Grieving and the holidays

Grieving and the holidays

By Jeffery C. Ward, MD
Medical Oncologist, Swedish Cancer Institute

A cancer doctor is very familiar with the anxious and fearful grief that accompanies a diagnosis of cancer. We are less acquainted with the lonely and empty grief that is experienced by those left behind when our patients die. However, when I wear my hospice medical director hat, I am privy to those struggles, and knowing that the loss of someone close is particularly difficult during the holidays, I have chosen to divert from subjects I am more familiar with and rely on the experts at hospice to help me present a meaningful discourse on grief during the holiday season.

For the bereaved, the joyous holidays trigger emotions of great conflict. Every act of preparing for the holidays, once a time of cheer and anticipation, becomes another stabbing reminder of ones loss. The demands of family and friends, always a bit stressful around Thanksgiving, Hanukkah, Christmas, and New Year, now are overwhelming, both physically and emotionally. Traditions, designed to create love and family unity, now seem empty and may even create divisions among the grieving. Even successful celebration may bring on a deep surge of guilt for enjoying the holiday alone. And those who have no physical or emotional reserves left for thanksgiving or joy making, may feel great pressure to “get on with their life, and join in the fun.”

It has been suggested that the key word in grief is “permission.” The bereaved need permission from themselves, and from family and friends, to grieve as long as necessary and in any way that works, remembering that what works may not always be the same. It means permission to only do what you can. A turkey and all the trimmings may just be too much this year. Eating out may be perfect. Having someone else do dinner may be better yet. 

Permission may also be needed to change some timeworn traditions. It must be recognized that they may not feel the same, or they may even feel wrong. In fact new traditions, designed to memorialize a lost loved one with a candle lighting, tree planting, or just a new ornament on the tree, may replace those traditions that are now too difficult.  Other traditions, such as the stockings on the mantle or the greeting cards may be abandoned till next year. One can try out the following questions when pondering whether to proceed with old traditions: Will it be the holidays without it? Could it be done differently this year? Is it a tradition or an obligation? 

Those grieving also need permission from those who love them to spend the holiday wherever they need to be and with whomever they need to be with to achieve the greatest comfort and peace. For some that means wrapping themselves in the warmth and familiarity of family and friends, but to others, limited attendance to family get-togethers or even spending the holidays with others rather than family may be in order. A holiday from the holiday may be just the ticket, whether it is skiing, a cruise, a different city, or even a different country. Sometimes the holiday will have greater meaning and healing power if spent alone communing with the memory of the deceased. Finally, others find that only by reaching outside of themselves at a nursing home, a soup kitchen, or shelter is going to bring the true spirit of the holidays back to their hearts.

Finally, of course, those who are grieving need permission to do just that: grieve. The surest way through the heartache of losing someone is to feel it, not deny it. Allowing the expression of feelings, crying when it helps, raging if it is needed, help the emptiness and loneliness to ultimately disappear. Suppressed feelings don’t change, and depression and despair set in.

Paradoxically, the holidays present to the bereaved both extra heartache and an opportunity for healing. Intimacy with death has taught me, more than anything, that our lives, each and every day, is precious. When the grieving passes, and the heart has room for holidays again, the lesson learned, or relearned, is that the best gift one can give to themselves, and to others, is to live their lives with a fullness that honors those they love, both those still with them and those who are not. Then the holidays once again become comfortable, the season bright, and they can enjoy all that it has to offer.

Jeffery C. Ward, MD
Without commenting on specifics to your mother’s case, I think I can address that fine line that physicians of all ilks, oncologists included, walk between disheartening bluntness and unrealistic cheerleading. There is no kindness, and there certainly can be harm, in taking the winds out of a patient’s hopeful sails if they are unprepared or unwilling to hear it. Neither can we practice patient centered care if we fail to share prognostic information, or worse yet, deliberately deceive our patients by shading the truth. Studies have suggested that primary care physicians often underestimate the prognosis of cancer patients. I think that mirrors the expectations of society in general when it comes to cancer. Contrastingly studies have suggested that oncologists tend to overestimate survival for most of their patients. The same way the Seahawks expect to win every game. I would prefer that my oncologist be honestly optimistic.

My advice would be that with your mother’s permission, and preferably in her presence if she is willing, that you express to her oncologist your fears that recurrent cancer may be a different beast than the first time around and ask that he or she clarify where things really stand in terms of risks and benefits of therapy and expectations for survival. Your fears may be allayed or realized, but then you can begin the emotional journey that the answers bring instead of being in the limbo you appear to be in now.
1/8/2014 7:53:10 AM
I was just at SMCCI today for genetic counseling, as my mother has uterine(found on her Fallopian tube)and has 2 recurrent and under going chemo and it's 3 different kinds this time. I am an RN and have worked at a small rural hospital for 22yrs now. A dr I work with and is also my mothers pcp blatantly commented to me that "she'll be real lucky to get through it this time"!!! I was floored, as he walked away. Pretty much consumes me. Her oncologist on the other hand is very optimistic. I've always thought that oncologist are honest with their patients, without giving the patient a sugar coated prognosis?!?! I'm not sure what to do or think? My mother is doing 2-3 weeks on, each Wednesday, then a week off. She is on her 4 treatment this week, and supposed to go until April, 2014....with reevaluating during these weeks.
Do you have any words of advice or encouragement regarding this situation?? I'm so worried about my dear mother. She is 71yrs old, but a young 71....drives, Always helping others in need, etc. Not sure how to shake my co-workers statement...or should I take him serious, opposed to her optimistic oncologist?? Hurting inside more than I can express. We are and always have been a very close family. I realize that life ends for all of it, but I hurt for her and what she is or may be going through emotionally and doesn't talk about. Then this awful statement from her pcp, and my co-worker! I'll read your response and take what you have to say to heart! Please help!
12/23/2013 9:29:38 PM
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