Don, thanks for posting this. As many of you know, I’m a pediatric palliative care doctor and pediatric oncologist. After my fellowship in palliative care at Emory I set up an adult program in an affiliated hospital. This was possible because our Board is through the American Board of Internal Medicine and covers all ages.
I noticed right away that many, if not most, patients have an internal clock. Although adult children and close friends may push for the loved one to “fight” or go to Rehab or do one more round of chemo, those pleas don’t change the clock. I quickly learned how to guide family members to accept this to fulfill the patient’s deep wishes to let his or her life cycle to complete itself.
We also know that grief begins at diagnosis. As Therese Rando, grief expert in Rhode Island cogently wrote in 1988, anticipatory grief is a misnomer. Medical, psychical, spiritual, and social impacts start rearing their heads immediately. The proportion of each aspect varies, yet all are real.
Your piece is particularly rich in terms of describing interventions. For example, yoga addresses the phenomenon that “the body holds the stress.” I can’t help but believe that many will be comforted by what you suggest.
My grieving process began when my husband of 60 years began struggling with dementia. I lost him in bits and pieces for 5 years until he died of COVID. During that time, I was too busy keeping us going and then starting over as a single older adult to really grieve. Now, a year and a half later, the grief continues . . it lessens, but never really goes away. My life is not the same.
I appreciate Patricia's point regarding the internal clock and fulfilling the patient's deep wishes to let his life cycle complete itself. Thank you.
A significant part over the loss of my parents and other close elders is all the questions I forgot to ask them. They lived through historical times with their personal experiences, and much of my family history is hard to find or lost.
Don, thank you so much for this sensitve, poignant article. It touched me on a personal level for a couple of reasons. First: Oddly enough, Mira and I met for a wonderful lunch a week before you posted this, and now you've given me more insight into the depth of our mutual friend's loss and grief. Second, in my opinion, there is no shelf life for grief - it will hit you in strange, unbidden ways for the rest of your life! A smell, a dream, or a memory can bring back the feeling of loss at any time, and yes, it may cause you to sob, even decades after the actual loss. (I disagree with DSM's addition of long grief as a disorder.)
There actually is a tradition in Judaism that provides for a longer period after the week of shiva. Shloshim is a thirty day period during which certain things aren't done (shaving for example). So there's a week of shiva, a month of shloshim and finally the one year anniversary of the death, the yahrzeit. People aren't expected to "snap out of it."
My mom, a geriatric social worker, was upbeat in her old age but also very conscious of when and how she wanted her death to be. She talked to my sister and I about it frequently over the years, and especially in her last year when, as she said, she was "weary" and ready to go. The conversations helped a great deal to prepare us for when she died. (My sister said that her one regret was that she couldn't then say to Mom, "Look, it went the way you wanted!" ) It also allowed us to start grieving early (which felt like "anticipatory grieving"). I find that having family and friends around now to whom I can say, "Mom would have liked that" and other observations I don't have to explain makes it easier and extends her life among us.
Don, thanks for posting this. As many of you know, I’m a pediatric palliative care doctor and pediatric oncologist. After my fellowship in palliative care at Emory I set up an adult program in an affiliated hospital. This was possible because our Board is through the American Board of Internal Medicine and covers all ages.
I noticed right away that many, if not most, patients have an internal clock. Although adult children and close friends may push for the loved one to “fight” or go to Rehab or do one more round of chemo, those pleas don’t change the clock. I quickly learned how to guide family members to accept this to fulfill the patient’s deep wishes to let his or her life cycle to complete itself.
We also know that grief begins at diagnosis. As Therese Rando, grief expert in Rhode Island cogently wrote in 1988, anticipatory grief is a misnomer. Medical, psychical, spiritual, and social impacts start rearing their heads immediately. The proportion of each aspect varies, yet all are real.
Your piece is particularly rich in terms of describing interventions. For example, yoga addresses the phenomenon that “the body holds the stress.” I can’t help but believe that many will be comforted by what you suggest.
My grieving process began when my husband of 60 years began struggling with dementia. I lost him in bits and pieces for 5 years until he died of COVID. During that time, I was too busy keeping us going and then starting over as a single older adult to really grieve. Now, a year and a half later, the grief continues . . it lessens, but never really goes away. My life is not the same.
I appreciate Patricia's point regarding the internal clock and fulfilling the patient's deep wishes to let his life cycle complete itself. Thank you.
Don,
A significant part over the loss of my parents and other close elders is all the questions I forgot to ask them. They lived through historical times with their personal experiences, and much of my family history is hard to find or lost.
Don, thank you so much for this sensitve, poignant article. It touched me on a personal level for a couple of reasons. First: Oddly enough, Mira and I met for a wonderful lunch a week before you posted this, and now you've given me more insight into the depth of our mutual friend's loss and grief. Second, in my opinion, there is no shelf life for grief - it will hit you in strange, unbidden ways for the rest of your life! A smell, a dream, or a memory can bring back the feeling of loss at any time, and yes, it may cause you to sob, even decades after the actual loss. (I disagree with DSM's addition of long grief as a disorder.)
There actually is a tradition in Judaism that provides for a longer period after the week of shiva. Shloshim is a thirty day period during which certain things aren't done (shaving for example). So there's a week of shiva, a month of shloshim and finally the one year anniversary of the death, the yahrzeit. People aren't expected to "snap out of it."
My mom, a geriatric social worker, was upbeat in her old age but also very conscious of when and how she wanted her death to be. She talked to my sister and I about it frequently over the years, and especially in her last year when, as she said, she was "weary" and ready to go. The conversations helped a great deal to prepare us for when she died. (My sister said that her one regret was that she couldn't then say to Mom, "Look, it went the way you wanted!" ) It also allowed us to start grieving early (which felt like "anticipatory grieving"). I find that having family and friends around now to whom I can say, "Mom would have liked that" and other observations I don't have to explain makes it easier and extends her life among us.
Subject that's worth more words. Awaiting more of them . . . .