Grief blog #3

Anticipatory grief is complicated. It is grief that begins before an actual tangible loss.

As a hospice nurse I see this one the most. It can be the sweetest or it can rip your heart out.

A hospice nurse’s job requires that she be with the patient and their family BEFORE and/or WHEN a patient dies, not AFTER the loss. Yet, I see grief every time I visit a patient.

Anticipatory grief is about what is going to be lost, not what has already been lost. It is a looking forward to the future knowing the eventual loss is out there.

Anticipatory means knowing what’s coming, and the feelings surrounding it. Most anticipation is positive, it’s all about excitement. Anticipatory grief is knowing that loss is looming and recognizing the sadness that will fill the void.

In the case of a diagnosis that has a prognosis of six months or less, the imminent loss is felt by the patient and the family/friends involved. The weighing of every moment spent against those that will be missed and not experienced. It’s the waiting for the inevitable to happen that is so difficult.

As I visit patients I feel how hard it is to be grateful for the time you have left when you know it is being cut short. When the present is being overshadowed by the “what-if’s,” the “how’s” and the “when’s,” it is impossible to fully appreciate the here and now.

Because it is a type of grief, patients go through the grieving stages when they are anticipating their own death. They experience the loss of a future.

It can be a very emotional time because patients and their loved ones may be going through the grieving process at a different pace. The patient may be in the anger phase while the spouse is in the denial stage, and so on. Couple that with trying to deal and manage with disease processes, pain, and deterioration and you have a grief soup that is hard to swallow.

This type of anticipatory grief doesn’t only surround dying though. It can be what a parent is feeling when their child starts their Senior year of high school or when a service man gets called to action. It can hit home when someone gets something they actually wanted, but with it, comes total change for their future; such as a move, or major change in relationships, etc.

Anticipatory grief is different in another way in that it often has some feelings of ownership or guilt by the person causing the loss. Using dying as the example, if the dying person is aware that their death is going to cause grief they will often feel a great burden for the sadness they are causing by dying.

When we think about caregiver burnout, anticipatory grief is one of the things that adds to the wasting away of reserve for the caregiver. It is exhausting taking care of someone who is sick and dying, physically and emotionally. It is exhausting grieving a loss that is going to happen. Anticipatory grief, for a caregiver, is a foreshadowing for the grief they will feel when the loss actually occurs.

It’s not all doom and gloom when anticipating the end of a life. The sweet surprisingly lovely moments surrounding anticipatory grief can be numerous. If one is given the opportunity to anticipate their death, and they are lucky enough to not be killed in an accident or a sudden death, their will be moments that are funny and tender mixed with the sad.

I have spent many hours talking to hospice patients and their spouses/family members/friends about the eventual death. Many are just plain curious about the process of dying, what to look for as the body shuts down. Some are fearful. Some are excited for what is to come. All are grateful for information and stories of past experiences.

It is a time to make plans, sign papers, look at pictures, tell stories, visit, or just rest.

If family dynamics allow, they are able to say and do things that they don’t want left unsaid. Looking forward to the death seems to bring petty things out into the open and reveal them for the unimportant things that they are.

Laughter is the best medicine and it is never more true than during this phase of dying and grief. One of my patient’s sons wrote his obituary for him to read and it was so hilarious. It was filled with things that were true about the patient but things that would never go into an actual public obit. It was a way for the son to recognize all the great times in his father’s life while his father could appreciate it. It was funny.

When my dad was dying I was able to hug him and cry and tell him I didn’t want him to die one day and then the next tell him that his newly acquired lifetime pass to Yellowstone, that he was so proud of, wasn’t much of a deal for him, was it? My dad laughed so hard at that and although not every family would have thought that was funny, mine did. My dad told everyone that visited him that story.

If the grief journey begins with anticipatory grief, it then changes to grieving the actual loss. Anticipating the grief is not where one stays; it is a path to the grief that will last forever, ever morphing as it lessens with time.