Impact of Grief:
Ours and Those We Serve
Tani Bahti - RN, CT, CHPN
Executive Director Passages
Support, Education in
End of Life Issues
¡Vida! Educational Series
Educational Objectives
• Appraise the impact of grief on you as a
provider
• List 4 possible manifestations of grief
• Describe ways to support those who are
grieving
• Identify ways in which grief opens us to
change and growth
• Discuss the ways our own grief may impact
our ability to help others make difficult
decisions
On Being Human
ON Being the Student
• Taking lessons from our patients and
families
On Being a Healer
Healing requires the recognition of
human face of each person and the
communication that both healer and
the healed share a bond that ties
them
to each other through their
humanity and their mortality.
-Rachael Naomi Remen MD
Emotional Manifestations of Grief
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Denial
Withdrawal
Anger
Acting out
Depression
Blaming
Guilt
Distancing
Physical Manifestations of Grief
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Sleeping
Eating
Joint Pain
Symptoms of ill person
Forgetfulness
Irritability
Stomach or chest pain
Weakness
Fatigue/over-active
• Responding to our grief and that of
others….
My heart has
broken...
...open
Understanding our Grief REactions
• Is it triggering our own losses?
• Is it incongruency between our perception
of what we hoped for as a good death and
what happened?
• Is it triggering fear about our future
losses?
About Grief
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There is no right way to grieve
There is no timetable for grieving
No one “gets over it”
The pain of grief is much longer and
harder than you ever thought possible
• Talking about loss divides the burden
• We can’t take away another person’s
grief
There is no way out of the desert
except through it.
-African proverb
There are no magic words
But there IS magic
in the power of your presence
.
The Healing Power of Connection
“ I recently read a story about a cow who gave
birth to a stillborn calf. She was weak and in pain
after the ordeal. And still, she managed to get up
and walk a long distance across miles of fields to
find her own mother for comfort. She was found
in the distant field with her mother wrapped
around her nuzzling her. Their two large bodies
like one.”
~Rae Sikora
By expressing our
own grief, we may
be providing the
necessary
permission for
them to express
theirs
• We are doing well with our grief when we are
grieving
• Somehow we have it backwards
• We think people are doing well when they aren’t
crying
• Grief is a process of walking through some painful
periods toward learning to cope again
• We do not walk this path without pain and tears
• When we are in the most pain, we are making the
most progress
• When the pain is less, we are coasting and
resting up for the next steps
www.hopeforbereaved.com
People need to grieve.
Grief is not an enemy to be avoided;
It is a healing path to be walked.
www.hopeforbereaved.com
The Work of Grief
• Changes our world
• Redefines our priorities
• Increases awareness of our own mortality
and those around us
• Increases our sense of vulnerability
• Helps us live more consciously
Role of Hope and Healing
• avoid complicated grief through
preparation
If I had only known….
• There are no do-overs
Recognizing the Barriers to
Good Communication
• Fear
• Guilt
• Grief
When grief means not letting go
What does “do everything possible”
really mean?
30% cancer patients die in the hospital
Who are we really palliating?
Are we using technology as
buffer to ameliorate our own
feelings of helplessness?
We did everything…….
• I even raised with her the possibility that
an experimental therapy could work
against both her cancers, which was sheer
fantasy.
• Discussing a fantasy was easier—less
emotional, less explosive, less prone to
misunderstanding—than discussing what
was happening before my eyes.
Oncologist
When unresolved grief or
ability to let go
affects our care
• Dr. S
• Chris and Colton
• My belief is that the use of heroic & experimental
technology is often a moral outrage, showing
callous disrespect for the sacredness of human
life and pathetic inability to face the reality of
human death
• Peggy Stinson
-The Long Dying of Baby Andrew
The number of respondents was 10,078
from 25 specialties through Medscape
• Would you ever recommend or give
life-sustaining therapy when you
judged that it was futile?
• Yes, 23.6%
• No, 37.0%
• It depends, 39.4%
• Would you ever prescribe a treatment that's
a placebo, simply because the patient
wanted treatment?
• Yes, 23.5%
• No, 58.3%
• It depends, 18.2%
• Would you hide information from a patient
about a terminal or preterminal diagnosis in
an effort to bolster their spirit or attitude?
• Yes, I soften it and give hope even if there's little
chance, 14.6%
• Yes, unless someone is going to die imminently,
I don't tell them how bad it is, 1.7%
• No, I tell it exactly as I see it, 59.8%
• It depends, 23.8%
Just because someone is dying…
No one failed
The role of a healer is to be present in the
midst of profound helplessness.
Understand Your Own Barriers
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Fear
Resistance
Death history
Discomfort with disagreements, anger,
grieving
• Discomfort with helplessness
• Making assumptions about what the
family knows/sees
Family Barriers
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Lack of information
Misinformation
Technology
Unresolved issues
Fear
Ability to let go
Jinxing - “If we talk about it, it will
happen”
Inability to hear
happen”
Impact of Having the Discussion
About End of Life Care
• People are not more depressed after
having a discussion
• Less use of aggressive intervention and
improved quality of life of those facing
death
• Cancer patients live longer and more
comfortably under hospice care
• Improved quality of life for patients is
correlated to improved bereavement
adjustment of caregivers after death.
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Results of NCI and NIMH study at the Dana Farber Cancer Institute Study
The Advocate’s Role
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Investigate
Explore
Educate
Advocate
Support
Illness is a
dynamic
and
transformative
process
Are you giving up on me?
• “I do not think we should continue with the
cancer treatment. It is time to stop
focusing just on the cancer and spend
more of our effort focusing on the rest of
you.”
• Atul Gawande, NYT article, “Letting Go”
Giving up vs. Letting Go:
Defining the Good Fight
Transforming Dying
• Acknowledging, embracing, preparing
despite the pain
Life is not measured by the
number of breaths you take,
but by the number of moments
that take your breath away.
A New Dialogue
• What do I need to live my remaining life as
well as possible?
• What do I need to accomplish?
• What is my source of strength?
• How do I still have value?
• Where do I find meaning in all this?
• How can I help my loved one/family to
make the best of difficult circumstances?
Obtaining Closure
Facilitating a good death
While death is inevitable, knowing you are loved is
not.
When I saw Hannah’s radiant face
in the center of that circle, I realized that healing can
happen even without a cure. No matter when
Hannah
died, she would die knowing that her life mattered,
that she was completely loved.
I couldn’t imagine a more profound healing than that.
Maria Housden, excerpt from
Hannah’s Gift - Lessons From a Life Fully Lived
People may not remember what you said.
People may not remember what you did.
But they will always remember
how you made them feel.
What you leave behind is not what is
engraved in stone monuments, but what is
woven into the hearts of others. -Pericles
Starfish Story