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Navigating Loss: Dealing with the Pain and Letting Go

“It isn’t what happens to us that causes us to suffer; it’s what we say to ourselves about what happens.” ~Pema Chodron

I remember when I first read the pathology report on my patient, Mr. Jackson (name changed), my stomach flip-flopped. “Adenocarncinoma of the pancreas” it said.

A week later, a CT scan revealed the cancer had already spread to his liver. Two months after that, following six rounds of chemotherapy, around-the-clock morphine for pain, a deep vein thrombosis, and pneumococcal pneumonia, he was dead.

His wife called me to tell me he’d died at home. I told her how much I’d enjoyed taking care of him, and we shared some of our memories of him. At the end of the conversation I expressed my sympathies for her loss, as I always do in these situations.

There was a brief pause. “It just happened so fast…” she said then and sniffled, her voice breaking, and I realized she’d been crying during our entire conversation. “I’m so sorry for your loss,” I told her again. She thanked me for caring for her husband and hung up.

I’d known Mr. and Mrs. Jackson for almost seven years and had always liked them both immensely. I thought the world a poorer place without Mr. Jackson in it and found myself wishing I’d done a better job of consoling his wife, thinking my attempts had been awkward and ineffective. I reflected on several things I wished I’d said when I’d had her on the phone and considered calling her back up to say them.

But then instead I wrote her a letter.

Navigating Loss

Dear Mrs. Jackson,

When you called me to tell me your husband had passed away and how hard a time you were having, I found myself frankly at a loss. Conventional wisdom about how to console people who’ve suffered grievous losses includes platitudes like “be there for them,” “listen,” and “let them know you care”—all valid and useful guidelines that I’m sure have brought comfort to many suffering people.

But inevitably conversations end, people go home to resume their normal lives, and the wife or husband or son or daughter is left alone with pain now occupying the space their loved one used to be. Though I don’t know how comforting you’ll find this letter, I wanted to share with you some of my thoughts about grief in hopes of making your journey through it somewhat more bearable.

Why do we suffer when we lose those we love? I think the true answer is because we believe we can’t be happy without them. Knowing how much you loved your husband, I can only imagine how strongly you must feel this to be true. And yet I often think the only reason the pain of loss abates at all is that we do become convinced we can be happy again—just slowly and unevenly.

Certainly, some people find themselves stuck in grief, unable to move on. Sometimes this happens because we actually become reluctant to surrender our grief even after it’s run its proper course, believing the pain of loss is the only thing keeping us connected to our loved one, or that to feel happy again would be to diminish the significance of the relationship we once enjoyed.

But neither is true. Even when people we love die, our relationships with them do not. We continue to have feelings about them, memories of things they did, imaginings of things they might say were they with us now. Just because the pain of losing them diminishes with time, their importance to us need not.

Normal grief is like a roller coaster: there are ups and downs, moments of pain intermixed with relief. If, however, after the first six months or so there seem to be fewer periods of relief rather than more, normal grief may have changed into full-blown depression. If you think this might be happening at any point, please let me know. I can help.

Everyone grieves differently. Don’t ever let anyone tell you how to do it. If you want to talk about your husband with others, do. If not, don’t. There’s definitely something mysterious about the human psyche–some intrinsic force within us that continually seeks to engulf pain and suffering the way our white blood cells engulf viruses and bacteria.

It’s an elixir we seem to swallow at the very moment our loss occurs that immediately begins to work on our suffering without us even knowing it but which nevertheless somehow eventually cures us of it.

After experiencing a devastating loss, if you’ve allowed yourself to feel the legitimate pain it’s brought and not sought to avoid feeling it, things slowly start to improve. We wake one morning to find there’s something in the day we’re actually looking forward to; or someone says something funny and we actually laugh; or we find ourselves able to plan things again, even if only a trip to the grocery store.

But there’s no definite timetable for this. Don’t allow anyone to hurry you along with their expectations about when your grief should end.

Just know that it will. It may seem to you now, while in the middle of the worst of it, that it won’t, that your happier self was only a dream and that this grieving self is here to stay for good. But that’s an illusion brought about only by your current life-condition. Nothing is forever, including the pain of loss.

Don’t grieve alone. I worry that you have no one with whom to share your grief (you’ve told me in the past how you were all alone except for your husband). While you may not have much energy for this, I find myself hoping you’ll join a support group, either at your church or by looking online.

There’s something often magically healing about spending time with others who’ve had or are having painful experiences similar to your own. It may seem an overwhelming prospect now, utterly beyond you, but often by holding someone else’s hand, by becoming their support, you’ll find your own pain lessens just a little bit.

When you shine a light to guide others on a dark road, your own way is also lit.

Forgive yourself your failures. You said on the phone you “felt guilty,” but not what you felt guilty about. I wondered about that.

I wondered if you felt guilty about having spent time doing things like seeing other people or watching television rather than spending every moment with him; or about feeling tired of caring for him; or about not always having a positive attitude when you were around him; or for wishing the nightmare of his illness had actually ended sooner—or any of a myriad of things family members have told me have made them feel guilty, too.

Or maybe you feel guilt about the decisions you made when your husband was no longer capable of making them himself. The end of a person’s life is often composed of gut-wrenching choices that land squarely on the shoulders of family members: to put in a feeding tube or not; to use mechanical ventilation or not; to use heroic measures or not; to decide not to press forward with an intent to cure but rather with the intent to palliate.

I know you struggled mightily with the decision to stop treatment and bring him home to be comfortable, but you must know your decision did not cause his death. His disease did. His disease is what thrust you into a situation you didn’t ask for or want, but accepted with grace, making every decision with as much deliberation and wisdom as you could muster, even when you were exhausted, and always with an eye towards his comfort.

Forgive my presumption, but if you feel guilt over any of these things—or over other things I didn’t mention—you must forgive yourself. There was never a need for you to be a perfect caregiver—only a caregiver who cared, and that you most certainly were. The person who gets sick is never the only one whose life is deeply affected by their illness. This was your experience, too.

I want you to know that watching the way you were with your husband always inspired me. I can only hope to face losses in my life with as much courage, acceptance, and humor as you and your husband did both.

While no one knows what happens when we die, we can say with certainty that we lie between two equally inconceivable possibilities, one of which must be true: either the universe has always existed and time has no beginning, or something was created from nothing.

Either case makes every one of us a miracle.

Photo by alexbrn

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About Alex Lickerman

Alex Lickerman is a physician, the former director of primary care at the University of Chicago, and has been a practicing Buddhist since 1989.  He blogs at www.happinessinthisworld.com.

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  • klynn

    Thank you for this profoundly touching piece…I really needed it today.

  • klynn

    Thank you for this profoundly touching piece…I really needed it today.

  • http://mindfulsearcher.blogspot.com/ Mindfulsearcher

    Thank you for this lovely post. I lost my mother to pancreatic cancer and her death was exactly as you described Mr. Jackson’s. My recovery from my grief at her loss was helped so much by the fact that I am a musician and was able to make a musical offering at her memorial service. So often, when I face difficult choices, I am reminded of my mother’s gentle guidance and know that she’s present helping me with my decision. I hope that Mrs. Jackson is comforted by the wonderful memories that live on in her mind and heart and know that your letter was of great help to her.

  • Kristina Gehring

    This is a wonderful post – however – I myself am currently in my own process of grief. I lost my 5 month old son 6 months ago to SIDS – and parts of this post do not apply. Dealing wth the pain and letting go when dealing with the loss of a loved one is immensely different when that loved one is your child. The “woulda – coulda – shoulda” syndrome is horrible, not having a reason for your child’s death makes things exponentially worse and even harder to deal with. SIDS is not an answer – its the lack of one.

    However, in our case, we were given a gift, a wonderful, joyous gift, for 5 months. Our son’s life had meaning, and thus his death should too. So for those dealing with the loss of a child, due to unexplained circumstances, many aspects of the grief process are different, changed, and exaggerated.

    I only hope that anyone dealing with the loss of a child, like I am, finds solace somewhere, regardless of where, as long as its healthy for self and others.

    I look forward to reading more of your articles.

  • Alickerman

    Kristina,
    I must agree (though I’ve not experienced the devastation of losing a child) that the two kinds of losses, while similar on the surface, are fundamentally different in important ways. I have a two-and-a-half year-old son and can’t even imagine the pain I’d feel in losing him.

    We all want what happens to us to make sense, to be part of a narrative that we understand and can use to explain to ourselves why certain things happen to us, if for no other reason that it helps us to move on, to proactively deal with the consequences of our loss. Lacking closure we don’t know how to think about our role in what happened and, I think, more easily get stuck in grief (the “woulda-coulda-shoulda” you mentioned). My sincerest condolences on your loss.

  • http://uzma7.wordpress.com Uzma

    Very powerful. More so because it allows people to accept pain and not hide it, to see it, embrace it and let it go. Such a hard time and such a healing one.

  • http://caity.nu Caity

    What an absolutely gorgeous letter. I am sure it really helped “Mrs. Jackson” through her rough time. I know it would have helped me immensely. Thank you so much for sharing such wonderful thoughts with us.

  • Stephanie

    I hope that if my parents or I go through cancer in the future, we can deal with a healthcare provider who is even half as insightful and caring as you are. Thank you for this article.

  • Grace

    I lost my husband of 20 years in an accident in January 2010. Our last words with each other had been ones of impatience on the phone. I will always regret that I did not get to say goodbye and reassure him of the deep love I had for him. He will always be a part of me. However, the difficult part is that he is not there to hold and comfort me and nothing can change that. Be gentle and be patient with each other and our grieving selfs.

  • http://www.perigee-syzygy.com Perigee-syzygy

    “While no one knows what happens when we die, we can say with certainty that we lie between two equally inconceivable possibilities, one of which must be true: either the universe has always existed and time has no beginning, or something was created from nothing.

    Either case makes every one of us a miracle.”

    Thanks for sharing such a wonderful letter. I especially was struck by the last two paragraphs. You expressed this mystery so beautifully. I may quote you on this!

  • Kimster

    Thank you for sharing this.

    “…believing the pain of loss is the only thing keeping us connected to our loved one, or that to feel happy again would be to diminish the significance of the relationship we once enjoyed.” So true. I think this is often one of the biggest contributors to extended grief. However, it is often much easier to distinguish it objectively than with yourself.

  • http://www.onekindwordproject.org/ Molly

    That letter was beautiful, and I’m sure it brought much comfort to her. I know it comforted me.

  • Nancy Marshall

    That was absolutely beautiful and very generous of you to write. I just lost my mom who had adenocarcinoma (of unknown origin). Your article “popped up” and right in front of me on the screen, it was if someone had been reading my mind and delivered me from pain on the spot as I was “stumbling” on various subject matters.

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  • Freeman

    To Kristina,

    Our daughter’s baby girl died after 15 weeks of life…she was born with a fatal chromosome disorder. A counselor convinced my daughter that if the baby had been healthy and lived,  she would have been a different baby… not the baby who was born with the fatal disorder. This thought seemed to give our daughter some peace and comfort. For me, the grandmother, it didn’t help much but maybe you can find some comfort in thinking this way.

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  • Chimerra6

     Grace, I so agree.  I recently lost my husband in a work place accident, but thankfully I spoke to him the night before – telling him how happy I was that he would be home in “2 more sleeps” and told him I loved him – basically just a quick call.  But…because it happened so suddenly, you and I never had the chance to reassure our sweethearts how very much a part of “us” they were, or more importantly, a chance to say goodbye.  That is what I yearned for, a last chance to hold him, kiss him and tell him how deep my love is and how my heart is ripped apart at losing him.  I hope everyone understands and follows your advice of your last sentence:  be kind, tell them you love them.

  • jwdudley

    Jehovah is the “God of Comfort”.

    “Blessed be the God and Father of our Lord Jesus Christ, the Father of tender mercies and the God of all comfort.”—2 COR. 1:3.

    Jehovah has made provision for the resurrection so that we may be re-united with our loved ones in the very near future. This promise is made sure by Jesus as found at John 5:28,29.

  • jay

    So helpful, so kind. many thanks.