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When Grief Breaks Your Heart

March 13, 2014

Can you die from a broken heart? Yes, you can.

There is a heart condition called stress induced cardiomyopathy or takotsubo cardiomyopathy—commonly referred to as “broken heart syndrome” because it often occurs during periods of high emotional stress and grief.

First recognized by Japanese doctors in the 1990s, the condition is characterized by a weakening of the left ventricle. The heart chamber changes shape, narrowing at the top and ballooning at the bottom. Thankfully it’s reversible.

Still, death during bereavement occurs more often than one might expect. At our hospice, time and again we see cases where spouses die 12 months apart. Recently, we had a situation where a woman had a heart attack at her husband’s funeral. It’s quite sad.

While we can attest to this anecdotally, research confirms our stories.

In a recent study by Carey et al, the authors found that the risk of stress-induced cardiomyopathy is highest in the first month after a death and then slowly declines during the first year. In a previous study (Shah, et al.), the same authors found that good health and material circumstances do no protect older adults from increased mortality rates while grieving the death of a loved one.
 
The stress of grief has health effects. Common grief reactions like loss of sleep and appetite can suppress the immune system which could exacerbate other medical conditions. 

So what can we do?

First, we can be aware that it’s a real risk. We can offer support to older adults during the first few weeks and months after the death of a loved one. In addition to offering support, we need to encourage older adults to seek medical attention and take care of themselves physically as well as emotionally. Many older adults disenfranchise their own grief and need to know that it’s okay to mourn the loss of their life partner. Support is available through grief groups, friends, faith communities and professional counselors.

No one needs to grieve alone.

 References:

Carey, Iain M.; Shah, Sunil M.; DeWilde, Stephen; Harris, Tess; Victor, Christina, R.; Cook, Derek G. Increased Risk of Acute Cardiovascular Events After Partner Bereavement: :  A Matched Cohort StudyJAMA Intern Med. Published online February 24, 2014.

Shah, Sunil M.; Carey, Iain M.; Harris, Tess; DeWilde, Stephen; Victor, Christina, R.; Cook, Derek G. Do Good Health and Material Circumstances Protect Older People From the Increased Risk of Death After Bereavement?American Journal of Epidemiology,(2013) 177 (4): 375.

Please join our grief discussion groups.

Online Condolences: Do they work for you?

February 11, 2014

 

The family cat died last week. I have often written about the death of a pet and how non-pet lovers often disenfranchise grief from the death of a cat or dog. More and more folks seem to accept that it wasn’t just a dog and acknowledge the role pets play in our lives.  What was quite remarkable to me was what occurred on my Facebook page.

I posted the photo of my aged, sad-looking furry friend with the caption “Kenny RIP”.  I had never posted animal photos before.  Much to my surprise, there was an outpouring of empathy, sympathy and compassion from family, friends, high school acquaintances, professional colleagues, former work associates and others that I only keep in touch with out of curiosity. These comments touched my heart and I was delightfully surprised to hear from certain people.

Rumor has it that Facebook is developing a sympathy button. Currently, when someone posts sad news, the options are to “like” it and/or to comment. Some posters are offended when people “like” their sad news. I appreciated not having a sympathy button in this instance as it prompted folks to comment rather than to hit the “like” button.  My “friends” expressions of sympathy ranged from sorry to it’s so hard to lose a beloved pet who is a member of the family to the simple aw and my personal favorite…love and sympathy, hugs.

Is it right or wrong, good or bad to express condolences on Facebook? Is a letter or a greeting card the only acceptable way to offer sympathy?  While expressions of grief can sometimes be offensive, offering condolences online is certainly okay. 

Consider your relationship with the grieving person. If your co-worker is grieving and he or she is someone you see every day, what would be most appropriate? An email, card, letter, or phone call? What makes the most sense? What would the griever want?  The internet offers an immediate response. Postal mail can take a few days after you’ve already taken a few days to sit down and write the letter or card. Will your friend or co-worker think you don’t care if he or she hasn’t received a card by the time she returns to work?

Here are two examples: A Facebook friend yearly posts a picture of her deceased husband on the anniversary of his death. Many, many friends comment. They share stories and words of inspiration that provide great comfort. An elderly bereaved client yearly places an ad in the local obits honoring her deceased husband. The Facebook friend receives immediate feedback, the client brings in the clipping and receives support and hugs from group members and staff, weeks later. 

Some people might think condolences on Facebook are empty expressions of grief. They may be from people you are rarely in touch with. But personally, I appreciated the sentiments from everyone. One post was from a former co-worker who fondly remembered the story of how my cat earned his name.

Offering condolences on social networks is perfect for the sometimes partial or distant friend. HOWEVER, nothing can take the place of physically being with the people you love.

The bottom line is that it’s really up to the griever and his or her comfort level in expressing grief on the internet and social networks. The role of the friend is to be a friend and honor that grief whether it’s through a Facebook post, picking up the phone or showing up at the door with a meal.

Please visit our on-line grief discussions groups at http://www.hospicewr.org/discussions/grief/.

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Reel Grief: What the Movies Can Teach Us

January 13, 2014

There are many ways to support the bereaved during their grieving process. Give gentle and unconditional support. Provide a listening ear.  Help with errands and chores.  Another approach is to recommend movies that focus on recovering from loss. A film’s lesson can be helpful and supportive, as well as facilitate and/or validate the grieving process.

 

1.13.14 Diane - The Movies and Grief

 

Movies are about the human experience, complete with love and loss. The complex, confusing and isolating feelings that are common to the bereaved are often portrayed on the screen. In addition, the movie can be fodder for eliciting these feelings or can act as a catalyst to start a conversation. Talking about a movie creates a safe way to share the difficult feelings of grief.

On some level (consciously or not), the bereaved can often relate to what the grieving characters in the film are going through. Identifying with a character can help develop confidence or remind the bereaved of his or her own inner strengths and resources. It can also be insightful when the relatable character in the movie is different or unlikable.

Watching movies often helps the viewer to step back and see the bigger picture. It can give you a more objective perspective on what’s happening.

Here are some questions to consider….

What are the main grief issues identified in the movie?

What strengths did you recognize in the characters that were grieving?

How does the main character build or maintain an enduring connection with the deceased love one?

What similarities do you see in your own life?

There are many movies that address grief and loss. Here are a few that might interest you and assist you through your grief journey.

 

FOR ADULTS

Rabbit Hole (2010) – Rabbit Hole is a moving, dark character study of what happens to a happily married couple when they suddenly lose the love of their life, their 4-year-old son.

Forrest Gump (1994) – This film depicts several decades in the life of Forest Gump who witnesses and in some cases influences some defining events in the 20th century. Along the way, he experiences grief and loss.

Steel Magnolias (1989) – A heartwarming story of life, love and loss in a small Louisiana Parish.

Truly Madly Deeply (1991) – This film can inspire those who have suffered a significant loss to discover new interests in life.

Ordinary People (1980) – This film offers an intense examination of a family being torn apart by tension and tragedy.

 

FOR CHILDREN

Bridge to Terabithia (2007) – This is a fantasy adventure film about the power of imagination and the magic of friendship and includes the death of a friend.

The Lion King (1994) – After the death of his father, the lion cub Simba goes into exile and eventually returns to the pride.

Up (2009) – A grieving widower and a young boy go on a great adventure together.

My Girl (1991) – A coming of age story about an 11-year-old girl that experiences death and transformation.

Post can also be seen on ShareWIK.

Tinsel and Grief

December 11, 2013

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Through the years we’ve offered many workshops for the bereaved on how to cope throughout the holiday season.  Today we offer you what we’ve learned from those grieving the death of a loved one.

  • My family collects superhero toys all year long. In December we go to the children’s hospital and donate them in honor of my son who died when he was eight.  Drew loved Spiderman.
  • It’s comforting to me to keep our old family traditions alive even though some moments can be painful. We do everything exactly the same as we always have.
  • I only shop online.  Mom and I always went holiday shopping together and now it hurts too much to go into the stores and see all the decorations.  So I just shop online.
  • We decorate our Christmas tree with Mother’s costume jewelry.  She had tons of it.  Our tree looks amazing and as we put up each necklace or pin or bracelet, we share stories about mom.  The first year it was really sad, but now it’s fun and has become a tradition.
  • I make my Auntie Clara’s cranberry relish.  Nobody likes it, but I still make it in her honor.
  • I give myself 30 minutes to listen to songs that make me cry.  I go into the depths of my sadness and then move on.
  • The first two years I stopped sending greeting cards, but I think I might start this year.  I think I might write one of those letters where you give updates on your family.  There are some people who would like to hear from us.
  • I will pull out my never-ending scrapbook and create a new page that both celebrates the holiday and honors my parents.  It’s been a tough year.
  • I volunteer at a soup kitchen and feed the homeless.  It gives me a sense of purpose.
  • I always have a get-away plan.  When I go to the family dinner or the office party, I drive my own car and park in the street so I don’t get stuck in the driveway.  That way I can leave whenever I want.
  • My children and I bake all the cookies and favorite dishes of my husband.  Joe loved sugar cookies and would make them with the kids.  Now it’s my job.  We make a day of it by playing Joe’s favorite music as loud as we can and making a mess in the kitchen.  We laugh and we cry.  It’s great.
  • We go to the cemetery.
  • Above the fireplace, we place candles and greenery around her photo.  It feels like she is there even though she isn’t physically present.
  • My grandfather loved sports and instilled the love for exercise in us.  We start a Thanksgiving morning with a 5K run and head back to the house for food and festivities.
  • I go to my daughter’s Facebook page and read the comments from all her friends.  It’s bittersweet but brings me comfort.

The holidays are a challenge for many who are grieving. Remember there is no right or wrong or good or bad way to grieve. Do what works for you and be kind to yourself this holiday season.

Please visit our online grief discussions groups.

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Grief Knows No Time

November 12, 2013

11.18.13 Diane - Grief Knows No Time
Photo by John Gara
 

I’m coming up on the 2nd anniversary of my dad’s death…which is also right around the time of Thanksgiving. In fact, Thanksgiving fell during Shiva and we had a small, but traditional turkey dinner. It felt dreamlike. Last year, we went back to our traditional meal at my sister’s with many family members and, although it was festive, we could feel Dad’s absence. This year Thanksgiving falls on the first full day of Hanukkah. It’s a rare event that won’t reoccur for nearly 78,000 years. I have a feeling that my Thanksgivings will never be the same either.

In grief work, we tell families that grief is often harder the second year.  Holidays, birthdays, and special occasions often feel surreal the first year. Perhaps you go on vacation or enjoy the festive meal at a restaurant or different relative’s home. The second year, it may become your turn to host the event. It’s not surreal – but very real. The absence of your deceased loved one is palpable.

In the second year, people are often caught off guard by what triggers their grief. Special days are reminders of this absence. In the first year of grief, friends and family members make special allowances…oh, this is her first year without… In subsequent years, the expectation of others and maybe even of yourself is that everything should be back to normal. This is not the case at all.

What helps during the second year of grief when the holidays are at hand? Think back to what you did during the first year. What eased your stress and anxiety? If coming together with family brought comfort, do it. If baking your loved one’s favorite pie was too difficult emotionally, don’t do it. Think ahead. Plan and choose what you want to do.

Thanksgiving and Hanukkah!  People are referring to it as Thanksgivukkah—a joint celebration of two separate holidays that memorialize our religious freedom with delicious food. Latkes, sweet potatoes or mashed potatoes? We’re doing all three. My dad would have been tickled pink.

Please visit our on-line grief discussion groups at http://www.hospicewr.org/discussions/grief/ .

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The Masks of Grief

October 15, 2013

This is a good time of year to talk about the masks of grief. Earlier and earlier, stores, television and the radio market Halloween. Decorations, candy, costumes and masks are everywhere. And masks are a great metaphor for the bereaved.

The purpose of a mask is to cover or conceal. Think about how often we put on masks that say… Look at me, I’m fine.  The phrase, I’m fine, is stated by everybody at least once a day. For many, it’s a lie we tell ourselves as much as we tell others. On the inside, we may be far from fine. We may be reeling with emotions.  Sometimes, we may even put up a mask internally when we are afraid to look at our own innermost bits and pieces. Perhaps we fear that we’ll crumble and fall apart.

Every now and then we need to wear a mask.  We may want to project a certain image and wearing a mask helps us play the part.  Some people refer to this as the… fake it ‘til you make it approach. And of course, we have masks for various occasions. There are masks we wear at work, at home, at school, and in the community.  But, it’s important to recognize what mask we are wearing so that we do so with care and remember how to take them off. From time to time, we must take a deep look inside.

One activity we do with school age children and adolescents at Together We Can grief camp, is create inner and outer masks to increase awareness of our feelings. Once the campers can recognize and label these feelings, they are encouraged to share their innermost ones with the group—where they are safe and their feelings will be accepted.

Masks

Photo: Masks created by children at Together We Can grief camp, Hospice of the Western Reserve.

As an adult, you may or may not want to actually create a mask, but consider what one might look like. To see the mask you wear outward, look to other’s reactions towards you. Your inner mask may be more difficult to picture, but it’s worth the effort to look deep. Stuffing feelings far below the surface can result in a plethora of mind, body and spirit symptoms. Remember, you do not have to grieve alone.

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Grief and Celebrity Deaths

September 27, 2013

Cory Monteith, Eydie Gorme, Dennis Farina, Bobby Blue Bland, James Gandolfini, Jean Stapleton, Joyce Brothers, Richie Havens, Jonathan Winters, Annette Funicello, Van Cliburn, Bonnie Franklin. This is just a small sampling of the many celebrity deaths in 2013.

We are fascinated by the lives of celebrities.  We grow up with them. They have been in our living rooms, our kitchens and our bedrooms. We know all about their lives – their struggles and their achievements, their hopes and dreams. They are our friends and when one of them dies, it can have a profound impact.

It’s natural to fixate on celebrities. Humans are social creatures and we have evolved to pay attention to people at the top. By observing them, you learn what high-status individuals do so you might more effectively become one. And, by knowing what is going on with high-status individuals, you are able to navigate the social scene – or simply have something to talk about at lunch with coworkers.

When a celebrity dies, the grief reaction can be quite unexpected. Society, friends, colleagues, teachers, parents do not understand why the death is so upsetting.  For youth, the death of a celebrity may be the first death they experience.  And if it’s a drug overdose or suicide, it can shatter their world view. Any death of a public figure can have an impact on spirituality and belief systems.

Noting the celebrities listed…. I was worried about how my nieces would react to Cory’s death.  With the deaths of Jean and Bonnie, I mourned my time watching TV with my parents and siblings growing up.  Van Cliburn’s death touched my heart as I recalled listening to his records over and over when I was immersed in the piano. And when Tony Soprano died, I was just plain sad. I loved that guy.

The outpouring of grief that often accompanies a celebrity death allows people to feel part of the community and share their grief in a safe and supported way. It can be a time to reminisce, share stories, and face their own mortality. If it is a first loss experience, the experience of grief can help prepare for personal loss later in life.

If you or your child is deeply impacted by a celebrity death, go with it. With grief, there are never right or wrong or good or bad feelings. And one death may trigger a grief reaction from a previous death. Give yourself permission to feel and consider this a time for personal growth and insight.

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Tips for Bereaved College Students

September 12, 2013

According to Dr. David Balk, Ph.D, author of “Helping the Bereaved College Student” and member of the Association for Death Education and Counseling (ADEC), at any time at least 22 to 30 percent of college students are in the first year of grieving the death of a family member. Developmentally, most college students do not have all the coping mechanisms to manage the loss. For some, it could be their first experience with death.

Bereaved college students often feel a sense of isolation. “Hi, my mom died” is not a great conversation starter at a party.  Furthermore, there can be a toll on concentration and academic performance.

Some find support amongst peers, but many peers lack the skills needed to provide that support.  In fact, sharing a death-related loss could result in avoidance rather than support.

While many colleges have guidance centers that offer support, few have bereavement programs. There is a movement lobbying towards more grief sensitivity on college campuses. Currently it is negligible, at best. Find someone on campus to advocate for your college student.

Bereaved college students need:

  • The campus to be a safe place of support
  • The campus to provide information on grief and loss. Knowing that normal grief entails intense emotional reactions that occur intermittently over time, helps students know that they are not simply going crazy
  • To know how to respond to people who ignore their grief or who tell them that they need to get on with it – that it’s not good for them to continue to grieve
  • Teachers to allow late work, make-up exams, or  taking an incomplete
  • To know that they are not alone

College students can also find online support.  The National Students of AMF support network is a nonprofit organization dedicated to supporting college students grieving the illness or death of a loved one.

Roadside Memorials

August 22, 2013

roadside memorialRoadside memorials are familiar sights on highways and city streets. These are public displays of mourning and can be found throughout the countryside and across the globe. They have become commonplace throughout the world and can be thought of as cultural manifestations of grief, mourning and memorialization.

Per Wikipedia, a roadside memorial is a marker that usually commemorates a site where a person died suddenly and unexpectedly, away from home. Unlike a grave site headstone, which marks where a body is laid, the memorial marks the last place on earth where a person was alive…

Some roadside memorials are spontaneous. Friends and family place meaningful objects at the place of death. Sometimes these items are attached to a tree, pole or some other permanent object that is already in place. Many comprise of a cross, flowers (real or plastic) and personal items. These memorials emphasize that this was a place where someone died.

Other roadside memorials are more permanent in nature. These memorials identify the person who died. Rather than being unstructured and unplanned, these everlasting memorials are maintained and cared for by family members or friends. These bereaved transform the place where something tragic happened into a place of care and nurturing. It is one way to maintain continuing bonds with the deceased. 

While researching this blog, I came across an article on the West Virginia department of transportation website. This small state has more than 400 roadside fatalities annually. They offer the bereaved the opportunity to request a Roadside Memorial Sign that is an official sign and placed by the Division of Highways as close to the site where the fatal motor vehicle accident occurred.  This helps families memorialize loved ones and remind motorist to drive safely.

Some people find these roadside tributes distracting. Some find them disturbing. And for  others, they are reminders of the fragility of life. I routinely pass a roadside memorial marking the death of one of my daughter’s childhood friends.  I like the cue as it causes me to take pause and remember.

For more information on roadside memorials, click here.

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The Peaks and Valleys of Grief

August 2, 2013

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On a recent trip to Alaska and the Yukon, I could not take my eyes away from the mountains.  We        don’t have mountains in northeast Ohio. And of course grief follows you wherever you go.

I was especially drawn to the jagged edged, raw looking brown mountains but found great comfort in the green rounded mountains.  The tour guide shared that the jagged edge mountains are younger. In time they become rounded and green with growth.  I immediately thought of the jagged edges of new grief.  And while time doesn’t necessarily heal, time does soften (round) the rawness of grief.  

We can thank tectonic plates for our mountain ranges.  When the tectonic plates collide, land features that start as folds and faults become large mountain ranges. Mountains exist because tectonic plates are continually moving around and colliding with one another. Over millions of years, mountains change and take on different forms. The colliding plates are akin to the roller coaster of grief which often takes on new forms as time passes.

Loving metaphors, it’s easy to relate grief to climbing a mountain. The slope is steep. The journey is hard. But along the way, there are plateaus to stop, rest, and take in the view before you continue the climb. When you finally reach the top you think ahhhh, I have arrived. But then you see another peak, another valley, another pass to climb. You continue on your grief journey. With each new crest and each new vale you carry more experience and skills to manage the trek. The jagged edges soften as time passes. Grief doesn’t end but it becomes manageable as you carry the memory of your loved one in your heart. That heart fulfillment can become as glorious as the views from the mountaintop.

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