Anticipatory Grief... a time of opportunity

Depending when you are coming upon this blog, I thought I should introduce an article on Anticipatory Grief ....


Looking back on my own experience of caring for my late wife and working with hospice families I see anticipatory grief as hard work. If you are not too exhausted from the drain of emotions and the hands on care giving, the time after the terminal diagnosis and before the passing of your loved one can be a time of reflection and even an opportunity to gain new insights into your dying loved one and yourself.  I feel like it is a last chance to tell your dying loved the things that you may not have ever got around to saying to him or her.  I told myself and tell my hospice families not to be left with regrets.  As you are caring for your lived one look for "windows of opportunity" to speak with your loved one while they are still alert.  Remember even when they are non-responsive they can still hear you, because as you may have heard, "the hearing is the last thing to go."

In my early days as a hospice social worker, I was sitting with a younger patient and her husband in a suburb north of Cincinnati.   She had been completely non-responsive for 3 days.   The husband wanted to talk about details of the funeral.  I recommended we go into a different room because his wife could see hear us, his intention was not to discuss funeral plans with wife. He stated he didn't believe she could hear us and proceeded on with his questions, comments. About 3 minutes into this conversion his wife was startled awake, partly sat up and told him, "I told you, I did not want roses at by funeral."  She then settled back down and became unresponsive,dying 2 days later. Expect the unexpected.  Don't miss the opportunities that may await you. - Tim Heller

Coping with an Impending Death

Suggestions to help you deal with the anticipated loss of someone you love

By , About.com Guide
Updated December 22, 2012
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

Wife & Terminally Ill Husband
Coping with the impending death of a loved one can cause many emotional challenges.
Photo © iStockphoto


While the sudden, unexpected death of a loved one can unleash a torrent of anguish and grief, a family member or friend who departs from the living over days, weeks, months or even longer can prove just as traumatic for survivors because of anticipatory grief -- the sadness felt in advance of the death.
Here are a few of the emotional challenges you might encounter as you attempt to cope with the impending death of your loved one, and suggestions to help you deal with them.
Feeling Exhausted

Regardless of whether you are serving as a caregiver or not, knowing that your loved one's time is limited will take a toll on your physical and emotional strength. People can only live effectively in a "state of emergency" for a short period. While that length of time will vary depending upon the person and the situation, once that limit is reached, the mind and senses will begin to shut down as a self-preservation measure. This can manifest itself in many ways, including:

  • an overwhelming need to sleep
  • lack of concentration
  • an emotional "numbness" or detachment.
It is important to understand that these feelings are perfectly normal and do not mean you are cold or unfeeling. Eventually, your body and mind will recover, and you will feel normal again -- until something else triggers a state of heightened emotional response. You should expect to experience such waves of feeling and to view the times when you shut down as necessary and healthy.
That said, make sure you also get enough sleep, eat properly, spend time with other family members or friends, and can recognize the signs of caregiver burnout.
Feeling Tongue-tied

Death is a difficult subject for most people to talk about, and particularly so when we must bear witness to the protracted death of a loved one. Because we feel uncomfortable, we often begin making assumptions in our head about what our loved one does or doesn't wish to talk about concerning their impending death, such as, "If I express how much I will miss him, it will make him feel worse," or "I won't say goodbye until the very end so she and I can find some happiness in the time remaining." The net effect of such internal conversations is often that nothing is said, which can actually make a dying person feel isolated, ignored or alone.
As difficult as it might feel right now, open and direct communication is the best way to interact with a dying loved one. Let him or her know that you would like to talk about how you are feeling, as well as what you can provide during the time remaining in terms of support and comfort. Once the honest conversation begins, you might discover that your fear about having this conversation was overblown.
Feeling Guilty

When someone we love is diagnosed with a terminal illness, it is very easy to focus all of our attention and energy on the patient almost to the exclusion of our own needs. The strain caused by caring for a dying loved one -- particularly for those providing a significant amount of the care -- can often lead to caregiver stress as the physical, emotional and even financial impacts take their toll. While it might seem unthinkable, caregiver stress can lead to feelings of resentment, anger or frustration toward the dying patient -- and those feelings often trigger a profound sense of guilt. If left untreated, such emotions can seriously complicate the grief one feels after the patient dies, putting you at risk of depression, thoughts of suicide or post-traumatic stress disorder.
If you exhibit signs of caregiver stress, you should immediately talk to your family or friends and say, "I need help." Ideally, someone can assume some of the responsibility that you have shouldered, even temporarily, in order to give you a break and alleviate some of your stress.
If that is not an option, then consider a more-formal type of respite care, such as an adult day-care facility or hiring an in-home caregiver, in order to give yourself the break you need. While it might seem difficult to force yourself to let go temporarily, you will return more refreshed and energetic and provide much better care to your dying loved one.
Sources:

"How to Say Good-bye When Someone You Love is Dying." www.caring.com. Paula Spencer Scott, Caring.com. Retrieved July 17, 2012. http://www.caring.com/articles/how-to-say-goodbye
"Resources Near Time of Death." https://hopkinschildrens.org. Johns Hopkins Children's Center. Retrieved July 26, 2012. https://hopkinschildrens.org/Anticipated-Death.aspx
"The Long Road." www.jenniferallenbooks.com. Jennifer Allen. Retrieved July 26, 2012. http://www.jenniferallenbooks.com/grief/pdf/longroad.pdf

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