Saturday, October 27, 2007

Grieving for a Parent

This week marked the 3rd anniversary of my Daddy's death. Because he had "beaten" cancer in 1991, and reached that all important 5 year, Cancer-free milestone, he, and we thought he was home free. When, in 2004, he began to have some back pains, he wrote it off to "old age." At 77, he had to expect some aches and pains, right? By the time he went to see the Dr. in July of 2004 because of bloody stools, the cancer had metastasized from his remaining kidney to his spine, stomach, liver,and lungs.

It was August before all the tumor typing and classing was done. That was when one resident finally gave us a prognosis, none of the Attendings would be that brutal. But this one Resident talked to one of my Stepbrothers and me. He wouldn't say anything in front of Daddy or my Stepmother, they had so much hope and faith, he just couldn't, I guess, or maybe the Attendings had told him not to say anything. But, we cornered him and just bluntly said, "Look, we're not like Mom and Daddy. WE know it's bad. Just give us a round number so we can start to prepare ourselves and the rest of the sibs, and our kids and nieces and nephews. They deserve that much. We'd like for them to be able to see him while he's still in good spirits, not when he's too weak or in too much pain to respond. " God Bless him, He took us at our word. "Well they want me to tell you a year. But I think that's way too optimistic, I don't see him lasting much past Thanksgiving, Christmas at the outside."
That knocked me for a loop. This was August. But I took a deep breath and gutted it up and thanks the Doc and shook his hand.

I went downstairs, cried for a few minutes and then I started calling. I called my kids, I called Daddy's closest out of town Cousins. I told them they didn't have to come that weekend, but they needed to come soon.

I also called members of his High School football team. The remaining members still got together for lunch once a month. I told them, honestly how serious it was. He was as close to these men and their wives as as he was to brothers. He loved them. And they came. The ones who lived close to the hospital came often and came to see him at home, too.

I am proud of that. I think it was a kindness and that it helped Daddy. I know it helped me and eased my mind to see him surrounded by all that love and affection.

As I was watching Daddy die, I was watching myself go through the classic stages of grief at the same time. Anger, Denial, Bargaining, Depression, Acceptance, yeppers, went through all of them. Though not necessarily in that order and I went through some of them more than once. It was surrealistic at times because I'd get this detached, clinical feeling of watching myself from a distance, "yes, now I'm Angry." "OK, now I'm in the Bargaining Stage." "Look, Holly you're in Denial again, and you KNOW that's not productive!"

One of the most useful tools I learned when I was in training to be a Grief Counselor was to give the client permission to be ANGRY at the person who is dying/has died. I hear what you're thinking, "WHAT?!?! How can you be mad at someone for dying?" Simple, when you think of dying as abandonment. And, if you're honest with yourself, emotionally, death feels like being abandoned now doesn't it. When a friend lost her Mother and was going through a really bad bout of depression a couple of weeks after the loss, I went to visit her. I said, "You know, it's okay to be mad at her. After all, she DID abandon you." If you want to yell at her and get it off your chest, I won't tell anybody." For a couple of seconds she just looked at me with this shocked expression on her face. Then she was crying and grinning at the same time, "I am pissed off at her. She DID go off and LEAVE me here. How dare she do that to me? I've still got a family to take care of and problems to go through, and, and and..."

See what I mean? When you're given permission to feel an emotion that is somewhat shameful, it is liberating. It allows you to own that emotion and work through it instead of keeping it bottled up and having it fester inside. Emotions WILL find a way to express themselves if you don't do it verbally,trust me. Ever had a tension headache? Known someone with an ulcer? If they'd express those nasty old emotions...

Losing a parent is one of the most stressful events that an adult experiences. We expect to loose them at some point, but we dread it, too. Unless there was a history of horrible abuse, and sometimes even then, we hope for a final showdown or resolution before our parents leave us. But for the lucky among us, our parents death symbolizes the loss of a layer of "insulation" between us and the world. NO matter that we are functional, independent adults and our parents may have been the infirm of body and mind; we may have been the caretakers with them in the dependent role. We still have the illusion of our parent as Protector, as guardian from all things dark and menacing.

Losing that illusion is a blow. One that it takes time to heal. I have been granted that time by a loving and understanding family.

I hope that those of you who have lost or face losing a parent have been or will be comforted or in some helped by reading this entry. AS always, if you have questions or comments, you may leave them anonymously in the comments section or send me an email at the addy listed to your right.

Saturday, October 20, 2007

An interesting blog someone else wrote

I got this from a Blog named: Rickety Contrivances of Doing Good. You can find it here. I have highlighted in orange the phrases and words I found most significant. I hope y'all find this useful, too. The author's name is at the bottom of the blog.
Sunday, October 14, 2007

Narrating Trauma
I've posted here before about the work I'm doing with the University of Nevada School of Medicine, helping them integrate more narrative medicine into the curriculum. Since I have a PhD in English and volunteer in an emergency department, the UNSOM folks like having me there, and I certainly like being there; it's a place where I can integrate several areas of my life that otherwise seem far-flung.In the ED itself, I think of myself as practicing a kind of narrative medicine, encouraging patients to tell stories and listening carefully to what they say. But I'm well aware that most of the medical staff has very little time to do anything similar (which is why chaplains are so important!). In the ED, narrative medicine seems like a luxury better suited to slower-paced specialties where caregivers develop relationships with their patients over time. And that's a real shame, because for patients able to speak at all, turning their fear and worry into narrative can have powerful healing effects.

A few weeks ago, I gave a very basic lecture on trauma theory to my freshman composition class. Trauma -- used here more broadly than medical caregivers define it -- is any event that overwhelms the individual's ability to cope. Trauma takes many forms, but all of them share certain characteristics:
1. Trauma is unpredictable and uncontrollable.
2. It threatens the individual with death, not-being.
3. It threatens and undermines meaning, toppling previous belief systems.
4. Because it is so overwhelming, the individual carries it inside even when it appears, to outside observers, to have ended. It is always now and always here.
5. Because it is so overwhelming, it is extremely difficult to talk about: partly because it defies language, partly because the individual fears invoking it again, and partly because often, no one wants to listen, or is able to understand.

And yet talking about the trauma, shaping it into narrative -- a story -- is essential, because narrative is the opposite of trauma:
1. Storytellers control what happens in the story, so telling a story about the trauma gives the victim control over it, the very control that was lacking in the event itself.
2. Telling a story is a way of asserting survival and existence: "This happened to me, but I'm still here to talk about it."
3. Telling stories is how we make meaning of what has happened to us, shaping chaos into coherence.
4. Telling a story about trauma externalizes the trauma, moving it from the victim's brain and body into public space. Story-telling helps survivors birth their own experience.
5. Shaping the trauma into language, taming it into a tale, helps survivors "rejoin the land of the living" by casting what has happened to them into shared language.

Stories build a bridge of words and images between the trauma and the rest of life. This is why I believe that narrative is as vitally important in the emergency department as it is anywhere else in medicine. Of course, many ED patients are unable to speak, and of those who can, some may be so overwhelmed that it will be days or weeks before they can begin processing what has happened to them.

But we've all met ED patients or visitors who compulsively narrate what has brought them there, who repeat the same tale to everyone who enters the room: even if the doctor's already heard it, even if most of the details have no possible bearing on anything medical. "I was eating a tuna-fish sandwich, and he just keeled over into his tomato soup, and then I was trying to pull his face out of the bowl and call 911 at the same time, and oh, gosh, these slacks are covered with tomato soup, aren't they?" "I was in Home Depot buying nails when I felt this crushing pain in my chest, and one of those guys pushing a huge lumber cart asked me if I was okay, and I couldn't answer! It was so scary not to be able to talk. It reminded me of that time in third grade when the other kids pushed me into the water and held me down, and the guy with the lumber was kneeling down next to me, and I didn't know how I'd wound up on the floor, and I'd dropped my nails and I wanted to pick them up, but he kept telling me just to stay there, the ambulance was coming."

Compulsive repetition of such stories isn't just a sign of shock. It's an essential coping strategy: the speaker is desperately trying to regain control by turning the event into a known, predictable narrative. If your ED has a chaplain, social worker, or someone else whose primary job is to listen, by all means try to have that person visit the room.

If you're a medical caregiver and you have two extra seconds, by all means listen, and try -- without interrupting -- to give some active sign that you've heard. Body language and facial expressions count for a lot here. But what if there's no chaplain or social worker in sight? What if the department's so busy that you don't have two extra seconds to spend listening to anyone? One easy answer is, "There will be someone to listen later, in or out of the hospital," and of course that's true. But I suspect that the earlier this process begins, the better. And so, if patients or bedside visitors are able to write, why not encourage them to start putting their stories down on paper? I've linked here before to this article about the healing effects of writing. I've often told my ED patients about this, and they're almost often intrigued. Several times, I've given a patient pen, paper, and encouragement to write the story down. It seemed to help.

If nothing else, writing is something to do, something to focus on during an overwhelming time in a chaotic environment. And paper always listens, even when people can't. The paper will contain the story until other people can make the time to listen too.

Posted by Susan Palwick at 7:06 PM

Labels: chaplaincy, hospital, medical school, narrative medicine, teaching