Episode 603: Good Grief

Death Becomes Her
By Nancy Kiu, Director of Medical Research

Death is definitely no stranger here at Private Practice. All of our doctors have certainly had more than their fair share of losing patients, friends, and family members. As we've learned by now, going through the loss of a loved one in the past does not make death any easier to deal with. Such is the case for Violet – even though she's an amazing therapist who understands the process of grieving on a psychological level, she still struggles with her own grief over Pete's death.

Violet is all too familiar with the five stages of grief - denial, anger, bargaining, depression, and acceptance, but she also knows that each person is different – not everyone goes through the five stages in order, if they even go through them at all. Everyone grieves in their own way, and this certainly holds true for our doctors.

On the outside, Violet appears to be holding it together – packing up Pete's office, cleaning out his hospital locker, and explaining to Lucas over and over again that his father is gone. But death and grief are things that even the most put together, well educated adults have trouble dealing with; how does one even begin to explain it to a child?

It becomes clear that even as Violet explains to Lucas that Daddy is with Mufasa, she hasn't quite come to terms with it yet herself. She's in denial, and buries herself in her work, forcing Sheldon to question whether or not she's even ready to see patients again. She couldn't achieve closure with Pete, so she's transferring her emotions onto her patient Adam, to the point where she's going behind his back and jeopardizing both her career and his emotional well-being.

Adam has been harboring a secret for over a decade – in times of desperation, he accidentally shot someone and fled the scene without knowing whether the man lived or died. He claims that he doesn't need to know what happened to the man, but he obviously feels burdened enough by this secret that it manifests itself in the habitual angry behavior that forces him to see Violet in the first place. Should he face his past actions and be held accountable for them? Or are some secrets better left alone?

Violet lets her emotions overcome her and crosses the line with Adam when she forces him to confront his secret. Now that he can't live with it anymore, can she convince him that living amends is the way to go? Adam can't go back and change what happened; all he can do now is live the best life he can by helping to improve the lives of others in hopes that it will be enough to set him free. Can your actions in the present make up for the mistakes of your past?

Addison is wrestling with her own secrets about her history with Mark Sloan. Now that she's finally with a man who loves her as well as her baby, she's forced to confront her past with a man whose baby she almost had. In her journey to motherhood, her relationship with Mark was momentous – it is probably the only time Addison will ever carry her own baby, and she will always have a connection with Sloan that she can never have with anyone else. She fears Jake won't be able to understand this connection, but being in a relationship also means opening yourself up to others. In order to move forward with a fresh start, you have to put all your cards on the table, otherwise, the secrets will eventually find a way to the surface. So Addison finally takes the biggest risk of all – exposing her history as a cheater to Jake – and she learns that sometimes, the truth can set you free.

In Sheldon's case, however, the truth is not at all liberating. Faced with the results he never wanted to know of a PSA test he never asked for, he's now forced to decide whether or not he should get a biopsy and find out, once and for all, if he has prostate cancer. This is a tricky area – controversial new guidelines recommend that men should no longer be routinely screened for prostate cancer with the PSA test, because the possible harm of cancer treatment outweighs the survival benefits of early detection. Some men who find out they have prostate cancer opt for aggressive treatment, sometimes with painful side effects, when oftentimes the prostate cancer grows so slowly that many men will die of something else first. As Sheldon said, most men die with prostate cancer, not of it. That being said, early detection is still a vital part in the fight against cancer. Sheldon saw what happened when his father was diagnosed with prostate cancer – it became his father's prison, and Sheldon doesn't want that to become his life. So even though Sam urges him to get a biopsy, Sheldon would rather not know if he has the disease.

While Sam urges Sheldon not to ignore his problems, he ignores Stephanie when she wants to know more about him. And although he advises Addison against keeping her history with Mark from Jake, he doesn't listen to his own advice and chooses not to tell Stephanie about his past with Addison. He claims it's because he's made mistakes, but as Violet says, "everyone has a history. We are our past. Own it." Sam doesn't own it. Will this decision come back to haunt him?

From the triplets to Pete, everything is changing for Cooper and Charlotte. So, naturally, Charlotte chooses to ignore everything and, like Violet, throws herself into her work by taking on all of Pete's ER shifts. She can't fathom hiring someone to "replace" Pete yet. Through the years, they forged a strong and unlikely friendship - he was there for her in the darkest point of her life, and she is profoundly grateful to him. But as Cooper rightly points out, by working so much, she is jeopardizing not only her health but the health of their three plum-sized Cooplettes. And so, Charlotte finally reaches acceptance when she agrees to hire a new ER doctor to replace Pete.

And Amelia? She's the only one who's been at acceptance this whole time. She knows full well the nightmare that is going through the motions of grief, and she knows that people are always there...in the beginning. Gradually, the support fades away, so to prevent that from happening to Violet, she covertly enlists everyone in the practice to take shifts spending time with Violet and helping Lucas. But even with Amelia's best intentions, only Violet can make peace with what's happened. If Lucas can reach acceptance, can she?

Denial: it's not just a river in Egypt anymore.