Let there be light ...

 

There is always a glimmer in those

who have been through the dark.

Atticus

Hello everyone - greetings of light-in-the-darkness to you all!

I would not have believed Atticus' ancient words in the dark, depleted days following years of family caregiving, the death of my husband, my mother's death 3 months later and all the mind-numbing tasks that inevitably follow the death of loved ones. I had given more than I had to give and was utterly spent. For months after the first rounds of bereavement tasks were complete, I did little more than sit in a chair by the window and breathe. And even that was an effort some days.

It was close to a year and a half before I regained sufficient physical strength to engage my grief in a meaningful way. And, to be quite honest, there were many days when I wished I had died, too, I felt so bereft and had so little life force left to fuel my living.

Some would have said I was depressed but, in fact, I was exhausted, grieving and traumatized. But, deep within me, invisible to the naked eye, healing was already beginning to take place. First came the s-l-o-w restoration of physical strength wrought by weeks and months of simple rest, good nutrition and short daily walks. (Though those initial "walks" comprised nothing more than a few steps to the front door where I stood on the porch with my face to the rain.)

Then, in the long silent hours of sitting by the livingroom window, staring at the garden, came quiet opportunities to re-connect with my Self, my memories, my feelings and the many sources of strength greater than my own - the healing rhythms of nature, the beauty outside my window, the wisdom gleaned from poetry and prose and a deep spiritual connection with Mystery. As my energy rose sufficiently to reconnect with people, the love of cherished relationships, old and new, sustained me through new choices in life and vocation. The glimmer that had desperately endured the darkness was fanned to a new brightness by my willingness to let healing take as long as it took and to accept the loving support of family and friends.

For some of you, 2020, (this strange, COVID, "year-out-of-time"), is ending in a similar state of grief, trauma and depletion.  You are full of unexpressed pain and sorrow and have not an ounce of strength left to give.  It feels like there is nothing left of you or in you. But please don't allow that to be your truth for long. Choose, instead, to gently and persistently fan the flame of your own life force.  Seek the things that have renewed you in the past and allow them to do it once more - even in the smallest "doses" and most unusual ways, given COVID's limitations.

As Atticus knew, way back in second century Rome, there is a tiny glimmer left in all of us who have been through the darkness, be that darkness the countering of COVID's grim effects, the fearfulness of not being able to work, the anxiety of becoming ill yourself or the exhaustion of caring for loved ones at home who were already ill or injured before the pandemic. This remaining glimmer can be buried so deeply that it seems all but lost - but it IS still there. And, with gentle fanning and exquisitely tender nurturing, it can break into flame and give light once more - first to yourself and then to the world around you.

When you do choose to heal, you may find you have sufficient energy to fan your own flame but, more likely, you will need some help. So, please do ask for that help. Even if it's hard at first. (You may have noticed that we nurturers are not always great at asking for nurturing, ourselves.) There will always be others who have walked the healing path before you who are willing and able to help you find your way.  Keep looking until you find the right ones for you - supportive friends, somatic therapists, spiritual advisors, meditation leaders, support groups and others. This care and support will make all the difference.

Festivals of light across cultures - Diwahli, Winter Solstice, Christmas, Hanukkah and others - remind us that there IS light in and after the darkness and that it can be fanned to a new intensity with time, care and exquisite attention. 

So, at this particularly dark moment in time, for each of us individually, and as a wider community, "Let there be light ...".

Living With COVID Grief ...

Grief is itself a medicine.

William Cowper

Hello, Everyone,

The COVID season of 2020 has been a season loss and grief - and it's not over yet. Loved ones have become ill and died. Jobs have been lost. Professional aspirations have disappeared at least temporarily. Human connections have been disrupted. Life plans have been altered. And even as society reopens, COVID-related change and loss continue.

As we cautiously begin to leave isolation behind, more losses accumulate. Those few hard-found gifts of COVID - a slower pace, more time with loved ones, reduced commute time, free parking at work, chances to pursue neglected hobbies and activities, giving and receiving more focused and intentional emotional support, opportunities for reflection, the surfacing of deeper values - threaten to drop away as life changes pace once again. 

Grief is also tied up in our imaginings about the future and the possibility of losses to come. We face the distinct possibility of a "second wave" as fall and flu season approach.  Will a loved one become ill as we open further and return to school? Will we become ill ourselves? Will we lose our jobs? This is called anticipatory grief and it adds yet another layer to our sadness, anger, anxiety, fear, guilt and envy.

With all these COVID losses compounded by contextual losses such as economic insecurity and systemic racism around the world, there's more than enough grief to go around. So, the trick is to find the right conditions in which to grieve our losses well. Because grief is so individual, "the right conditions" will differ for each of us but here are a few general practices that might help:

1.  Acknowledge that you've had, and will have, many losses during this COVID season of life.  Every change - positive or negative - brings loss, and grief is our healing response to loss. We grieve automatically, provided nothing gets in the way. Becoming aware of our losses and accepting their presence makes space for our grief, direction and focus to our mourning and provides opportunities for others to support us.

 2.  Pace your grief when you have multiple losses. It can be overwhelming to try to grieve everything at once. Take baby steps. Make space for grief, one small piece at a time. (And know that you may return to the same loss over and over again before it feels integrated.)

If grief begins to feel overwhelming to you, try self-regulation skills like breathing practices, grounding exercises or physical shaking to calm you when you're  "amped up" and anxious or enlivening practices like engaging your five senses, walking meditation, squeezing  your forearms with the opposite hands when you start to feel "shut down" or numb. 

2.  Find a sanctuary where you feel safe and comfortable expressing your grief emotions. If you're able to do it, give your grief feelings freedom to arise spontaneously. But, if you can't because it seems neither safe nor possible, try identifying a sanctuary where you can retreat intentionally to take down your guard and let your inside and outside match. This creates intentional space for your hardwired grief response to do its healing work. 

For some, this sanctuary will be in the arms of a loved one who lives inside your bubble; for others it will be found alone in the car, the shower or in bed at night; and for others still, it will be within a formal ritual or ceremony (in person or online) or out in the beauty of the natural world. What matters is that you feel safe enough to allow your grief to surface for a while.

3. Express your feelings in ways that feel natural and comfortable to you. There is no "right way" to grieve.  And you don't have to cry to prove you've grieved. The fine arts provide many possibilities for expressing grief - story-telling, journalling, writing poetry or letters, listening to or playing evocative music, drumming, dancing, singing, collage, drawing, painting, sculpture, pottery, photography, fibre arts or woodwork. Use avenues of expression that feel natural for you. You don't have to squeeze yourself into someone else's idea of "proper" grief expression.

If your body feels tight with emotion that you want to release but can't, you might try listening to music, watching movies or reading poems that have triggered your tears in the past. They will likely do the same thing again.  (Repeated cycles of Truly Madly Deeply, Shadowlands and A Rumour of Angels helped release my frozen tears through seven years of chronic sorrow and more years of bereavement grief following my husband's death.)

Physical motion can also do much to diffuse pent-up emotion. Walking or running in nature, dancing or engaging in individual sports can all help.

If you are yearning to share your grief with another human being but feel constrained by the  COVID restrictions, try reaching out to loved ones, a therapist, a spiritual advisor or a support group through appropriately secure video meetings like Zoom or Skype, phone calls, texting or social media. Handwritten letters, though seemingly old-fashioned these days, can offer a particularly personal and connected way of sharing your grief.

4.  Create rituals that support and facilitate your grief.  Grief specialist, Alan Wolfelt describes grief rituals as "symbolic activities that help us, together with our families and friends, to express our deepest thoughts and feelings about life's most important events". A ritual doesn't have to be fancy or complicated and it can be experienced individually or in a supportive group.

Examples of grief rituals might be to: 

a.  Have a physically-distanced or Zoom meal where each person brings an item that symbolizes their life before COVID and another that symbolizes life since COVID. Focus discussion on the meaning and feelings attached to each item. Listen respectfully to each person's reality.

b.  Create art in memory of life before COVID and share it and your feelings with others.

c.   Light a candle to hold space for your grief and write a letter to your old life, expressing how much you miss it.

d.   Use ceremonies with sage, incense or fragrant essential oil to cleanse or let go of the old life and open you to the new.

There are as many rituals as there are people - let your imagination go and create what will work best for you. 

However you decide to deal with the changes and loss of COVID-19, try to honour yourself and your losses by making space for the "good medicine" of your grief.

The Paradox of Grief and Gratitude ...

Wherever there's change, there's loss

and wherever there's loss, there's grief.

Bill Bridges

Hello, Everyone,

I have used the quotation above often in workshops and writings and here it is once again. Appropriate for the times, I think ... 

So much has changed in recent months and these changes have brought with them loss and grief in abundance, especially for family caregivers already coping with chronic sorrow and helping professionals carrying years of cumulative grief.

Since the pandemic has taken hold,  family caregivers have lost already-scarce freedoms, resources and supports -  the coffee shops that once provided a brief haven at the end of a morning's respite, the familiar care aides who knew the needs of an ill loved one and didn't require training each time they arrived, the day programs that offered respite as well as support and advice, the volunteers who helped with transportation or yard work or exercise regimes or meals, the warmth and encouragement of a simple hug. Some caregivers have had the worst of anticipatory griefs - standing by as loved ones with worsening COVID symptoms were transferred to acute care facilities, perhaps never to be seen again.

Healthcare professionals have also carried the weight of grief. They've grieved the loss of patients they had hoped to save, relinquished long-held standards of care and infection control, worked without essential equipment, given up contact with their own families, forsaken any semblance of a balanced personal life and mourned the loss of cherished co-workers and friends.

And then, together, we've felt the collective grief of watching as our systems of work, healthcare, education, transportation and economics wavered under the weight of the virus. The tangible losses of unemployment, closed churches and mosques and food insecurity have been multiplied by the broader intangible losses of predictability, control, justice and our assumptions that we could protect the weak and the vulnerable.

This COVID-19 grief is natural and expectable and it will come in waves for a long time after the losses cease. Grief is the way we heal from broken attachments - and it happens automatically provided nothing gets in its way. Grief is a turning inward to reflect, to feel, to recalibrate. There are resources to support this highly individual healing process and we will explore some of them next time.

Paradoxically, the losses stemming from the COVID virus, and their attendant grief, are often accompanied by a sense of deep gratitude. There is something about walking at the edge of life that brings authentic blessings into sharp relief - spring blossoms in a time of death, the kindness of nurses holding phones to unite families in their last goodbyes, messages of support and encouragement painted by children on apartment windows, meals left on doorsteps, 7pm clapping and cheers as healthcare workers change shifts, songs that connect the isolated. We can draw upon this natural pairing of grief and gratitude to nurture ourselves during difficult times.

Brother David Steindl-Rast, the Austrian founder of A Network for Grateful Living and a 93 year old survivor of the Nazi occupation, is a beloved teacher of the practice of gratefulness. In a 2016 interview with Krista Tippett, he said,

To open your eyes and know another day - we can't take it for granted. In my youth, we couldn't take it for granted because every night, the bombs fell. There are all sorts of reasons why you (might not) see another day, and you do. And that's a wonderful thing."

His words could apply equally to these days of pandemic.  The practice of gratefulness is not about being grateful for the pandemic, itself, nor for the numbing pain and despair of these times. Nor is it about avoiding or minimizing our sadness, anger, fear and confusion.  Rather, a gratefulness practice offers the opportunity to experience more than one feeling, in full, at the same time - to know gratitude at the same moment that your heart is breaking with grief. To know sorrow and joy in the same breath.

A gratefulness practice allows us a pause to heal, grow and reconnect with ourselves, others and what or whomever we hold sacred. It doesn't take away our grief but it does help to balance it. So, when you wake in the morning or before you go to bed at night, take some time to think of - or,  better yet, write down - the things for which you're grateful. Some days there will be a long list and other days, as gratitude writer, Sara Breathnacht, says, the only thing you'll be grateful for is that the day is over. Either way, recording your gratefulness will not only help balance your grief in the moment, it will provide a wealth of positive memories from which to draw strength in the future.

Keep well, everyone! I'm grateful for all of you!

The Wild Edge of Sorrow ...

There is some strange intimacy between grief and aliveness, some sacred exchange between what seems unbearable

and what is most exquisitely alive. Through this,

I have come to have a lasting faith in grief.

Francis Weller

The Wild Edge of Sorrow

Hello, Everyone,

I began the post below earlier last month but was interrupted and forgot to hit the "publish" button so here it is now, sans the snow! .....

Here in Vancouver, we are trapped in the wilds of winter with more snow on the ground, in the trees, on the roads and in the air in this past week than we usually see in a year! The whole world seems to be held in muted abeyance, hibernating as it waits for its natural rhythms to return. It's a time to bury yourself in a cozy blanket with a good book and that's just what I've been doing all weekend.

Having lost four dear ones since mid-December (five, if we count my sister's Maggie-dog, a lovely Bernese Mountain Dog who captured all our hearts), witnessed the devastation of so many  lovely trees at the lake during this year's unusual snowfalls, been stunned by the deaths of six innocent Muslims at prayer in Quebec City and experienced profound sorrow at the hateful rhetoric arising from so many parts of our world, I have been reading a new-to-me book on grief. I'd like to share some of its goodness with you this morning.

Francis Weller's book, entitled The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief, is one of the better volumes on grief I've had the pleasure to read. Beautifully written, it covers five categories of loss which Weller says form five gateways to grief - 

1.  The gateway of illness and death

2.  The gateway of the parts of our selves that didn't receive love -  parts that were then lost  through being wrapped in shame, banished and marked unworthy

3.  The gateway of the world's sorrows -  the loss of care for the earth and the devastated state of the earth and its creatures 

4.  The gateway of what we expected and did not receive -  the loss of the welcome, engagement, touch and reflection we are all hardwired to expect at birth and throughout our lives but may not have received because we weren't raised by a village that could meet multiple needs or because

5.  The gateway of ancestral grief - the losses of our ancestors, often unknown or unacknowledged, and the secondary losses arising from the ways in which they coped with their pain (violence, alcoholism, eating disorders, emotional abuse and neglect, rejection of culture etc), all still carried within our bodies

Weller spends a good deal of time talking about the importance of ritual, a form of support readily available to the bereaved but often missing for people with disenfranchised grief such as chronic sorrow. Because this grief response is not mentioned specifically in the book, the volume also lacks the needed cautions reminding family caregivers to avoid doing deep grief work around more than one loss at one time so as not to become overwhelmed.

I found this book a poetic read with exquisitely evocative language. It provides a needed reminder for all of us to acknowledge and work with our losses so they don't have a continuing negative impact on our selves and our world and so that our personal aliveness can be kindled through the transformation of our grief. Weller's writing is empathic and resonates with the grief of the reader and, although its  recommended group work for healing grief is not a process that appeals to my introverted soul, it obviously appeals to and helps many others. I would recommend this book to anyone interested in learning more about ritual and the healing of grief.

A second book I've found supportive and soothing in these days of sadness is Jan Richardson's new book, The Cure for Sorrow: A Book of Blessings for Times of Grief. While written from the specific perspective of a United Methodist minister and new widow in the US, this book touches on universal themes of loss, grief and transformation and invites us to "know the tenacity of hope and to recognize the presence of love which ... is 'sorrow's most lasting cure'". Here is one of Jan's new blessings, one which I think applies to caregivers as much as to the bereaved:


The Blessing You Should Not Tell Me

Do not tell me
there will be a blessing
in the breaking,
that it will ever
be a grace
to wake into this life
so altered,
this world
so without.

Do not tell me
of the blessing
that will come
in absence.

Do not tell me
that what does not
kill me
will make me strong
or that God will not
send me more than I
can bear.

Do not tell me
this will make me
more compassionate,
more loving,
more holy.

Do not tell me
this will make me
more grateful for what
I had.

Do not tell me
I was lucky.

Do not even tell me
there will be a blessing.

Give me instead
the blessing
of breathing with me.

Give me instead
the blessing of sitting with me
when you cannot think
of what to say.

Give me instead
the blessing
of asking about him -
how we met
or what I loved most about the life
we have shared;
ask for a story
or tell me one
because a story is, finally,
the only place on earth
he lives now.

If you could know
what grace lives
in such a blessing,
you would never cease
to offer it.

If you could glimpse
the solace and sweetness
that abide there,
you would never wonder
if there was a blessing
you could give
that would be better
than this -
the blessing of your own heart
opened and beating
with mine.


Blessings to all of you who grieve today.

The Presence of Absence at Christmas ...

I notice your absence.

I notice your non-presence and reflect

on the time when you were present ...

Jarod Kintz

Hello everyone,

I've just finished all the happy "work" of the holidays and now there is time to sit back by the fire with a cup of tea to reflect on the holiday experience thus far. 

The winter holidays are usually the most joyful time of year for me. I love everything about them - the lights, the colours, the gifts, the music, the connection with family and friends. This year, however, changes in the pattern of life have subdued some of that joy. One sister, who lost her partner last spring, is grieving. The other sister is far away in Dawson City, without her family, working through the holidays. My dear friends, whose daughter is spending Christmas in a hotel room in a small city in Borneo rather than joining them for Christmas dinner, are missing her presence. And my own traditional plans for Christmas Day have taken a different path this year, asking me to spend most of Christmas Day alone.

At one point during the week, I sat down with my journal to better understand the strength of my emotional response to these "absences". I was sad and angry and lonely to a degree that seemed a bit of an overreaction to the actual circumstances. (After all, I am hardly a Syrian refugee being torn from everything I know or a family caregiver saying goodbye to a loved one who will die over the holidays.) As usual, after digging a little deeper, I realized that the intensity of my response came from layers of similar experiences in times past, times when the presence of absence figured strongly in my life. 

Whether at the very beginning of life when I lived as a boarder baby in a hospital nursery or during the many times in my childhood when my beloved father disappeared without warning on an alcoholic binge or throughout the early years of my bereavement following the deaths of my husband and mother, this "presence of absence" has had a strong, if sometimes unconscious, effect on my life. Now, when current holiday experiences trigger the emotional memories of these absences, my old and new reactions can mix together and become a little over-the-top.  

It is in the nature of life that we live in the presence of absence. Something or someone is almost always missing or about to go missing. Most of us build up an internal file folder of "absence experiences" over time, a folder that has the potential to raise our emotional intensity whenever it is reopened by a current loss or disappointment. 

So, what do we to do when this file folder is opened unexpectedly and all those old pages of absence fall out on the floor with their attendant emotions?

The first step is to recognize that this, indeed, is what's happening. This recognition lets us separate present experience from past emotion, allowing us to respond to the current absence with more appropriate intensity.

Secondly, we can reach out for a "presence" to calm and balance the experience of absence. Tell a trusted friend how you're feeling, write in your journal, pray, meditate, lean into the web connecting all human beings for support and comfort.

Thirdly, make a concrete action plan for doing the best you can with the absence situation that faces you. I have a large turkey thigh in the fridge waiting to be stuffed tomorrow morning, a fire all ready to be laid in the fireplace and a new book on hand to open tomorrow afternoon. I've also booked telephone visits with particularly supportive loved ones, spread throughout the day. It won't be the Christmas I want but it can be a better one than the lonely one I'd imagined.

And, finally, after the holidays have passed, you can consider seeing a good therapist to work at emptying your absence file folder of some of its older pages so that your holiday emotions can gradually become less overwhelming.

Whatever the absences present in your life this holiday season, may each of you find sufficient gifts of peace and joy to balance them. 

  

Merry Christmas, everyone!

Jan

A Friend Indeed ...

Hello, Everyone,

This morning, I want to say a bit about friendship, having learned of the death of an old and dear friend, Susan (Mitchell) Voth, on the first day of this new year. (My heartfelt condolences to her family and friends.)

I met Susan in 1970 during my urology rotation in nurses' training at St Paul's Hospital in Vancouver.  I was an eighteen year old junior surgical student and she was a relatively new RN from the Maritimes who kept everyone - patients, students, staff and physicians - in stitches much of the time. While she struggled with a learning disability that made her handwriting and spelling atrocious, she had the kind of natural wisdom and intuitive knowing that made her an invaluable partner on nightshift when a patient's condition was going south and the issue hadn't quite declared itself. Her heart was as big as all outdoors and she stayed in touch with many of her patients and families over the years.

Susan and I became fast friends during my training days and were roommates, on and off, over ten years until each of us married. She and her first husband, Al, who was later killed in an airplane accident, moved to the prairies to farm and we eventually lost track of each other. I was happy to have the opportunity to reconnect with her briefly when she visited Vancouver years later after marrying her second farmer husband, Henry.

Susan was a good friend to me and I realize, now, that we understood each other so well because we  shared the effects of our particular childhood trauma - Susan had lost her mother at the age of two and I had experienced significant medical trauma and maternal separation at birth. We had also lived through many years of our fathers' alcoholism. Those shared experiences gave us a natural empathy for each other and our friendship helped fill many gaps from our younger years.

From Susan, I learned to cook, camp, canoe, enjoy a little good scotch, choose a good lobster, like pop music, socialize in large groups (I was very shy), play my guitar in public, drive a car (first a volkswagon beetle, then an MG Midget and finally a volkswagon van that took us 23,000 miles around North America in 1978),  to laugh more and worry less, and even to recognize that I had a spiritual life worth developing (though our paths-of-the-spirit soon diverged). Her family - her Dad, Helen, and siblings, Nancy, Peter and Mary - welcomed me into their homes and offered rich adventures on the ranch in Manitoba; in Cornerbrook, Newfoundland; on the St Stephen, NB - Calais, MA border; and by the sea in St Andrew's, NB, adventures that I would never have had otherwise and will never forget. I owe a debt of gratitude to each of them.

We know from the literature on trauma and social bonds that all human beings need social support to survive and thrive. When we have someone we can trust with our stories and our feelings and from whom we can receive support without judgement, we heal better and faster from the wounds of life.   Susan was one of the first of a large network of valued family and friends who have provided that kind of friendship to me. I am forever grateful.

If you have a friend or friends who have been particular supports to you, why not take some time today to think of them and their value in your life and then, perhaps, pick up the phone or write a note to tell them, specifically, how much they mean to you and why.

If, on the other hand, you're feeling isolated and alone and can't even think of a person you'd call a friend, watch this space next time when we'll look at the process of making friends. (An important skill for those who have never had many friends or whose support networks have shrunk significantly through ongoing care-giving or compassion fatigue.)    

 

The Myth of Closure ...

Hi everyone! I've been working hard on the chronic sorrow book all summer and while doing some research for it, I came across a TED Talk by Nancy Berns, sociologist and author of Closure: The Rush to End Grief and What It Costs Us. It was great to see that someone this thoughtful had taken the time to address our society's popular myth that closure is the endpoint of grief.

We all live with loss. In fact, transition specialist, Bill Bridges, says that, "Where there's change, there's loss; where there's loss, there's grief." So, even if we have a positive change like a new baby or a new job or move to a new house, we still lose whatever it was that we had before - and thus we grieve.

Grief is painful. When we grieve, we automatically start looking for ways to alleviate the pain and move on, to find closure as quickly as possible. But Nancy Berns says that there is no such thing as closure:

Closure doesn't even exist. It's a made up concept that we use to talk about sadness and grief...that can do more harm than good. ... We don't need closure to heal.

The notion of closure seduces us, though. It promises that we can escape the painful place of grief and return to joy through closing off our grief. This notion distorts what's actually going on with our grief. The truth is that we don't leave grief to go to joy - the two are entwined like light and shadow. We can experience both at the same time so we don't have to push for premature "closure" in order  to feel some happiness again.

Nancy recognizes that our grief will take as long as it takes and that what we really need is companioning rather than implicit or explicit messages about putting our grief in a box, putting a lid on it and shelving it so we can join others in their world of happiness. These messages are well intentioned because our loved ones hate to see us hurt  - but they are not helpful.

We could all do worse than to listen to, and act on, Nancy's TED Talk advice on how to support someone who grieves:

So, the next time that you see someone who's entering that space of grief - it might be a family member, might be a friend, a coworker, just someone you recently met - don't hand them a box. Don't tell them to find closure. Meet them where they're at. And they might be broken and down and beaten up.

She then goes down on one knee on the stage and continues ...

Meet them where they're at. And while you're there, take a moment and look around, 'cause you might be surprised at the view you have when you're on your knees. And if you're the one broken, you might  be surprised at how comforting it can be to have someone just meet you where you're at, not to try and get you to stand before you're ready, not to try and take away your pain or explain it away. Just to be with you. And when you're ready, to give you a hand up, to take those steps ... 

You see it's not about closure. Healing? Yes. But that's different. 

Nancy's full talk, Beyond Closure, is well worth hearing. You can watch it on YouTube.

Cumulative Grief in Healthcare Professionals ...

Earlier in the fall, I mentioned that I believe there is a missing, or at least underemphasized, component in our consideration of compassion fatigue in health care professionals. That component is cumulative grief.

Most of us are familiar with the Baranowsky-Gentry model of compassion fatigue which states that primary traumatic stress (the trauma that happens to us directly or that we witness directly), secondary traumatic stress (the trauma we experience indirectly through knowing about trauma in others' lives) and burnout (the chronic stress of perceived workplace demands exceeding perceived resources) converge in the life of the helper to cause compassion fatigue, a diminished capacity for or interest in being empathic with another's suffering.

As I have worked with family caregivers, I have modified this model a little to say that primary traumatic stress and secondary traumatic stress, in the presence of burnout and Chronic Sorrow, can lead to compassion fatigue. I have found this change to be helpful in emphasizing that CF is primarily a trauma issue that occurs in conjunction with burnout - not a form of burnout, itself, - and that the grief of Chronic Sorrow, extending from a loved one's diagnosis until his or her death, may also contribute to family caregivers' vulnerability to CF.

Once I had adjusted my CF thinking to incorporate the Chronic Sorrow of family caregivers, I began to wonder about the cumulative grief of healthcare professionals.

Grief is our normal, hardwired, healing response to loss and it will generally heal itself if we stay out of the way and support rather than blocking the natural process. But what if we work in an environment where loss is the norm? What if we form caring attachments to patients and families over and over again only to have the patients die and the families to move on with their lives? What if we work in environments that do not make time and space available to process our own grief or, worse, those that ridicule and shame such "weakness"?

There is a significant and growing literature base, still at the descriptive stage for the most part, focused on cumulative grief, which is defined as:

... our emotional response to the occurrence of multiple deaths,

either at the same time or in serial fashion,

without sufficient time or opportunity to

adequately grieve for each person who has died.

P. Marino (1998) Paraphrased

Phenomenological studies on cumulative grief have emerged from the fields of palliative care, oncology, critical care, paediatrics, gerontology and advanced nursing practice, particularly since the mid-1990's. There are also several professional magazine articles offering advice on how to cope with this accumulated grief, testifying to the importance of the topic at the grass roots level of practice. Last week's episode of CBC's White Coat, Black Art called, "When Your Life is Circling the Drain", reflects the impact of multiple deaths on young medical residents.

Not all work-related losses are considered traumatic, especially when healthcare practitioners have been able to provide "a good death" for both the patient and the family. Thus cumulative grief doesn't fit easily into our currently-held understanding of CF. However, these losses are real and can have a significant impact upon us, especially if left unattended. Do they actually contribute to increased vulnerability to CF? We don't know that yet but it is a rich area for further research.

In the meantime, I will continue to address cumulative grief within the context of CF in my healthcare workshops as it almost invariably and spontaneously comes to the fore.

Photo by BigStock Photos

Companioning through Grief...

Although it is a bright and vibrant fall morning here in Vancouver, my thoughts are focused on grief. A dear friend's mother died of mouth cancer two nights ago, I have been asked to speak to a group of family caregivers who have lost a loved one to ALS and I am rereading the transcript of a seminal keynote address given by Dr Alan D Wolfelt to the Association of Death Education and Counselling conference in Chicago in 1997 entitled, Companioning vs Treating: Beyond the Medical Model of Bereavement Caregiving.

These three occurrences have combined to return my thoughts to the early days of my own bereavement following the death of my husband and, 3 months later and quite unexpectedly, that of my mother.

During those days I was completely depleted, shell-shocked and bereft. Friends and family surrounded me with love and support but, as is often the case in our North American culture, that support gradually dwindled as time went on. Some, who didn't understand the the notion that grief takes as long as it takes, became impatient and frustrated with their inability to "fix" me. Others, who had walked the path of grief before me, waited patiently for the the cloud of sorrow to lift and stood again and again with hearts and arms wide open as, after periods of "improvement", that cloud of grief descended once more in the face of anniversaries, holidays or family celebrations.

Five things helped me through those months and years of sorrow:

1. The incidental comment of an acquaintance whose husband had died years before mine - "It will take 5 years before you know who you are without him". With this comment she gave me permission to take as long as I needed to grieve. The number of years wasn't important. It was the implicit expectation that my grief would take as long as it took. (For some, a long goodbye has already been said and soon after the death there is a sense of relief and an early readiness to engage with life again. For others, the road is longer.)

2. Moorings, the beautiful writings of Rabbi Vicki Hollander. Vicki had been my grief counsellor for a brief period during my husband's illness and, when she moved away to Arkansas and then to Texas, she left me with these poetic and practical reflections on what I might expect at different times during the first year and a half of my bereavement.

3. The Two of Us: My Life with John Thaw by British actress, Sheila Hancock. This autobiography / biography has been, rather surprisingly, a great source of comfort over the years. Interspersed between stories of her life with actor, John Thaw, (Morse, Kavanaugh QC, Mister Tom) are italicized selections from her journal telling the story of his cancer diagnosis, death and her early bereavement. Reading these segments was the most empathic experience of my bereavement and I will be forever grateful for the intuitive love and generosity of my husband's cousins who left a copy on the bookshelf in my sitting room during a visit to England in the Spring following Derrick's death.

4. The support of my spiritual director / grief counsellor whom I saw on a weekly then bi-weekly basis.

5. The support of family and friends who stayed in for the long haul, waiting until the sun shone again in my life.

What was the experience that linked these five supports? The experience of companioning. As Alan Wolfelt said in his keynote, companioning is different from "treating" or "fixing":

More specifically, for me ...

* Companioning is about honouring the spirit; it is not about focusing on the intellect.

* Companioning is about curiosity; it is not about expertise.

* Companioning is about learning from others; it is not about teaching them.

* Companioning is about walking alongside; it is not about leading.

* Companioning is about being still; it is not about frantic movement forward.

* Companioning is about discovering the gifts of sacred silence; it is not about filling every painful moment with words.

* Companioning is about listening with the heart; it is not about analyzing with the head.

* Companioning is about bearing witness to the struggles of others; it is not about directing those struggles.

* Companioning is about being present to another person's pain; it is not about taking away the pain.

* Companioning is about respecting disorder and confusion; it is not about imposing order and logic.

* Companioning is about going to the wilderness of the soul with another human being; it is not about thinking you are responsible for finding the way out.

If you would like to learn more about companioning and other aspects of grief recovery you can read more at Alan Wolfelt's Griefwords.