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How Resilient People Get Through Anticipatory Grief

Practical steps to hold you together during a loved one's health crisis.

Summer isn’t when we’re inclined to think about death. The lush greenness, life bursting at the seams, doesn’t lend itself to feelings of loss and sorrow.

But life’s seasons don’t necessarily correspond to the seasons of the year. Time rushes on, and even people whose challenging life experiences have made them resilient are faced with new challenges, including new sorrows to be endured as they unfold, and survived with courage and a renewed love for life.

In early July my 84-year-old mom was given a diagnosis of lung cancer based on what, thankfully, turned out to be incomplete information from the CAT and PET scans. An endoscopic lung biopsy on July 23 determined the dark spot on her right lung was not malignant after all.

The dark cloud that had hung over us for two weeks lifted—but not completely, because Mom experienced complications from the diagnostic procedure itself. She spent the next week in the hospital and has just completed two weeks at a rehab center. She’s champing at the bit to come home, and I am eager to have her back where she belongs.

Meanwhile, yesterday I had news from a longtime friend that his husband will begin home-based hospice care because the glioblastoma (brain tumor) he’s battled for the past year and a half has spread its deadly cells throughout his brain. Even his surgeons, among the best anywhere, advise against further treatment lest it exact an even more terrible toll on his mind’s functioning and quality of life.

As a psychotherapist himself—as well as a poet, playwright, and performance artist in his free time—his life has been dedicated to helping hearts and minds to heal. After working closely together for a year through his brain fogs, surgeries, and increasing downtime to design and this past spring publish his second volume of poetry, poeMEMoir Volume 2, I know for certain my friend is not someone who believes in “survival at whatever cost” because he believes so powerfully in life. In fact, I told him earlier this summer he is the most “alive” person I know. And now he is slowly dying.

John-Manuel Andriote/photo
I took this photo at Bluff Point State Park in Groton, Connecticut. I have been hiking here since I was a boy, and it is a place I go to help me cope with anticipatory grief and other challenges.
Source: John-Manuel Andriote/photo

For me, in Mom’s and my friend’s case—and with respect to far too many friends before them—I’ve experienced a lot of what is called anticipatory grief, a normal part of mourning when someone is expecting a death. I am grateful and relieved this isn’t an imminent reality for Mom, though I’ve been reminded that even cats’ proverbial nine lives eventually run out. My friend, on the other hand, seems to be at the bottom of his ninth.

Anticipatory grief is a lot like the grief one experiences after a death. The thoughts and feelings it arouses include anger, forgetfulness, isolation, and sadness. It's not only grief for our loved one's impending death, but the accumulation of losses leading up to it--including perhaps their loss of abilities and independence, loss of stability or lost future dreams, or any of so many other losses.

The Visiting Nurses Service of New York suggests five steps for dealing with anticipatory grief:

  • Allow feelings of grief to help you prepare. Examine unresolved issues, make your peace if necessary, settle legal and financial matters, and discuss end-of-life wishes.
  • Educate yourself about what to expect. Learn about your loved one’s condition, its symptoms, treatment side effects, and the prognosis.
  • Connect with others who can provide insight and support.
  • Enlist help and continue to live your life. Don’t put your own life on hold.
  • Create moments your loved one can enjoy. These may become your most cherished memories.

In an insightful, practical advice-full blog post called “Grieving Before a Death: Understanding Anticipatory Grief,” the website suggests a few more things to keep in mind:

  • Accept that anticipatory grief is normal.
  • Acknowledge, and honor, your losses. Allow yourself to acknowledge you are grieving even though the person hasn’t died.
  • Remember that anticipatory grief doesn’t mean you are giving up. It can help you shift your energy from hoping your loved one recovers to focusing on being supportive, caring, and loving.
  • Communicate. Grief is different for everyone, and so is anticipatory grief. Keep the communication channels open with family and friends so everyone can better understand one another.
  • Take care of yourself. This may mean meditation, or running, or spending time with a book. Whatever ways you like to care for yourself are the best ways for you.
  • Consider counseling.

For those of us who have been a caregiver for a loved one, the anticipatory grief we feel is complicated by our loved one’s needs. Studies abound showing that people who are resilient adopt proactive coping, or problem-focused coping, strategies to address those needs. They are future- and goal-oriented, and able to mobilize helpful resources to help support them.

The Alzheimer’s Association of Northern California and Northern Nevada offers these steps for caregivers—or anyone, really—facing a loved one’s deteriorating health:

  • Manage your stress.
  • Be realistic.
  • Give yourself credit, not guilt.
  • Take a break.
  • Accept that there will be changes in your loved one’s health status.
  • Know you aren’t alone.

I’ve found it helpful when faced with Mom’s or other loved one’s health crises to stay as focused in the moment as possible. “One day at a time” is a useful slogan. So is the Serenity Prayer (“Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”)

It’s also helpful to remind yourself: You have been through tough times before, and survived. Of course it hurts, and still will hurt after your loved one is gone. If you follow the steps outlined above, and resolve to feel your feelings rather than try to anesthetize them with substances or distractions, you will get through this one, too.

No one ever said resilience was easy.

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