The Forgotten Grief: For Professionals
Perinatal Loss and Bereavement: A Guide for the Health Care Professional
Facilitating Parental Choices and Grief
When I worked onsite in hospital settings and
occasionally emergency rooms with parents experiencing loss, I noticed the extreme discomfort
many hospital personnel, especially physicians-in-training had with the grieving process.
When I encountered medical students, most had received little training in dealing with extreme crises,
and what they had learned in 'interpersonal skills' was rote and artificial, seldom meeting real needs
of real people, and it became apparent that the effective students were ones who were naturally gregarious
and people-oriented, but unfortunately many, with technical backgrounds were uncomfortable with the personal
side of medicine. When I gave presentations and lectures, the most frequent question was "What do I say?".Medical Students and Physicians, in all other aspects of medicine learn to observe, test, diagnose and treat. While there is some subjectivity in difficult diagnoses, there are many tried and true 'methods' or 'procedures' which are the guidelines in medical practice, or if there are several, the trained student or experienced physician can with facility choose a 'logical' strategy.
When dealing with extreme emotional responses though, such as a diagnosis of a terminal illness or reactions to a death, most physicians would like to attend only to the physical and leave social concerns to other members of the staff, but since they are the chief medical contact, and the most trusted by parents, they find themselves in need of sharp interpersonal and crisis intervention skills which are as critical to physical as to emotional healing. When confronted with training though, most want a 'list' of things to say and things not to say. When thrown into grief counseling without training or knowledge, the comments even a well-meaning staff member may say can seem barbaric to the patient: it is a troublesome dichotomy as the caretaker truly wishes to alleviate pain, but ignorantly may cause it. I wish I could produce an easy "Things to Say" list- it would immediately relieve the physician although perhaps not the mourner. For several years when parents met in groups or came back for interviews, I heard deep pain expressed at some things which were said in the hospital such as "Don't worry, you can have others" [they don't want others at that moment], or "It's probably for the best, it would have been deformed" [a stillbirth never seems 'best' and the truth is, most babies who die are not deformed at all!].
Pro-Active vs Facilitative
One could probably devise more easily a 'Things NOT to Say' list, as there seems to be some standard responses that caretakers mistakenly think will help including the above. Any attempt to ameliorate the incident of the death, to explain it away, dismiss it, hide it, or demean it are all, always highly inappropriate and cruel. Even sensitive people though when confronting a crying new bereaved mother, reach for something, anything to say. The first issue one must understand about oneself, is that he or she is used to >telling patients what to do, and treating them. This mode is 'pro-active'. The student or physician DOES something, gives something, writes something, and so on. All of treatment is 'pro-active'. This is not just a fundamental problem for the medical setting it is true in counseling as well: new students want to learn 'things to do' or how to 'do therapy'. Teaching, also is 'pro-active'. We like this mode because it puts us in control of the situation, erases painful pauses, or unbearable silences.I had a discussion some twenty years ago with a Pharmacology professor who was certain that one day, they could find a pharmeceutical which could 'cure' grief---he meant of course take away the pain. That however is a very surface understanding of mourning. That horrible gut-wrenching unbearable pain, is part of the process of grieving, and masking the feelings or visceral components could only be temporary and potentially even more harmful! Here it is in sum: there is no pill, no miracle cure, nothing you can say or do which will make anyone's grief of any kind 'go away', outside of bringing back the lost person. Nothing. And that is the fundamental problem of training new people to deal with another's grief and mourning: we have to start with dismantling all we understand about 'fixing' problems, and learn to stand back and face grief ---our own or others as a problem which cannot be fixed or erased.
We enter instead into a "Facilitative Mode in which we are not looking for a 'solution', but listening, learning supporting and finding ways unique to the individual to comfort and to care. To use a medical example, if a patient loses an arm to a disease process, we do not go through dozens of procedures to recreate the lost arm. We instead help the person to adjust to the loss, find ways of healing from the wound, rehabilitate the person to re-enter life effectively. With mourning, it is the same, only with even more complexity.2
When a baby dies a series of complex emotions and cognitive experiences are set in motion. [These are described elsewhere in this site in detail.] The physician is most like to encounter the mourning process
Grief & the Hospital: Self Assessment
I. fffffff)Grief & the Hospital:Links, Resources, and Information
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Title taken from "The Forgotten Grief" published in American Journal of Orthopsychiatry,1982.
2Note: Most researchers and theorists include the loss of any limb or body part as a mourning process, and find that there are consistent similarities as persons deal with a loss of a physical part of themselves.