The Many Stages of Grief and Belief
I have just tackled the last unit on death and dying in my diploma. I wanted to do this unit because it forms such a big part of my job and is also an interesting topic that I wanted to learn more about. However, it took me a good year until I finally actually started it. And this was not only because nobody passed away while I was on duty, which should be a positive thing really, but probably more so because a little insecurity signalled that I might have to begin to look behind my emotional barriers and address my own issues to do with endings and the passing of others and myself.
Death is an uncertainty. Yet, the only certainty is death. This concerns humans as much as animals, plants, the whole universe. But because we only know life as it is, it can frighten us to not know what will happen. Uncertainty is often worse. A saying by Paulo Coelho goes: “Fear of suffering is worse than the suffering itself”.
Death can happen at any time, yet we walk around with a distinct sense of security. This helps us to live our life to the full, which we wouldn’t be able to were we to worry about potential dangers around every corner. Death at a young age is usually seen as more tragic, compared to a natural end after a long and successful life. Just, how much more tragic is a gradual decline with Alzheimers, which can weigh heavily on relatives and carers, not to mention the individual himself, compared to a sudden death, maybe due to an accident, where the suffering might be more intense but shortened? At what point are we considered to be “at the end of our life”, if we know that one day we will quite definitely die anyway? How accurate are diagnoses in relation to life expectancy, if some outlive theirs by a few decades, whereas other’s comes to an end unexpectedly quick? These questions remain mostly unanswered, partially because we have no control over life, even with all the medical enhancements, and also because we all experience fear and grief differently.
While working my way through this unit I happened to stumble across a related article in a newspaper. It was about a young doctor that had recently been diagnosed with cancer and had written about both sides, her experiences as a doctor and now as a patient. I ordered both her books straight away (intake goes to charity) and am following her blog (http://drkategranger.wordpress.com). She is exactly my age, which, together with my current thought processes on dealing with death and worrying about ovarian cysts, found its way into my deepest inner self. How would I feel if I was suddenly diagnosed with a terminal illness? What would I do? On top of it comes the worry of my partner that I would rather die young than undergo invasive treatments, since I tend to prefer the natural approach to illnesses.
Since we are all individuals with different life experiences and beliefs, we will all deal with death differently. Some get overtly emotional and cry, others simply withdraw, unable to talk about their feelings. There are those who express anger, who don’t want to give up, who think they have many things left to do and can’t see how they can possibly do it all with the time they have left. They would give anything for a little more time. There are worries about pain and suffering. And there are those who accept this part of life for what it is and often become the rock for their relatives and friends, who might have an even harder time coping with the upcoming loss, since they are the ones left with a gap in their lives. All these responses go hand in hand with the five stages of grief, as outlined by Kübler-Ross: denial, anger, bargaining, depression, acceptance. These can affect everyone involved in someone’s death. The dying individual as much as relatives, old acquaintances and those involved in the care.
How we deal with death depends on our belief or religion. Buddhists, Hindus and Sikhs for example, believe in re-birth, whereas the belief of a Jehovah’s Witness is that their whole existence stops forever when a person dies. Atheists do not hold any belief at all. Christianity proposes that life is a gift from God which is available to all who believe and seek forgiveness and the Mormon Church views life as a test to see if we are ready to return to God after death. Judaism holds the belief that death is the end of earthly life, but that eternal life is offered if we have the right relationship with God. Islamic practises see death as a transition from one state of being to another as part of the will of Allah. (From The Royal Marsden Clinical Nursing Procedures)
Some people only begin to find solace in a religious belief when they are in despair, even if they didn’t belief in anything whatsoever during their whole life. The opposite can be the case as well. Sadly I have known someone who was very dedicated to his spiritual beliefs during his lifetime but was said to have lost all his faith just before he died, making his passing very unsettling for him and those near him.
Then last night there was a documentation on TV about death row in the US. They interviewed those on life sentence and talked about those who had been sentenced to death. This takes on a completely different view on death. Surely, these prisoners must have done terrible things to be sentenced to death. How do they deal with what they have done and what will happen to them? With homicide as much as with euthanasia, the question is: who can justify a killing of another being?
I could probably say that I find it easier to cope with death than the process of dying. I am generally quite open to anything, yet there comes a point where I encounter a natural barrier, something that stops me opening up too much to a situation in order to avoid getting upset. Or maybe even more out of fear that I would lose control over my emotions.
I would do most things for my patients, but sometimes I rather feel like not getting too involved in their care, or with them personally, because I fear I would be overwhelmed with emotions. Sometimes I feel that I am unable to offer all my sympathy and concern a situation requires and end a conversation with a pat on the arm and a reassuring word and smile, which appears rather awkward and foolish to me.
It was a huge moment of change for me when I began working in care, at first being terrified to apply personal care. This has now become routine for me over the years, but it doesn’t have any personal emotions attached to it. Even though you consider dignity, personal preferences and apply a professional standard, there is a difference between a routine bed bath and a comforting hug or holding someone’s hand. It requires a different set of emotional awareness, and actually also preparedness.
The worst is if someone, and this relates to anyone, even in my private life, begins to cry. My immediate response used to be to just run away, to just not have to deal with it. More recently I have begun to remain calm and just listen. To give the individual time to get the first tears out, let the first steam out of the kettle, and then to offer constructive support, to just be there for them, without being overly sympathetic. I am aware of these processes and am still working on them. Attending a course for basic counselling skills has hugely contributed to my awareness and development.
Very “coincidental” came the natural conversation with a patient about his acceptance of death being the gate to eternity, as he called it. He was talking about how he had served in Australia during the war and had only come back to the UK to see his parents, when he fell in love and ultimately become a Christian because of his mother-in-law. He never used to believe in anything in particular before that, if anything than rather more in guides. Now he sais that he has ticked all the boxes that allowed him to go back to God. He had asked for forgiveness for all his sins, had lived a good and interesting life and was rather excited to see what would happen when he finally passed over. He was actually doing really well for 93. I liked his open and cheerful attitude towards death. Of course, a natural death after a long and happy life would be the best option. Wouldn’t it?
A year on after writing about endings I have maybe come a little bit closer to accepting that everything ends one day. Still, we won’t know what will happen after. But I firmly belief that it will be our own belief that will influence that moment for the better or worse. Which way will you choose?