Monday, January 21, 2013

Dealing with Grief

As humans, we are designed for relationships. We are driven to connect with others, and these connections are the root for many joys and pleasures, but also give purpose to our lives. There is a cost, however, that is demanded for these benefits. That cost is grief.  At some point we will lose that relationship, either subjectively or in actuality, as through death.

Grief is a universal experience, not dependent on age, status, gender or intellect, and yet is so individualized that it makes preparing for it and experiencing it hard to generalize.  There are some issues that would behoove us to discuss in order to help others, or ourselves, when a loss occurs.

One of the essential needs someone has after the death of a loved one is the opportunity to tell the story of who that person was.  This may include the retelling of their death, or the circumstances of their illness, but it may also be memories from the past and accounts of them as a person.  The ironic thing is that usually after death, other people don’t want to bring the loss up, for fear of creating sadness or being awkward. Once someone said, “After my husband died, he was always on my mind, so the idea that by saying his name, or asking me a question about him would send me into a depressive tailspin is ridiculous!” In truth, those grieving crave the opportunity to talk about their loved one, and are just waiting for someone to bring it up.
This desire to keep the memory alive by retelling the story of their life does not go away in the weeks after the loss, if anything, it gets stronger.  The odd notion that a year after someone dies, life should be back to normal, just devoid of that person, is foolish. What better time to ask a friend to tell you some memories about the person who’s gone.

The other important concept in grief is that there are no stages to go through leading to acceptance.  There are common aspects of grief people may have depending on the circumstances of the death itself.  For instance, some may feel guilt. This may be guilt in the decisions made, or regrets just prior to the event, but can also be survivor’s guilt in ‘Why didn’t I go first?’ Others feel relief, which can seem abnormal, but usually, if there has been suffering involved its natural to have relief that the suffering is over.  Still others get angry, wanting to blame someone or something for the loss. Finally, some feel anxious or helpless, such as with the loss of parents or a spouse who’s provided much support. 

The key is that these emotions are normal, and it’s possible to feel many all at the same time.

While grief is an expected part of death, if it begins to affect your health, your job, or your relationships it may be time to seek help. 

There is a price for relationships, and at some point we all experience grief. By inviting others to tell their stories we can ensure that when our turn comes, someone will be around to listen to us. 

Wednesday, January 2, 2013

To Value Struggle

I’m not sure when it happened, and I doubt anyone living could recall a different time.  Regardless, somewhere along the way we as a society began a journey away from the process to focus on results. I recently read about a study in the field of education looking at this.  A group of 1st grade students from the United States was matched with a group of students from an Eastern country and given an hour to solve an insolvable math problem. The students from the United States worked for an average of 30 seconds before giving up. The students from the Eastern country spent the entire hour working, despite the problem having no answer.  The study was designed to look at struggle, or how children react to challenge. The implications were that we value results more than the process itself. 

Although this study was in the education arena, I immediately saw cross over into healthcare. Medicine as a field is structured to be results driven. Hospitals, physicians, and therapists are graded and reimbursed according to results. Did the patient’s blood pressure normalize? Was the diabetes managed? Just like in education, the reason results trump process is because it is easier to measure success with data. How, for instance, would we gauge a successful process of weight loss without looking at results?

Yet, there have been immense consequences by ignoring the process and focusing only on results. It has led to the desire for immediacy and avoidance of challenge. If we value the end result, then the quickest, easiest way there, becomes the goal. If your blood pressure is high, let’s give you a pill, instead of the agonizing process of changing your lifestyle.

I see this especially with pain. Emotional, physical, spiritual, it doesn't matter the source, we want it gone immediately. Quite simply, as the education study showed, we don’t value struggle.  Had we as children been told “You should be proud of how long you stuck with that problem” rather than being praised for the solution, would things be different?

Instead, as we face hard things in our lives, we don’t think, what is this teaching me? Instead we say, get me out of this immediately. This focus on results has even effected how we face death.  Patients display this when they've been told they are dying and subsequently want it over immediately. The frustration and angst during the sometimes slow process of dying would be different if we valued struggle.  Sometimes it is the families, requesting more medications to mask an uncomfortable process, rather than explore why there is discomfort.

We in healthcare do this too. We have gotten so attuned to results that we are more comfortable ordering more tests and more therapies that give results, rather than looking at what processes are at hand.  If all of us were more comfortable with the process and struggles of aging, perhaps we would better recognize when dying begins.

I don’t think we should lose our emphasis on results, as it is partly this drive that has made us great. A balance, though, would benefit us all. With that said, we should relish in the struggle to get there.