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I recently found an article I had saved from the October 18, 2011 magazine section of the Boston Globe. It was titled "Lost and Found." Why did I save it? It told the story of a family who had experienced the death of their four-year-old boy from leukemia six decades earlier. He was an identical twin. His twin, who survived him, is now a grown man. The story had many parts to it. The one that struck me the most was the memory and sadness that his surviving twin and his mother still experience. The pain of their loss had never left either of them. His mother, now 90 years old, still thinks of this son and the pain she feels that she associates with his death, and the sadness she has felt over this loss all these years. His twin has lived a full life. He is a musician, is married with children of his own. He often asks himself why it was his brother who died and not him, and he still thinks about what he has lost, and knows the sadness of his own grief. Each in his or her own way has gone on with their lives, but has carried this death and some of their grief with them.
As I read this article I was given an article to read about grief, written for oncology physicians on what they need to know about grief. The article, that appeared in the Journal of Supportive Oncology, Vol. 9 Issue 5, September-October 2011, pgs 172-180, focuses on the resolution of grief. The authors, Kacel, Gau, and Prigerson, caution the reader to be alert to the fact that grief can easily lead to what they call Prolonged Grief Disorder. As they write they suggest that in a short period of time, grief should be resolved, and they imply that people then are "cured." They don't ask if "cure" is really possible. The main part of the article deals with identifying what they call Prolonged Grief Disorder, focusing on what can go wrong as people struggle to cope with their loss. I wondered as I read this article how many of the bereaved I know are "cured" of their grief, or if they all suffer from Prolonged Grief Disorder. Given the focus in this article, I think a caring oncologist is given the wrong message.
My own experience and my research has taught me that grief is not an illness. Realistically, treatment is not available that would lead to a "cure." It is one of the most difficult aspects of life in a world in which relationships are important. People die, and if we care about them we will grieve. We will be sad. We will long for them. Nonetheless, we will experience major shifts in how we live our lives as a result of the loss. We are not sick and this sense of loss will probably in some way be with us for the remainder of our lives, as exemplified by the brother and mother of the twin who died at age four. We seek support from our family, from friends, from our community and we are comforted as we remember.
I wonder how much we help the bereaved if we focus our help on preventing them from developing what we see as an illness? If you know that difficult times may be ahead as you try to deal with the death of a spouse, a parent, or a child, and that these are not signs of illness but normal and expected, are you then not fearful of the consequences? You can call on your various resources to help you cope. Oncologists who want to help should not be afraid of the pain that a grieving person can experience. It is not easy and sometimes it even leads to tears in all those involved. But this pain is part of living and we each must find our way of coping.
It is very important that children learn to not be afraid of this pain, that it is appropriate and expected. With the help of those around them they can find ways of coping and living with it. This means that the adults around them must also learn to accept their grief, learn to live with it and learn how to cope with it. One of the best ways to cope is to let others help as well, and to learn from each other.
