledgment. I have often written about using in-flight oxygen liberally, as failure to do so can lead to hypoxia with dangerous consequences. Failure to acknowledge and address grief causes emotional hypoxia, and you may not realize you’re gasping until you’re too far gone.
As I pen this, such a day looms large. On Friday, June 23, 2018, I received a phone call from Dave Strickland, my childhood friend. He simply stated, “Jon, there’s no easy way to say this, Elliot took his life last night.” Elliot was Dave and Zoe’s eldest son, a sweet, kind, smart 25-year-old lad who only weeks before I had taken to a football match together with my son. How could this be? In the following 7 years, while it still makes no sense to me, and having lost other friends and colleagues to suicide and many more loved ones to other causes, I have become more practiced in learning to process grief. When Elliot died, I had already lost my father, dear friends, and had endured a bitter and painful divorce that fractured my family. I thought I knew grief.
The five stages of grief were originally coined by Elisabeth Kübler-Ross in relation to supporting end of life based on her work with those dying in hospice but were adopted for broader use with her approval. First is denial—a common initial reaction to loss, characterized by shock, numbness, and disbelief. Then follows anger, arising as the realization that this has happened, the ire directed at the deceased, others, or even oneself. Then comes bargaining, where people try to negotiate with a “higher power,” to make a deal to change the situation or undo their loss. Depression settles in with profound sadness, even despair and withdrawal from life, activities, and other relationships. Finally, one reaches the stage of acceptance—this does not mean one is “okay” about what has transpired but is learning to find ways to live with it. This has now been expanded to seven stages; shock and denial, pain and guilt, anger and bargaining, depression, the upward turn, reconstruction, and finally acceptance and hope. This last phase involves accepting the reality of the loss, finding meaning and a way to move forward with hope for the future.
However, these stages are not linear, not predictable, and one may flip back and forth or miss stages, and of course, the whole process is deeply personal and as my Liverpool experience showed me, there is no right or wrong way.
Zoe addressed her grief by keeping two diaries and drawings, one for her, one for Elliot. From this, Doodle Lady was born, and as my dear friend shared her thoughts and drawings, it was apparent she had found a way to personify grief and, if you will, deal with it. These musings have now been compiled into a heartfelt book: To Grief with Love: A lyrical and pictorial voyage through loss (available at usual online retailers).
I asked Zoe how she approaches grief, and she told me, “I see it not as something to ‘overcome’ but as something to hold gently, even gratefully.” She speaks to grief as an unwanted companion, but one worthy of love, nonetheless. “Grief is a mirror,” she wrote, “reflecting the depth of our love.” That resonated with me as both a doctor and a pilot, professions steeped in control, precision, and rationality. Yet grief cares nothing for procedure. It’s VFR into IMC with no instrument rating.
What struck me about Zoe’s work is how she gently challenges the cultural tendency to rush grief, to tidy it up and stow it in the overhead bin. In aviation, we’re trained to identify and mitigate risk, but grief isn’t a risk, it’s a reality. Trying to suppress it is like ignoring a low oil pressure warning and pressing on regardless. Eventually, the engine fails.
The book offers a powerful invitation: to write letters to your grief. Maybe a strange concept for pragmatic pilots; I mean, who wants to write a love letter to something that hurts so deeply? But in doing so, you reclaim some agency. You can start flying again, not with the aim of outrunning grief, but of flying with it in the right seat.
In a long medical career, I have seen much grief; the loved ones of someone who died, the patient with a fatal diagnosis grieving their impending mortality, and the colleagues grieving the patients they could not fix, let alone living with their own losses. Brits, of which I am one, are characterized as having a “stiff upper lip,” but “just getting on with it” to avoid being perceived as unfit or weak is emotionally damaging; we could all benefit from being more self-aware, more vulnerable. Aviation, while an individual pursuit, is inherently communal—fellow pilots, ATC, maintenance, ground support. While grief is deeply isolating, those mourning loss need their crew: family, friends, professionals, peers. There is no shame in needing support.
Suicide is a major public health issue in the US, with over 49,000 deaths recorded in 2022, and is a leading cause of death, particularly among younger and middle-aged adults. Men account for nearly 80% of suicides, with the highest rates seen in white males over 45, though rates are rising alarmingly among adolescents, veterans, and indigenous populations. Risk factors include untreated mental illness—especially depression and substance use disorders—social isolation, financial or relationship stress, chronic pain, and easy access to lethal means, notably firearms, which are used in over half of all suicides in America.
In aviation, the stakes are uniquely high: pilots often conceal mental health struggles for fear of losing their medical certification, which can deter them from seeking help. The cockpit culture of stoicism and high personal standards can exacerbate feelings of failure or hopelessness. For aviators, recognizing the warning signs—withdrawal, erratic behavior, or expressions of despair—in colleagues and ourselves can be lifesaving. Suicide is not a failure of character, but a medical emergency. As pilots, we perform safety checks on our aircraft before every flight; it’s time we normalized doing the same for our mental well-being and that of those around us.
Zoe Strickland emphasizes the power of community in grief recovery, encouraging people to “be seen in their sorrow.” Neither fixed nor judged, just seen. In the same way an air traffic controller does not chastise a pilot in distress but offers calm assistance, learning to offer presence over platitudes to those grieving sends a strong message: “You are not alone,” and that is never truer than when we’re grieving. Whether you’re dealing with the loss of a partner, parent, or pet, or the quieter griefs of aging, loss of a job or identity, your pain is valid. And your story deserves airspace.
Safe flying requires we learn, and use, checklists and protocols, and our aircraft are equipped with redundancies, to protect us should things go wrong. Why not have the same degree of preparation for one of life’s inevitabilities? All of us will suffer grief at some point, so perhaps it would be good to remove the taboos and talk about how to best manage it. I reflect on the fact that when I attended medical school, while they taught us brilliantly about anatomy and physiology, surgery and drugs, there was zero tuition on how to help people through grief. While things are better today, they could be better still. In aviation we learn how to navigate inclement weather, why not in life as well?
Each year, on the anniversary of his passing, there is a named lecture for Elliot facilitated by the OLLIE Foundation (One Life Lost Is Enough) and this is available to watch online. In her book, Zoe references Kintsugi, the Japanese art of repairing a broken pot with gold-dusted lacquer, making something fractured whole again, recognizing the flaws but adding beauty. If you or someone you care for is hurting from grief or may be at risk of suicide, please be there to offer support and consider seeking professional help, be that therapy, support groups, or anything else—there is no wrong answer. Maybe even keep a diary and doodle.
Fly well.
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