Surviving With Grief

Everyone will experience grief during his or her lifetime. Grief occurs after some kind of loss—from disappointments such as an unmet expectation (“I thought I would be able to travel home for Thanksgiving this year, but I can't.”) to the loss of a job to the death of a loved one.

There are many ways to experience grief. Grief can appear as feelings, physical sensations, and/or changes in behavior and thinking. The feelings that go along with grief include sadness, anger, guilt, anxiety, loneliness, fatigue, helplessness, shock, yearning, relief, numbness, longing and emptiness.

Physically, grief may show up as feeling empty inside, tightness in the chest or throat, being very aware of noises, trouble breathing, feeling weak, having no energy, and dry mouth. Other symptoms of grief include changes in behavior, such as disturbances in sleep or appetite, and changes in thinking, such as finding it hard to concentrate and feeling confused.

Preparing for Grief

In August 1998, Cynthia Furness' father was diagnosed with mesothelioma, a rare kind of cancer that occurs in the membranes of the lungs. From the start, Cynthia and her family learned that remission was not likely.

Furness, a teacher and writer, immediately began to cope with the expected loss of her father. “There was never a question that he would survive the cancer,” Furness recalled. “All we could do was wait.” Her father, Sheldon Scribner, was told he had six to 18 months to live.

In fact, Scribner lived another 20 months. During that time, Furness did everything she could to deal with her dad's imminent death. She called him every other day and traveled 75 miles each way every two weeks to see him.

Cynthia Furness' parents posed for this photo many years before her dad was diagnosed with malignant mesothelioma

“It was important to me to somehow capture an essence of who Dad was, in words, music, and pictures,” she said. This included conducting on-camera interviews, creating audio tapes of her and her siblings singing her dad's favorite hymns, and compiling a photo collage of her family, the center of which contained a picture of her parents, framed by pictures of the Scribner children. Photos of grandchildren rounded out the collage.

“When it was finished, it effectively captured the essence of the continuity of their legacy for their family. It became a treasured item,” Furness said of the collage, noting that her father kept it in view no matter where he was in the house.

Furness said she also sought outside help in dealing with her dad's illness. “After Dad's diagnosis, I purchased a dozen books on death and dying,” she said. “My method of coping with a tragedy like this is to obtain as much information as possible and then decide on a course of action.”

In addition, she coped by talking with a therapist. “I can't overestimate the positive impact that having a competent therapist has made through the difficult circumstances of my life in the past year.”

Furness, who was also going through a divorce, joined a divorce support group and a church. She found additional support in colleagues, friends, and in the enjoyment she gets from her work.

“For myself, as a teacher, I have been grateful for the energetic, receptive faces that I see every day at work. The children really have helped keep me focused on the living,” Furness said.

According to Mary L.S. Vachon, RN, PhD, consultant in psychosocial oncology and palliative care, Toronto-Sunnybrook Regional Cancer Centre; associate professor, Departments of Psychiatry and Public Health Sciences, University of Toronto; and clinical consultant, Wellspring, Toronto, Ontario, Canada, there are many ways to cope with the expected loss of a loved one.

Vachon advises people who know a loved one is going to die to try to prepare in advance, if they are able. The grief counselor said there are several ways to do so, including simple tactics, such as spending time together. Vachon suggests seeing to it that the person gets the best care and symptom relief possible. She said, “Consider hospice or palliative care programs in your area.”

In the last weeks of her father's life, Furness' family sought the help of a hospice. Until then, the family felt that all the resources they needed were at their disposal. “As Dad neared the end, he needed more and more assistance,” Furness said. “Hospice providers bathed and shaved him for the last two weeks. At that point, they were able to offer printed information about the signs of impending death, so we would be ready.”

Furness appreciated the hospice's involvement in her father's final days, stating that the hospice was able to interact with her family in ways her father's healthcare team did not.

“There is very little in standard medical training that prepares medical practitioners for handling the grief of family members,” she said, “All that changes when a hospice becomes involved. Family members, as well as the patient, were accorded with compassionate respect and given the time that each needed to understand what was necessary for Dad's care, and why.”

Vachon believes there are additional ways for people to prepare for the death of a loved one, many of which Furness found helpful. “Videos, photos, and journals are all helpful if the person is prepared to do this. If kids are involved, they may want to do a scrapbook of their relationship with the person who is sick, with drawings, poems, writings, photos, etc.” Vachon also suggests that the person who is terminally ill make videotapes or write letters to family members.

Experiencing Grief After the Death of a Loved One

When Furness talks of her father's last days of life, she does so with clarity, recalling the details vividly. Her father was so weak that he fell on his way to the bathroom. After his fall, his pain grew unbearable and his morphine dose was increased. He was also given supplemental oxygen as he was experiencing "oxygen starvation" from the effects of the cancer. Furness was by his side, singing to him and reading him his favorite Bible verses while the sound of the oxygen he needed to breathe filled the room.

Furness remembers, “During the night of the day that he died, he told my mother, ‘Dying.' That's all he could say. She knew. Hours later, in the small of the night, we gathered around his bed to listen to his breathing and touch him. We talked to him, but he had slipped into a coma. Still, we knew he might hear us. It's the last sense to go. His breathing changed, and he died.”

Furness says of this photo of her dad, “This was taken early in April – the 8th, I think, two weeks before he died. The suspenders kept his pants from falling down, because he had grown so thin. He could no longer wear a belt because the malignancy had invaded his intestines and there was a mass in his abdomen that made constriction there painful. He didn't get out of his chair much after that. His fateful fall to the floor was one week after this picture. I have no more after this one – I couldn't stand to document it.

In the days following her dad's death, Furness felt many emotions. “Doubt, rage, fear, sadness, grief, humor, gratitude, and a deepening respect for my siblings and mother. Disbelief. Dizziness. Wave after wave of changing emotion.” Furness also wondered, “What now?”

She spent another week with her mother and then took a few days for herself. She talks of the first two days when she finally returned home, “I was absolutely incapacitated for two days after that. Couldn't eat, sleep, couldn't get off the couch. But after that, I slowly got back to the business at hand.”

While Furness struggled to understand what her life would be like with her father gone, she watched her siblings and her mother struggle also. She saw strength in some of her siblings and in her mother that she had not known existed before. She talks of how her family found strength in each other and stressed the importance of letting everyone grieve in their own way and their own time.

“Each person has his/her own timetable for grieving, dictated by background and personality,” Furness said. “I think the process of grieving, the acceptance of loss, has a timetable as long as life lasts. I will never forget nor will I not feel the loss whenever I think of my dad, as long as I live.”

Although individuals deal with grief in different ways, Vachon said the grieving process is generally made up of three components: loss, grief, and recovery. Vachon has created what she calls a “personal rule of thumb for the course of grief.”

“From the time of the death to the first month or two the person is in a stage of numbness and disbelief, then the real pain of grief begins to set in. Two to three months after the loss is a very painful time. From six to nine months people often begin to question, ‘Is this all there is to life?' The ‘business' associated with grief is often completed and the sense of loss can be very painful,” she said.

Vachon continued, “From about nine to 12 months, one is often living two years at the same time – aware of what is happening in the moment while at the same time often feeling that one is back a year ago. People can often recall quite clearly what was going on one year ago. Many people expect grief to be over after the first year but I find that sometimes the second year can be more painful than the first.”

“To me, recovery is learning to live around the memories,” Vachon said. “I think of grief as scar tissue that you learn to live around. You are never the same, but the memories become part of you, tender at times, stronger at other times.”

In losing her father, Furness says she also allowed herself to learn. “I learned that my father valued me. He told me, many times, during his illness, in spoken and in unspoken ways. He wrote it in a letter enclosed in the birthday card that he made for me last year.”

She continued, “Grief appears at unexpected, odd moments now, when I remember something that Dad had always loved, ways that he has taught me to handle decisions, and many other things.”

Recognizing Depression

Vachon said there are some ways to tell if a person is experiencing depression in addition to their grief. “Grief has overtaken your life if you develop the signs of a major depression or if several months after the death you have made no progress to integrating the death into your life and beginning to move on in some way,” Vachon said.

Those who feel overcome with grief may wish to talk to a grief counselor. According to Vachon, “A person may require grief counseling if they are experiencing the signs of depression or if they feel that they are having a hard time with their grief and feel that it would help to speak with someone experienced in providing such counseling.”

Recognizing depression in a person also experiencing grief is different from recognizing it in someone who is not grieving. Vachon notes that a diagnosis of major depression is not given to someone who is grieving unless they have five or more of the symptoms of major depression and if the symptoms persist for two or more months after the loss. These symptoms include depressed mood, loss of interest or pleasure, significant weight loss without dieting, trouble sleeping (either too much or too little), feeling restless or lethargic nearly every day, feelings of loss of energy almost every day, feelings of worthlessness or excessive or inappropriate guilt, diminished ability to think or concentrate, recurrent thoughts of death, recurrent suicidal ideation, and suicide attempt or having a specific suicide plan. A person having any of these symptoms should see their doctor for help.

Living With Grief

Cynthia Furness is getting on with her life. It has been several months after her father's death and the teacher says, “I am now 47 years old and have just embarked on a completely new chapter in my life.” Recently divorced and the owner of a new home, Furness still grieves for her father and seems to miss him most at moments like her daughter's June wedding or her recent moving day.

Since her father's death, Furness has faced her own cancer diagnosis. She recently had surgery to remove a malignant tumor from her thyroid. She is hopeful that the surgery removed all of the cancer.

“Is life getting easier since Dad died?” Furness asks. “My personal life has improved with the ending of a failed relationship. I have now moved into my own place, which I can decorate in any way I choose. I can embark on a new chapter of my life, pursuing a doctorate in education in doing therapy or in developing my writing for publication.”

She continues, “All that has happened in the past year has brought me to my knees. Whatever I do after this will forever be colored by it.”

Grief Resources

Experiencing grief is a normal part of life. Understanding it and getting support are helpful when dealing with it. Vachon suggests visiting the Self-Help Clearing House website, which contains links to online and real-life support groups. To find a grief counselor, a person may ask their loved one's healthcare team or their own doctor or nurse for referrals. GriefNet is another resource on grief and grieving.