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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The other side of the fence

pregnancy testThis column was written in October 2014…

Countless consultations start with the words “I’m pregnant.”

I quickly learned not to jump in with an enthusiastic “Oh congratulations, I’m delighted for you!” Make no assumptions.  Sensitively ascertain the patient’s state of mind before celebrating or condoling.  A new pregnancy can generate a range of emotions in the mother-to-be, from despair to ecstasy, but in my experience indifference is rarely, if ever, predominant.

Likewise, I imagine that for many GPs the news of a patient’s pregnancy also triggers an emotional response in them.  The emotions felt may be simply a case of transference, they might be an inherent sense of wonderment at the creation of a new life, or they may be complex, perhaps intertwined with feelings surrounding the GP’s own reproductive history.

Barring the occasional faux pas as a result of an incorrect assumption, I think we GPs are, on the whole, very good at managing both our own and our patient’s emotions surrounding a desired pregnancy, and mostly pretty good at handling those surrounding an undesired one.  From what I’ve observed, however, many of us are far less comfortable handling those involved with a lost or non-pregnancy.

Admittedly, it is very hard to know how to respond to a desperate patient who wants nothing more than parenthood, but for whom this dream has remained elusive.  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.

After nine years and five miscarriages, I’m sitting here typing this as my 23 week daughter moves around in my distended abdomen, reassuringly.  On my joyful and life-changing journey through this so far remarkably straightforward pregnancy, I’ve had many new experiences.  I’ve relished discovering that my clothes are too tight.  I’ve been relieved beyond words to get the “all clear” on the 18 week morphology scan.  I’ve discovered that, despite my best efforts, I have become one of those annoying super-gushy types of pregnant women.

The most surprising aspect to me, however, has been the reactions of friends and colleagues.  Without exception their responses have been overwhelmingly positive and supportive, for which I’ve been immensely grateful.  What has intrigued me though is that many have started to treat me more inclusively, seemingly because I’m now “one of them”, a member of the “parenthood club”.  When I’ve gently explored this with a few, they’ve 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.

In my experience, both as a patient and as a medical educator observing doctors-in-training, many GPs face a similar struggle when interacting with patients with infertility and/or miscarriage.  Either resorting to platitudes or avoiding the heart-of-the-matter can leave vulnerable patients even more isolated and unsupported.  Unlike disorders like cancer, disclosing and discussing infertility and miscarriage publically is somewhat of a social taboo, and this, I believe, is part of the problem.

While we are told, for good reason, that it is important to leave your personal baggage at the door of your consulting room, it’s not always that easy.  We all have things in our past (and/or present) that can potentially influence how we feel about, and interact with, certain patients.  Being aware of these factors and their effects is vital, but is it always necessary to neutralise them?  Not only is complete objectivity impossible in the kind of work we do, but judicious and thoughtful use of our life experiences can make us better clinicians – and better teachers.

I hope that I can use my experience to help support both patients and other doctors in managing the complex emotions surrounding fertility issues, and also encourage more open discussion in the general community.

While immensely thankful and blessed to now be on the green side of the reproductive fence, I will never forget how painful and isolating it can be on the other side.

First published in Medical Observer, 17th April 2015

The ending to my pregnancy story was not a happy one. You can read about what happened here

https://genevieveyates.com/2015/04/27/lived-experience/

 

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