Family physicians should be at the forefront of understanding and assessing incomplete grief responses of patients. This has not been the case for many physicians. Doing so requires a specific curriculum and motivated-well trained faculty, and learners interested in, willing to learn, and emotionally strong enough to do this work. However, I have found that residencies are troubled by what to teach, how to teach, when to teach, and where to teach it. Residents may have uncomfortable feelings, disinterest, cultural barriers , and occupied with so many other tasks to invest themselves in the process of it..
Come join me in looking at a patient who had a family physician who overcame the obstacles and learned the skills to assess and in this case, make a referral to me.
Jack came to the office at the request of his family physician. The physician was an individual I had trained to assess and diagnose grief reactions. The physician had called earlier and indicated that he was sure Jack was suffering from a disrupted grief response and needed professional intervention.
Jack appeared more than apprehensive when he sat down in the
office. I decided to say nothing and see
what he would be willing or able to talk about. Jack finally spoke and
described feeling sad and lonely since his father had died six months ago. He
shared that his father had become a great friend to him over the years and his
sudden heart attack and death left Jack feeling devastated. “I can’t seem to
get over it.”
The physician also noted that had developed a sleeping
problem and had lost some weight. Jack could
not concentrate and seemed to feel off balance.
The other two siblings were “doing better” according to Jack, although his
mother was also seeing the physician for weight gain and high blood pressure. I
wondered if they were really doing better. Jack forced a smile and said I had just created a riddle.
At no time did I sense any real feelings from Jack. His
conversation was highly verbal but not emotional. Where were the emotions for a
young man with such a great loss? Why would Jack have a need to get over his loss so
quickly? Why did he not permit himself
to feel his loss and then his grief, really feel it? While we say that time heals, we must do something
healing in that time in order to heal.
Since all healing comes from within, I suspected Jack needed some
guidelines and therapy to begin now, the process of grieving his terrible loss.
Lastly, deep and intense feelings of sadness are early prerequisites of a grief response, but
are not in themselves a grief reaction.
There were at least six dynamics regarding this situation. There may be more, but probably not less:
1. People seldom allow themselves sufficient time
to complete their grieving.
2. There are physical responses to grieving.
3. . Jack was "off balance" from his loss and needed to
make emotional and psychological corrections to regain a sense of balance in
his life
4. A lack of awareness of how to feel and then
grieve were skills and experiences Jack needed.
5. Dealing with the obsessive components of loss
and grief.
6. Family responses to a grieving situation.
What would he accept from me, a stranger who
entered his world? A world of apparent
loneliness, isolation from himself and others, and fear of his own unknown. He
talked of not sleeping well and obsessing over how he was notified of his
father’s death, and he then believed he lost his way emotionally. I was impressed
with how lonely and isolated Jack felt. He was also afraid of his own future. A
future without his father so there were differentiation issues to be part of
any therapy work
I asked Jack to consider joining a grief group at his local
hospital, and think about therapy to help make the corrections needed to
balance himself again. That six months was probably too early to complete a grief response, and
that he may have to go back and begin again; this time with more appropriate
guidelines to feel, experience his loss, and then move to real grieving. I told
him it was a lot to think about but we live in a world in which we seldom teach
our children how to mourn us, how to grieve us, and how to live through the
experience and hopefully come out stronger than before. Our society really is not much
better at any of this either. I suggested he talk this over with his physician
and his minister. We needed all the allies we could collaborate with.
Finally, I suggested a family meeting to talk about the loss of the father and how they might be able to help each other with mutual grieving and the healing as a family. I also began a discussion about how obsessive thoughts about his father’s death and Jack’s sense of loss tended to take his emotions and feelings in a downward spiral and create difficulties in concentrating and positive activities of daily living (ADL’s.)
Finally, I suggested a family meeting to talk about the loss of the father and how they might be able to help each other with mutual grieving and the healing as a family. I also began a discussion about how obsessive thoughts about his father’s death and Jack’s sense of loss tended to take his emotions and feelings in a downward spiral and create difficulties in concentrating and positive activities of daily living (ADL’s.)
Jack asked for a week to talk with these other people and would then get back to me with his answer. By the way, Jack returned and this time was ready to work....he struggles, but he says his challenges are worthwhile.
While life frequently seems to be about losing what we love most, it is made easier and more comforting when we can learn how to honor our ability to grieve and mourn our losses. We are then transformed and can move on, because life is so precious.
This case was referred to me by a family physician who believed that Jack needed more, much more, if he was to return to a life of real meaning and purpose. The outcome is yet unknown, but Jack has taken the beginning steps to a healing sense of grief; and made possible by a physician aware and sensitive to Jack's needs.
Teaching the nuances of this important and difficult work is always to be done. The obstacles can be resolved by investing in clarifying and meeting the needs of our residents to learn in a safe, emotionally responsive, and protected educational environment.
While life frequently seems to be about losing what we love most, it is made easier and more comforting when we can learn how to honor our ability to grieve and mourn our losses. We are then transformed and can move on, because life is so precious.
This case was referred to me by a family physician who believed that Jack needed more, much more, if he was to return to a life of real meaning and purpose. The outcome is yet unknown, but Jack has taken the beginning steps to a healing sense of grief; and made possible by a physician aware and sensitive to Jack's needs.
Teaching the nuances of this important and difficult work is always to be done. The obstacles can be resolved by investing in clarifying and meeting the needs of our residents to learn in a safe, emotionally responsive, and protected educational environment.
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