The importance of rituals in the grieving process

Last century, while at medical school, I studied the various models of grief.  There was a 5 stage model, a 7 stage model, the Kübler-Ross Grief Cycle and a couple of others, the details of which didn’t deposit firmly enough in my memory bank to now recall.

Being young and eager to know “the answers”, I asked “But which model is right – which one most accurately describes the grief process?”

Grief is messy. There is no right or wrong.  There is no neat stepwise process or clear signposts along the road.  Everyone does it differently.

I learned about Grief’s complexities and idiosyncrasies firsthand, very soon after medical school.  In the November of my intern year, my partner, Adam, died of testicular cancer.

I continued to get better acquainted with Grief over the next 15 years, thanks to multiple personal losses, including five miscarriages.  So when I lost my infant daughter, Amalie in December 2014, I thought I knew what to expect.  But as it so often does, Grief threw me a few curved balls.  I discovered that not only do different people grieve differently, but that individuals grieve differently at different times.

Previously, I hadn’t found ceremonies around loss particularly helpful. While respecting the cultural importance and religious significance of grieving rituals, I hadn’t experienced their healing power. Until now. On reflection, I think the key for me was in the timing.

Within a couple of months of losing Amalie, life around me had ostensibly gone back to normal. Most people were treating me as if nothing had ever happened. In a way that was good, as I didn’t want to be wrapped in cotton wool, but on the other hand, it accentuated how far from normal I felt. I often felt quite isolated, cut off from the world as if I was trapped in a Perspex container watching everyone go about their daily lives but not being able to connect with them. The colour had been washed out of my life. I felt flat and empty.

Then three months after Amalie died, my colleagues organised a tree planting and memorial service.  After getting council approval, we planted a coastal banksia tree in parkland near where I live.

Planting a tree for Amalie

Planting a tree for Amalie

It was a really beautiful service. A few people talked and many people cried.  The skies cried too (a few brief showers which gave way to sunshine) and the birds sang.  I scattered some of Amalie’s ashes in the roots of the tree as it was planted.

It was an exhausting day but the ceremony was exactly what I needed at the time.  As well as the symbolic value, it reminded me that people really do care – the love and support by those present (in person and in spirit) was palpable, and it meant the world to me.

After feeling increasingly disconnected, the emotional distance between me and those around me was all but obliterated.  Connection is a powerful healer indeed.

I’ve been visiting Amalie’s tree daily since the service. Visualising her ashes being incorporated into the root system of the tree as it grows and strengthens is comforting and meaningful beyond words.

I’ve woken up each morning since the service feeling that little bit lighter and more positive about the future.  I know there are still hard times ahead, but I’m ready to face them, knowing my family, friends and colleagues are there to help me through them and to catch me if I fall.

I still don’t have any answers for my past-medical-student self, but I feel I’ve got to know and understand a new facet of the complex creature that is Grief, and for that I am grateful.

……….

First Published by Sands Australia on 30th April, 2015.

http://sandsaustralia.blogspot.com.au/2015/04/the-importance-of-rituals.html

Below is a copy of the letter I wrote to my daughter (read aloud as we planted the tree in her memory)

My darling daughter Amalie,

Thank you.  Thank you for coming into my life and bringing me more joy, peace and fulfilment than I thought possible, albeit only for six short months.

I felt you move inside me, and part of me wished I could kept you there, protected, forever.  I would have done anything, anything at all if it meant harm did not befall you.

But alas your life journey was tragically short, nipped in the bud.  I was lucky. We spent several months together. The rest of the world only knew you for a few short days.  But the ripples from your arrival and departure are still being felt, by so very many people.

There have been trees and flowers planted in your name all over Australia and beyond. Like this one. They will grow and flower, celebrating your life. And my hope is that as they are tended, they will not induce sadness in those gardening, but instead, gratitude and wonder at the blessings your short life has reminded us we have.

You Dad, Nanna, Granddad and I will feel pain too, that is inevitable. Pain that we will never get to see your first steps, your first day at school, your first love, your first heartbreak. Pain that you will never know much love you can feel for a child growing inside you.

But pain is not only inevitable but invaluable for a full and fulfilling life.  The lows give life contrast and context.  They help breed resilience, empathy and humility, and these are some of life’s most important skills. So much comes down to attitude.

I won’t complain because roses have thorns, but instead rejoice because thorns have roses.

You are my rose, Amalie. My perfect little daughter. You made me feel whole… complete… for the first time in my life.  You were the piece of the puzzle I didn’t fully understand how much I was missing having – the piece that rendered almost everything else in my life insignificant in comparison.

I understand so much more now- about myself, about motherhood, about the world.

And for this, I will be eternally grateful.

All my love,

Mummy.

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Lived Experience

“The problem with young doctors,” a GP supervisor of mine used to say, “is not that they don’t know enough or even that haven’t doctored enough – it’s that they haven’t lived enough.”

By “lived”, he wasn’t referring to going bungy jumping in New Zealand – unless of course that particular experience had resulted in being in traction with multiple fractures. He preferred to employ doctors with lived experience of being ill or injured, of having children and, preferably, of caring for a beloved parent or grandparent in an aged care facility as well.   He wanted doctors who really understood what it was like to be a patient and/or the loved one of a patient. To him, a personal health record was far more important than a professional one.

The transformation of doctors by personal illness or tragedy is not an uncommon narrative. Hollywood has used variations of this plot numerous times in films like The Doctor (1991).  On the small screen, many a Grey’s Anatomy, House or Chicago Hope doc has been forever changed by a personal brush with cancer/trauma/addiction/leprosy.

Albeit without the glamour of a Dr McDreamy standing by, I too have been profoundly shaped professionally by personal illness and the loss of loved ones.  These experiences have taught me things that years of medical training did not.

Physical illness has taught me why patients need patience. Experiencing days when it feels like I’m trying to walk up the down escalator has brought home to me why people with chronic illness can get so drained doing “routine” things.

My most valuable lessons though, have come from seeing my loved ones suffer, and from being the one left behind and thus coming to the realisation that a patient’s death is not the end of the story.

As an intern, in 2000, I lost my then partner, Adam, to testicular cancer.  At such an early stage in my career, as a medical student and then a very junior doctor, watching a loved one struggle with and ultimately lose his battle against an incurable disease was particularly influential in my development as physician.

loving memory tombstoneI learned firsthand that treating cancer is so much more than trying to cure. That it’s more than trying to alleviate symptoms when cure is not possible.  I discovered that it is about how whatever life left is lived, and ultimately, how one dies.  This philosophy sat comfortably with me and helped me help countless patients over the years.

Much as I loved and respected Adam’s mother, I didn’t really understand her response at the time. She was in the “chance of cure at any cost” camp, wanting any treatment which had even the remotest possibility of success. This drive persisted even when it became painfully obvious to me and to Adam’s treating doctors that cure was impossible, and that Adam’s aggressive treatment regimens were causing terrible suffering.

But now I get it.  I understand now how maternal love can be so powerful that it overwhelms intellect, logic and fiscal responsibility.  For I too became a mother… and lost a child.

In December 2014, my only child, Amalie, died of neonatal sepsis. It had taken me 9 years and 5 miscarriages to meet her, and our time together was tragically short but will be forever treasured.

When she was in the NICU, fighting for her life, I would have given anything to see her pull through. In those frightening moments, no treatment would have been too extreme, no cost too great.

I thought I understood intellectually why the death of a child is so devastating for a parent.  Now I understand it viscerally, and realise that I had no idea what it is really like.

It is too recent and the emotions are too raw for me to incorporate this “lived experience” into my clinical practice in a meaningful way right now. But I will.  As I have done before.

Adam and Amalie have made me a better doctor.  They’ve made me a better person. I owe them so much.  I can’t pay them back but I am, and will be, paying it forwards.

I think my old GP supervisor would be proud.

First published in Medical Observer, 24th April 2015

 

Came too early, gone too soon

2008-06-20 006 Sunset over the PacificAfter nine years and five miscarriages, I finally had a joyful and life-changing journey through a remarkably straightforward pregnancy last year. I had many new experiences.  I relished discovering that my clothes are too tight.  I was relieved beyond words to get the “all clear” on the 18 week morphology scan.  I discovered that, despite my best efforts, I became one of those annoying super-gushy types of pregnant women.

The most surprising aspect to me, however, was the reactions of friends and colleagues.  Without exception their responses were overwhelmingly positive and supportive, for which I was immensely grateful.  What intrigued me though is that many started to treat me more inclusively, seemingly because I was now “one of them”, a member of the “parenthood club”.  When I gently explored this with a few, they reflected that it has been difficult for them to juggle their desire to talk freely about their kids while being sensitive to my situation, and that at times it has been easier not to engage at all.  I know I’ve played a part in this too.

While the drive to procreate differs between individuals, for many of us, myself included, it can be an overpowering one.  The primal reproductive instinct is at the core of many people’s sense of identity and life purpose, as well as having cultural, social, spiritual, financial and familial implications.

The second half of 2014 was the happiest time of my life.  I was in the “club” and on track to fulfilling my lifelong dream.

But everything changed on 1st December, when a simple urinary tract infection developed into a serious kidney infection (pyelonephritis) and started spreading to my blood (early sepsis).  It triggered a premature labour and a mad rush to the nearest hospital (we were out in the desert at the time, hours from civilisation). I didn’t quite make it and ending up delivering my own baby, just metres away from the hospital entrance.  That was certainly not part of my birth plan!

Considering her dramatic and premature entrance, baby Amalie did remarkably well at first.  Her birth weight was over the magic 1000g line and her vital signs were excellent.  We were cautiously optimistic.

Alas, four days later things took a turn for the worse and, tragically, Amalie’s tiny system was overpowered by E. Coli, just as my body was starting to win its fight against the same bug.

Suddenly and cruelly, I was ejected from the green side of the reproductive fence.

I’ve received amazing support from friends and colleagues, but, understandably, many struggle, not knowing what to say or what to do.  Some either resort to platitudes or avoid the topic completely which can leave me feeling even more isolated.  I’ve found that focusing on the intention rather than the words is the only way to shield my heart from unintentionally insensitive remarks.

After all, rarely can a response make things better. What matters is the connection.   Parenthood club member or not, I know I need to maintain the connection with my family and friends to get through this terrible time.  And to remember Winston Churchill’s advice: “When you’re going through hell, keep going.”

RIP Amalie Ella.  Came too early, gone too soon.

I waited so long for you and had you with me so briefly, but every moment we spent together will be treasured forever. My heart is in pieces right now, but I will use the strength of my love for you to try to focus on being immensely grateful for your life rather than being devastated by your death.

You’ll travel with me forever, my darling daughter.

…………….

First Published by Sands Australia on 12th March, 2015.

http://sandsaustralia.blogspot.com.au/2015/03/came-to-early-gone-too-soon.html