an email from Jane Gailbraith and a new resource
Sent: Sun 5/10/2009 2:43 PM
To: Charlotte Lankard
Subject: Grief resource
THE LONELY PATIENT
My column that ran in the July 26 edition of the Oklahoman has been placed on the front page of this blog. I wrote about the loneliness of terminal cancer patients – not because friends and family do not care, but because friends and family are overwhelmed with their own feelings and reactions to an impending death and the tendency of the patient will begin to hide their thoughts and feelings in order to make everyone else feel better.
In response to that column, my friend Jan who has also been given the prognosis ”terminal” – wrote - and has given me permission to share her thoughts with you.
FROM JAN
This was great. I loved the 4th paragraph. Relationships…..begin to change and will keep changing. That is life.
I think the thing that has struck me lately is that when I am thinking about relationships changing I think of that period of unease and resistance to change and that there is an evolution of change. That change usually evolves into a different relationship.
But when I think that I may not have time to see the evolution, I am sad and I want the relationship to remain stable and not go through that painful rebirth period because I may not have enough time to see the new relationship and the relationship will end midstream at a bad place.
Then it struck me that death really doesn’t end the relationship. But that you can let fear paralyze your willingness to embrace change. And if life is change, you can choose to stop living before you die.
I’m so glad to see that section on not looking sick and a secret identity.
That’s the irony…..a terminal patient wants to still be treated as who they are and yet give up so much of who they are in an attempt to hold on to who they used to be before.
I remember that Jim in one of his poems talked about needing to have people still have hope. I think there is a real connection between wanting to have hope ourselves and needing to see that hope in other people’s eyes.
The isolation comes in when we know we aren’t getting an honest response because we feel the need to withhold the despair we sometimes feel. What a mess.
The part that touched me the most were the two lines about lack of praise
for expression of fear, guilt and sadness. I think families are made to feel that while the patient may have some latitude to express those
feelings, family members are perceived as self-centered or somehow not
entitled to those feelings.
My son and I talk a lot about that and how he feels guilty about his reactions sometimes because any problem less than terminal illness seems self-indulgent when someone you love is facing death.
You know I think Jim has done such a good thing by doing this and I hope he won’t give it up. And I think his family has so much to contribute by giving their perspective, but I can certainly understand why they want to stop.
It’s too bad because they are in the position to be a voice for the other
dimension of this, but maybe they will be able to do it someday when they’ve had a chance to reflect instead of doing a blow-by-blow as it happens. Jan
LIVING WITH CANCER DIAGNOSIS BRINGS CHALLENGES
Living with a cancer diagnosis is not easy. Often you must live with unanswered questions. Are there hopes for remission? Is that really a possibility or are they just trying to make me feel better? Is it terminal? If so, how long do I have?
Living with a cancer diagnosis affects many areas of your life. Two of the most common are relationships and your belief system.
Relationships are affected when chronic illness of any kind strikes. Difficulties develop which are so complex that statistics show nearly 85 % of marriages with these challenges fail. No one warns you of this and too often couples are into the problems before they realize what has happened.
Creating a support system can be helpful. A cancer support group or individual or couple counseling can help you stay aware of how your relationship is being impacted and what you need to be alert to.
A cancer diagnosis can impact your belief system. It may expand it or it may challenge. If you’ve been taught that everything happens for a reason or that people get what they deserve, then you may feel hopeless and let down by your faith. You may find yourself asking, “Why has this happened to me?”
You may feel angry at God and then feel it is a terrible sin to be angry with God – or you may fear you have lost your faith.
Such feelings can deprive you of strength and reassurance that faith offers at a time when you need it most. Your faith needs to give you comfort and support, not feelings of abandonment, so talk to someone you trust.
Suggested Reading from a Doctor with Cancer
Wendy Harpham, MD from Dallas Texas is a physican who was diagnosed with non-Hodgkin’s lymphoma in 1990 .
Since then she has undergone every conceivable issue related to cancer:
*choosing experimental treatment over conventional
*coping with raising small children
* living with cancer-related fatigue
* experiencing seven recurrences
* having to recognize that her old life as a family practice physician was gone forever.
When she was first diagnosed she was committed to educating her patients and she wrote a pamphalet for them about all the things to do when you learn you have cancer. It eventually became a book called Diagnosis: Cancer that was published the month she found out about her first recurrence.
Other books followed. After Cancer: A Guide to your New Life, which provides cancer survivors with questions and issues to address as they move out of treatment and into the “new normal.”
Her next book When a Parent has Cancer tells what she and her husband learned about how to help children and parents cope with the experience. Tucked in the back cover of the book is a children’s book Becky and the Worry Cup written about the experiences of her oldest daughter Rebecca.
Next came The Hope Tree: Kids Talk about Breast Cancer, a book she co-authored with Laura Numeroff to help families talk with their children.
Happiness in a Storm: Facing Illness and Embracing Life as a Healthy Survivor, addresses survivorship from all illnesses and provides practical philosphy and science-based knowledge to get good medical care and find happiness while you are sick.
Her most recent book is Only 10 Seconds to Care: Help and Hope for Busy Clinicians, is aimed at physicans but also extraordinarily helpful to patients.
Her books are available through any bookstore and her website is www.wendyharpham.com
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Trying to Live a Normal Life
A dying process has no fixed time limit. When my husband was diagnosed with pancreatic cancer, we were told he might have 6 months to live, but he only lived another 100 days. I’ve known others that lived years beyond what was expected.
Not knowing “how long you have” is hard for the patient and the family. This is a time when some enter a period of what is called “anticipatory grief”.
Anticipatory grief does not substitute or lesson the post-death grief process. It is not just post-death grief pushed ahead in time.
When a family is anticipating a single death, they are also anticipating multiple losses – loss of hope, a future together, levels of functioning, security and invulnerability.
The most common concern for anticipatory grief is that it can result in premature detachment from the dying person, resulting in a feeling of abandonment.
The most difficult challenge for a family during this period is to try and maintain as normal a lifestyle as possible.
Jim’s family has set a good example for us by trying to maintain normalcy. His wife, LeAnn, not only continues her job as a teacher and is involved in the activities of her husband and teenage children and her friends, but she also prepares for and runs marathons. Her latest run was the Oklahoma City Memorial Marathon in April.
Jim’s daughter Maddye and son Ford pursue their own interests, hang out with friends and do normal things that teenagers do.
Jim, in addition to chemotherapy treatments and regular trips to M.D.Anderson Cancer Center in Houston, continues his job as an attorney at the Oklahoma Court of Criminal Appeals, writes poetry, is completing a 2nd book, participates in poetry readings, lunches with friends, sees movies and spends time with his wife, his kids and his friends.
It is common that a few people will judge them for trying to live a normal life, but it is an important aspect of weathering this experience because nobody can face death all the time and unless you take time for yourself, for letting out your feelings and taking care of your health, you may well run out of fuel before the process is over.
A TEEN MOMENT
Lynn from Western Oklahoma wrote to tell me of an encounter about 20 years ago with her 15 year old son after her diagnosis of cancer.
They were having a typical teenage/parent conflict and he blurted out, “So how do you think it feels to grow up having a mom that’s going to die all the time? My life is awful and nobody wants to hear about my problems because you have the monopoly on that.”
Lynn says the down side of having a relationship where your kid is comfortable enough to tell you anything and everything is that …. sometimes they do.
She remembers how much that hurt her because she had wanted so much to protect the kids from being consumed with cancer and when he threw those words at her saying his own life was upside down, she felt guilt and responsibility for having failed to do that, especially when she had thought she was doing such an outstanding job of managing it all.
When her son saw her reaction, he immediately tried to take it back. She remembers him sobbing and telling her how he hadn’t meant it. She, however, knew he was telling his truth and so did he.
She said, ” I even felt worse that he couldn’t say what he was feeling without such guilt. It was totally circular guilt and regret. I remember not having a clue what to say or do to make this less significant and less painful to both of us.”
Lynn remembers longing for just a few hours to have a respite without argument. She wishes she had said …..”between three and six on Mondays and Thursdays, we are going to forget what is happening that is consuming us.”
Now in looking back at that experience, Lynn wonders whether that was just an “I hate you and I hate my life” moment that teens so often experience instead of the “I hate you and I hate my life, but only because you have cancer” moment that she had interpreted in that split second. She says in hindsight she wishes she had just glared at him and responded with ”I don’t believe you mean that for a single second.” Even, she said, if I didn’t believe it, a least he might have been able to.
A few days ago, Lynn asked her now grown son if he remembered that incident. His response was, “Mom I remember that I said that a lot and I also remember that you said that I was full of it and to stop trying to manipulate you with pity!”
She said he even got her tone of voice down perfectly, and muses, “Funny, I think he honestly remembers it that way. I feel like I must have done something right in spite of myself.”
A text message from Houston
Tuesday evening, April 21, got a text message from Jim from the Cancer Center in Houston saying, “Good news! Everything is still stable.”
He has been doing the chemotherapy with the usual side effects – hair loss, nausea, lethargy – and it is all worth it because it seems to be stabilizing the cancer….it’s not going away, but neither is it growing!
We’re celebrating and will take all small victories. Way to go Jim!
New words for courage
When I see the word courage, I always think of 6 words – brave in the face of danger, but from this day forward, I will think of 6 different words – Jim, LeAnn, Maddye and Ford Chastain.
I read the April 19th Sunday Oklahoman’s front page storyby staff writer Ken Raymond and wondered if the Chastain family really understood what they were signing on for when they agreed to let us follow their experience of living with terminal cancer.
What I want to say to them is “You are incredibly courageous. Courage does not mean the absence of fear, it means choosing to live in the midst of it, and I marvel at the way you are trying to live normal lives – when the definition of normal for you has changed. ”
Try as this family might to put this aside and forget it is really happening, that isn’t possible. Everything they do gets heightened – even normal adolescent quarrels with parents and siblings - and then to have it on the front page of the Oklahoman for all the world to read – takes guts.
Thank you is not nearly adequate to express to them what I want to say, but it’s all I’ve got.
* Thank you for allowing us to look over your shoulder while you take this very personal journey through terminal cancer.
* Thank you for helping every family with teenagers understand that when they experience exactly what you are experiencing, fights are normal even in a close knit and loving family.
*Thank you to LeAnn and Jim and Maddye and Ford for demonstrating how that automatic stress reaction looks when we feel trapped – fight or flight.
Some people want to fight – LeAnn and Maddye are terrified and furious there is nothing they can do to stop it and if you get in their way, don’t misunderstand the anger that lashes out.
Some people want to flee – Jim and Ford are feeling afraid and helpless and they shut down, withdraw, and get quiet, which is what I did when my husband and I were in the last weeks of his battle with cancer.
The feeling was I wanted to run away. I can remember how guilty I felt because I was feeling that way, but now I understand those “feelings” don’t mean a thing, they are simply the body’s way of trying to offer protection.
*Thank you on behalf of all the families who have yet to walk through this experience. Your openness and honesty will help them to understand their own feelings and behaviors as normal – under the circumstances – and they won’t have to feel so guilty as they might have before you allowed us to intrude on your pain.
I read somewhere that courage is that little voice inside saying I will try again tomorrow. Today, the Chastains are the most courageous people I know and what I know about them is that tomorrow they will get up, shower, dress and face the day again.
My heart is full of gratitude and admiration for them all.
April 16, 7:00 p.m. Baptist Medical Center – HOW TO BE WITH A LOVED ONE WHOSE LIFE IS ENDING
Speaking and reading about the dying experience is not morbid, rather it will teach you how to live with care and appreciation.
For simple, useful, concrete suggestions to use when that time comes, join me on Thursday evening, April 16, 7:00 p.m.at the Baptist Medical Center’s James L. Henry auditorium to hear Megory Anderson.
Anderson is a theologian, author, educator, liturgist and Executive Director of the nonprofit SACRED DYING FOUNDATION in San Franciso.
Her presentation will not be about mourning and how to handle grief, it will not be about the mythology of death or funeral planning. Rather, she will teach us how to be with a dying loved one, how to provide them with something more than pat answers and how to make it a meaningful experience.
We will learn how to use a variety of things, such as music, rituals, poetry or prayer that have been an important part of the person’s life experiences.
To make reservations, call the INTEGRIS HealthLine at 951-2277.
A WORD TO THE DYING IN THE WORDS OF POETS – AND OTHERS
Poets – and others – often express for us those words and feelings held inside that we have trouble voicing.
If you are entering the dying experience, following are 14 things for you to consider that may help you, and also those who love you.
1.DYING IS SOMETHING WE ALL WILL DO.
Teach me your mood, O patient stars! Who climb each night the ancient sky, Leaving in space no shade, no scars, No trace of age, no fear to die. RALPH WALDO EMERSON.
For the thing that I fear comes upon me, and what I dread befalls me. i am not at ease, nor am I quiet. THE BOOK OF JOB
Dear God, be good to me. The sea is so wide, and my boat is so small. BRETON FISHERMAN’S PRAYER
To begin depriving death its greatest advantage over us, let us adopt a way contrary to that common one, let us deprive death of its strangeness, let us frequent it, let us get used to it. MICHEL DE MONTAIGNE
If you want to die happily, learn to live.
If you want to live happily, learn to die.
LATIN PROVERB
2. BE WHO YOU ARE
Nature never repeats herself and the possibilities of one human soul will never be found in another. ELIZABETH CADY STANTON
I’ll walk where my own nature would be leading; it vexes me to choose another guide. EMILY BRONTE
For an impenetrable shield, stand inside yourself. HENRY DAVID THOREAU
To be what we are, and to become what we are capable of becoming, is the only end of life.
ROBERT LOUIS STEVENSON
3. FEEL ANY AND ALL OF YOUR FEELINGS.
Seeing is believing, but feeling is God’s own truth. IRISH PROVERB
Be at peace with your own soul. Enter eagerly into the treasure house that is inside you. The ladder leading to the Kingdom is hidden within your soul. Dive into yourself, and in your soul you will discover the stairs by which to ascend. ISSAC OF NINEVAH
Below the surface-stream, shallow and light, Of what we say we feel – below the stream, A light, of what we think we feel – there flows with noiseless current strong, obscure and deep, The central stream of what we feel indeed. MATTHEW ARNOLD
Rich tears! What power lies in those falling drops. MARY DELARIVIER MANLEY
You are healed of a suffering only by experiencing it to the full. MARCEL PROUST
4. LET YOUR FEELINGS OUT.
What soap is for the body, tears are for the soul. JEWISH PROVERB
Give sorrow words; the grief that does not speak whispers the oe’r fraught heart and bids it break. WILLIAM SHAKESPEARE
It takes two to speak the truth – one to speak, and another to hear. HENRY DAVID THOREAU
He speaketh not; and yet there lies a conversation in his eyes. HENRY WADSWORTH LONGFELLOW
The best prayers often have more groans than words. JOHN BUNYAN
Out of the deep I have called to you, O Lord: Lord, hear my voice. PSALM 130
5. MAKE YOUR NEEDS AND WANTS KNOWN.
We want people to feel with us more than act for us. GEORGE ELIOT (MARY ANN EVANS)
Shared joy is double joy and shared sorrow is half-sorrow. SWEDISH PROVERB
Let those who have need of more ask for it humbly. And let those who have need of less thank God.
SAINT BENEDICT
The fragrance always remains in the hand that gives the rose. MAHATMA GHANDI
6. LET WHOEVER IS CLOSE TO YOU TAKE THIS JOURNEY WITH YOU.
Good company is a good coach.
JOHN CLARKE
We are all travelers in the wilderness of this world. And the best we can find in our travels is an honest friend. ROBERT LOUIS STEVENSON
It brings comfort and encouragement to have companions in whatever happens. DIO CHRYSOTOM
Bless to me, O God the earth beneath my feet. Bless to me, O God, the path whereon I go. Bless to me, O God, the people whom I meet, today, tonight, and tomorrow. CELTIC BLESSING
After you had taken your leave, I found God’s footprints on my floor. RABINDRANATH TAGORE
7. ASSERT YOUR RIGHT TO MAKE YOUR OWN DECISIONS.
Life is either a daring adventure, or nothing. HELEN KELLER
Do not be too timid or squeamish about your actions. All life is an experiment. RALPH WALDO EMERSON
Of all paths a man could strike into, there is, at any given moment, a best path which, here and now, it were of all things wisest for him to do. To find this path and walk in it, is the one thing needful for him. THOMAS CARLYLE
Risk! Risk anything! Care no more for the opinions of others. Do the hardest thing on earth for you. Act for yourself. Face the truth. KATHERINE MANSFIELD (nearing her own death).
8. EMBRACE THAT WHICH PROMOTES YOUR OWN WELL-BEING AND GROWTH.
A day is lost if one has not laughed. FRENCH PROVERB
A life without festivities is a long road without inns. DEMOCRITUS
Come, let us give a little time to folly, and even in a melancholy day, let us find time for an hour of pleasure. SAINT BONAVENTURA
I rejoice in life for its own sake. Life is no brief candle to me. It is a sort of splendid torch which I have got hold of for the moment, and I want to make it burn as brightly as possible before handing it on to future generations. GEORGE BERNARD SHAW
Die when I may, I want it said of me by those who knew me best, that I always plucked a thistle and planted a flower where I thought a flower would grow. ABRAHAM LINCOLN
9. LET GO OF THAT WHICH BLOCKS YOUR WELL-BEING AND GROWTH.
Remember that you have only one soul; that you have only one death to die; that you have only one life, which is short and has to be lived by you alone;and there is only one glory, which is eternal. If you do this, there will be many things about which you care nothing.
TERESA OF AVILA
We must, strictly speaking, at every moment give each other up and let each other go and not hold each other back. RAINIER MARIA RILKE
May I tell you why it seems to me a good thing for us to remember wrong that has been done to us? That we may forgive it. CHARLES DICKENS
10. TELL YOUR STORY
What was hard to bear is sweet to remember. PORTUGUESE PROVERB
Some memories are realities, and are better than anything than anything that can ever happen to me again. WILLA CATHER
A good story is medicine to my bones. ABRAHAM LINCOLN
I shall remember while the light lives yet and in the night time I shall not forget. ALGERNON CHARLES SWINBURNE
Childhood has no forebodings, but then it is soothed by no memories of outlived sorrow. GEORGE ELIOT (MARY ANN EVANS)
11.DECIDE WHAT YOU YET WANT TO DO,
THEN DO IT.
Dost thou love life? Then do not squander time, for that’s the stuff life is made of. BENJAMIN FRANKLIN
Be living, not dying. LAO TZU
Not life, but good life, is to be chiefly valued. SOCRATES
Do you know that disease and death must needs overtake us, no matter what
we are doing? What do you wish to be doing when it overtakes you? If you have anything better to be doing when you are so overtaken, get to work on that. EPICTETUS
If I knew the world were coming to an end tomorrow, I would still go out and plant my three apple trees today. MARTIN LUTHER
12. NURTURE YOURSELF SPIRITUALLY.
One cannot die hidden from God. ITALIAN PROVERB
The most beautiful thing we can experience is the mysterious. ALBERT EINSTEIN
Lord, one day I will live with you where you are. May you live with me where I am now. JOHN MASON NEALE
May the Great Mystery make sunrise in your heart. SIOUX PRAYER
What is it that dwelleth here I know not, yet my heart is full of awe and the tears trickle down. SAIGYO
13. DARE TO HOPE
Hope is patience with the lamp lit. TERTULLIAN
There never was night that had no morn. DINAH MULOCK CRAIG
When God shuts a door, God opens a window. JOHN RUSKIN
A death blow is a life blow to some who till they died, did not alive become;
Who had they lived, had died but when they died, Vitality begun. EMILY DICKINSON
You will go out in joy and be led forth in peace; the mountains and hills before you will burst into song, and all the trees of the field will clap their hands. THE BOOK OF ISAIAH
14. WHAT WILL YOU DO WITH WHAT YOU NOW KNOW?
Destiny is not a matter of chance, it is a matter of choice; It is not a thing to be waited for, It is a thing to be achieved. WILLIAM JENNINGS BRYAN
Wherever your life ends, it is all there. The advantage of living is not measured by length, but by use; some people have lived long and lived little; attend to it while you are in it. It lies in your will, not in the number of years, for you have lived enough. MICHEL DE MONTAIGNE
God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Grant me patience with the things that take time, tolerance of the struggles of others that may be different from my own, appreciation for all I have, and the willingness to get up and try again, one day at a time. THE SERENITY PRAYER
There is nothing I can give you which you do not have. But there is much, very much, that while I cannot give it, you can take. No heaven can come to us unless our hearts find rest in today. Take heaven! No peace lies in the future which is not hidden in the present instant. Take peace!
The gloom of the world is but a shadow. Behind it, yet within reach, is joy. There is a radiance and Glory in the darkness, could we but see, and to see, we have only to look. I beseech you to look. FRA GIOVANNI
13. DARE TO HOPE
Hope is patience with the lamp lit. TERTULLIAN
There never was night that had no morn. DINAH MULOCK CRAIG
When God shuts a door, God opens a window. JOHN RUSKIN
A death blow is a life blow to some who till they died, did not alive become;
Who had they lived, had died but when they died, Vitality begun. EMILY DICKINSON
You will go out in joy and be led forth in peace; the mountains and hills before you will burst into song, and all the trees of the field will clap their hands. THE BOOK OF ISAIAH
