House Calls

Families facing cancer and other crises.

The Death of Elizabeth Edwards

When life seems unfair.

This week, the death of Elizabeth Edwards, six years after her diagnosis with breast cancer, felt profoundly sad, but not in a clean, straightforward way. It was also uncomfortable. It is not just that her course with this treatable and often curable cancer seemed brutally short, but also for other reasons: that she had such young children, now 10 and 12; that her marriage unraveled in a public, humiliating way during her treatment; that even she was engulfed by the televised drama of exposure, betrayal and score-settling that followed John Edwards' admission of his affair. And then there is the heartbreaking death of her and John's older son when he was only 16, back in 1996.

It is simply hard to find comfort in her story. It is hard to say, "Well, at least she had the love and company of her family during the last year." Instead, one imagines her anguish and rage imagining her ex-husband raising their children with his mistress. Neither is there refuge in blame. Did her fertility treatments cause her cancer? Did she do something to push her husband into the arms of another woman? Although these are the ways the living often reassure themselves, it's just not reasonable to conclude that she had done anything that fundamentally brought on the tragedies in her life.

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But Elizabeth Edwards' story is a deeply human story. Life isn't fair. Sometimes we cannot protect our children from danger. Sometimes smart, loving, wonderful people, on whom others depend, develop terminal illnesses. And sometimes the people we love disappoint us.

And still, I found something touching and heartening in the reports that she had died at home, surrounded by family. Particularly that John Edwards was there. I don't imagine it was a deathbed reconciliation, a simple happy ending. But there is a family there, however battered, still finding a way to come together and make the terrible somehow bearable. And there seemed to be grace, dignity and honesty about the seriousness of her condition, with an opportunity for those who loved Elizabeth to be with her, say what they may have wanted to say, ask what they may have wanted to ask and to comfort one another.

There is also comfort in the fact that her youngest children were 10 and 12, terribly young to lose a parent. But they were 4 and 6 when she was diagnosed. And 7 and 9 when she was diagnosed with a recurrent terminal illness. Most children will not have substantial memories of a parent they lose before the age of 7. All of their memories will have to be constructed by the survivors, with photographs, videos and stories. So her treatment did give her son and daughter enough time to build substantial memories. They knew her, and most importantly, they know what she treasured about them. This is what children carry through their lives from their parents: a sense of what makes them a treasure. And her young children will surely have this, even as they move through adolescence and adulthood without her.

I imagine that John Edwards' presence at her side reflects that they had found some peace with one another. This will make the biggest difference for all of their children, including their young adult daughter. It would be easy to vilify and blame their father. It's much easier to be angry at a person, especially one who has behaved so badly, than it is to be angry at cancer. But these children will need their father. And they will need to feel it is not a betrayal of their mother to love him and need him and be attached to him. They will need him to fill in the blanks about their mother as they move through their lives. Would mom have liked this prom dress? What would she have thought of this college? What was their older brother like? Hopefully, there will be many adults who were connected to Elizabeth to answer those questions, share those stories, and help her children to imagine what she might have thought or said. Her books may be a meaningful touchstone for them, but it is the living people who remain, who knew her and are dedicated to her children who will animate her for them while also standing in for her. Their father should be at the top of that list.

I hope that the other adults within and around this family will find ways to support John Edwards in parenting without feeling it is a betrayal of Elizabeth. I imagine (I suppose there is a little hope, also) that his grief will be very complicated, wrapped up with guilt, and he will need support also. The limited data that exists suggests that the factor that best protects children after the death of a parent is the stability and emotional adjustment of their surviving parent. They have the financial resources to minimize disruptions; I imagine that now might be a time for John Edwards to devote himself fully and selflessly to parenting. He would have the chance to be devoted to a cause other than his own, to do what his three surviving children need. It would be good for their children, and it might even be healing for him.

Cancer in a parent is challenge for children, but it does not have to be a tragedy. It can be an opportunity to support healthy development and resiliency. But sometimes the prognosis is not good, and children lose a parent to cancer. Then the work is harder. The children and remaining parent will need room to grieve, but they also still have to pay the bills, get to school on-time, practice piano and have the rules enforced. Even under the best of circumstances, single parenting is very hard. And then you have families where cancer is not the first, or maybe even the worst strain they have faced. But, as Elizabeth Edwards herself often observed, individuals can be remarkably resilient. And this resiliency can be well-nourished by a family, even a battered and unconventional one. If there is trust, honest communication, room for anger and forgiveness, and, foremost, unconditional love from the adults for the children, those children will be alright. I imagine all of this when I think of Elizabeth Edwards being with John and their children at the end of her life. And I hope she was able to imagine it, too.

Susan Swick, MD, MPH, is a psychiatrist at Massachusetts General, as well as an instructor at Harvard Medical.

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