Permission to Grieve (Part 2)

Grief is a strange thing, because the idea of loss encompasses so many different things, including the loss of an abstract concept.

I know that an acute grief reaction can occur in women who are expecting to have a well baby, but instead have been told their child has a birth defect – the grief over the diagnosis is just as real as their grief over the well child that existed only in their imagination. In some cases, the pain can even feel as visceral and as violent as if the well child has been murdered.

I once met a lovely and vivacious girl from Australia at a friend’s wedding. The both of us didn’t know anyone else there other than the bride (who was of course busy making her rounds of all her guests), so we just ended up chatting to each other most of the evening. She told me about how she’d worked as a lawyer to please her family, saving up all her earnings in order to pay her way through achieving her dream of becoming a veterinarian. At the time, she was finishing up her final year of veterinary training in Australia. We traded stories about our clinical work. Towards the end of the evening, we got up and danced with the bride and groom, giggling and laughing like old friends. I had to leave the party early, but not before promising that I would drop her a line if I ever headed out to the land of Oz.

It was almost two years later that we were planning a trip to Australia, I remembered my promise and I contacted my good friend (the bride who’d invited us both to the wedding) to ask for her help in connecting the two of us via email.

My friend was completely flabbergasted that I didn’t know what had happened to that beautiful girl. She’d died a few months after the wedding, in a horrific car accident.

I couldn’t believe it. Dead? No way. But it was true. It happened when she was bringing her family back to the Perth airport, after they’d attended her graduation from veterinary school. Her family members all survived with a few injuries, but she was killed instantly.

In telling me the story, my poor dear friend had to relive the devastation and despair that she felt upon receiving the news of the death of her best friend and had been asked to give a eulogy at her funeral. The accident was so terrible and so tragic that it had even been reported in our local newspapers – I’d completely missed it because I’d been pregnant with Little E at the time and had turned into a hermit crab for nine months.

For the rest of that day, I felt utterly miserable but I didn’t quite think that I had a right to feel so upset. So I pushed the feelings away and just tried to carry on with the rest of my day. After the kids were in bed, the Barn Owl asked me why I seemed to be moping around the house, and I just burst into tears.

Debs G: There was a terrible accident and she died!

Barn Owl: That’s bad. Was she your friend from school?

Debs G: No. I didn’t know her at all.

Barn Owl: I don’t understand.

Debs G: I don’t either! I never knew her, and I’m sad about it! And now she is dead and my friend was very sad about it, and I wasn’t there for her! I’m sad about that too!

Finding out about the death of someone you know, even someone you’ve only known very briefly, is always a shock, and it’s important to remember that the right to grieve does not need to be earned. If you feel bereft because death has stolen someone from you, that in itself gives you the right to grieve.

Although I had only known this girl for the space of a few hours, she still left a lasting impression, and that is worth something to me. I’ll always regret not following up on our meeting sooner.

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Permission to Grieve (Part 1)

When I was in my first year at University, I met an interesting girl.  Now, this girl was cool.  And I mean cool.  She had an interesting life.  She’d done all these things and seen all these things that I wished I had done and seen.  She was talented – a fantastic artist, singer and dancer.  And I wanted ever so much to be just like her.

We became friends.  And for that first year of University, life was a whirlwind of me trying to impress her with how cool I had become/was becoming.  I did and said a lot of things that I regret now, and did and said more things that I will never regret.

We used to do crazy stuff together – on the weekends, we’d go to Chatswood and busk outside the St George bank.  Not because we were poor or anything, but because it was fun.  And I had a LOT of fun when I was hanging out with her.  With her, I did a lot of things that I wouldn’t normally have done.

She taught me how to live.  She taught me that if I wanted to do something, that I should go out and do it instead of waiting and fretting until the opportunity passed.

But…

She wasn’t a good friend to me.  Things were said (I only regret some of them).  We had a huge fight (it was horrible) and after that, we stopped being friends.

I’ll admit that I wasn’t the nicest to her after the fight either – I was free to others with my reasons for the friend break-up, as it were, and added a lot to the drama surrounding her life.

So, I didn’t speak to her or see her again for almost 13 years.

Last week, I heard that she’d died.  A car accident.  It was very sudden.

I went to her Facebook memorial and there was a great outpouring of grief.  People left well wishes.  And it seemed that from the time we stopped being friends and the time she died, she’d become a completely different person.

A much better person.

Thing is, though, I wasn’t sure how to feel about the whole situation.  Her death made me feel my mortality, but that was really about it.  I didn’t have many good memories of our time together and what memories I did have were tainted by the messy end of our friendship.

Sometimes, however, we need to give ourselves permission to grieve, even if it’s over someone we didn’t know well, or whom we didn’t get along with.  They were still part of our lives.

Whether she’d changed or not, though, her death is still sad.  Still sudden and unexpected.  She had a lot of life in her and though she wasn’t my good friend, she had been a good friend to many others.

Her loss will be mourned and it is a tragic waste that she was taken so young.

So, I cried a little, and then I was ready to face the next day.

Grief, Loss and Small Children (Part 3): Getting over loss and life changes

It’s easy to think that the feelings of grief and loss are only associated with major life events such as death. However, for small children, their circumstances can change very quickly, year upon year, as they themselves grow up and change or the world changes around them. It is unsurprising that childhood grief and feelings of loss can include such things such as parental separation, changes in schools or classes, moving house, even failing friendships.

Growth is always loss. Every time you’re gonna grow, you’re going to lose something – James Hillman, We’ve Had a Hundred Years of Psychotherapy – And the World’s Getting Worse

Last year, as J started in a new school, he missed his old classmates dreadfully, especially his best friend. After three months in his new school, his best friend invited him to a party. J looked forward to going, but when he arrived there, he found that his best friend had changed so much that they were as good as strangers to each other. This realisation hurt J deeply.

How horrible it is that people have to grow up – and marry – and change! -L.M. Montgomery, Anne of Avonlea

For months after that, he would often talk about his best friend and his old school, fervently wishing to be able to forget everything. I was constantly reminding him that those memories were precious, and that old friends often pop back into our lives in surprising ways.

Nothing is ever really lost to us, as long as we remember it – L.M.Montgomery, The Story Girl

One of the easiest ways to gently help children through these difficult times, is through books. As you can tell from the book quotes above (and in my previous post), authors can ease our troubles with a well-turned phrase, and sometimes, a good book can help illustrate those concepts that are difficult to explain.

Here are a few books that I highly recommend for those with children who are going through or preparing to go through a difficult time. (To find out more about each book and where to buy them, just click on the book covers.)

1.Wibbly Pig’s Silly Big Bear by Mick Inkpen


This is a very sweet story, which I feel focuses on love and friendship, and validates the feelings of sadness and loss that children have when someone they love has gone away.

In this book, Wibbly Pig is both frustrated and amused by the shortcomings of his Silly Big Bear, whilst at the same time being amazed by Silly Big Bear’s unique qualities. It is these many little quirks that make Silly Big Bear so beloved, that he is dearly missed when he is gone. I love the simple, uncluttered illustrations, as well as the gentle pacing of this story. A great one for the tiniest ones in the family.

2.Grandad’s Island by Benji Davies

In this lavishly and vibrantly illustrated book, a young boy, Syd, accompanies his Grandad on an epic adventure, to a beautiful island. When Grandad decides to stay on the island, Syd must journey home alone and it is not an easy trip.

I feel that this book very thoughtfully and carefully deals with the subject of the loss of a grandparent as well as the concept of heaven. The end of the book is particularly comforting, showing that no matter how far away a loved one may seem, they still remain close to us in our hearts and minds. The book does not at all mention death or dying, so it has a very subtle touch and is suitable for very sensitive young children.

3.The Velveteen Rabbit by Margery Williams

This book is particularly good for early readers and primary school aged kids and is about the transforming power of love, as well as the pain of growing up and change. The Velveteen Rabbit’s love and loyalty leads both to his separation from the person that he loves as well as the achievement of his life’s dream.

This is good book that perfectly captures the bittersweet feelings when reflecting upon a lost friendship, whilst illustrating how one must let go of the darlings of the past in order to step into an exciting new stage of life.

4.Scaredy Squirrel by Melanie Watt

Scaredy Squirrel is so scared of dying and is so cautious that he never leaves his tree – until one day, he has an accident that leads him to an amazing discovery!

This is a hilarious book with super-funny illustrations that encourages children to embrace the unknown and step out of their comfort zone in order to discover new and amazing things about themselves and the world around them.

A very good one for the anxious or nervous child who is fearful of change (or of starting a new phase in life).

5. Charlotte’s Web by E.B. White

Here’s one for primary school-going kids or for confident readers! It is also a great book for reading aloud! This is one of the most lovely books about loyalty and friendship, and it deals very sensitively with loss, sadness and grief. The book also realistically touches on about how relationships change as people change and grow up. It’s hard not to feel moved when reading about the unlikely relationship between a pig and a spider.

The book also mentions some of the positive, active things that one can do in order to honour someone who has died, and I think it is a good starting point for opening up conversations with older children who are grieving.

If you have a good book you would like to share, or if you would like more book recommendations for other age groups, leave a comment below.

Grief, Loss and Small Children (Part 2): Discussing Death

A note about today’s post: When our grandfather (the Aged P’s dad) died, I wanted to write a post about how we talked about death with J and Little E, and helped them process their grief. However, as my own personal grief felt too fresh, I was not able to properly organise my thoughts on the subject, so this post has actually been percolating in my mind for over a year now.

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For the Barn Owl and myself, death is something that we encounter quite often in our line of work as doctors, and sometimes helping patients and their families to prepare themselves for the inevitable is part of the job description. However, managing the impact of a death on an individual and helping them through the process of grief and loss is something entirely new to me.

In our family, we have never shied away from the topic of death. This is because the Barn Owl and I feel that death is not something that should be feared, but should be viewed as a natural part of life. Since J and Little E were very small, we have had no qualms in taking them with us when we are paying our respects at a funeral (which, in Singapore, is generally an open casket arrangement) or when visiting the graveyard or columbarium.

During these visits, we always talked to J and Little E about what happens when people die and it is amazing how much a child can understand.

I remember the first conversation that I had with J on the subject. J was just a little over 2 years old at the time and we were at the funeral of his Godpa’s late grandmother, who was a kindly and well-loved lady. During the funeral, family members recounted stories and memories, and showed photographs of family gatherings where the lady was often smiling and laughing. At the end of the service, I brought J to the casket and he peered down at her face and said to me, frowning, “Auntie there. Not same. Gone.”

“Yes,” I replied, “This is just her body. Her body is dead and she has left it behind. She is not here anymore.”

“Yes,” said J, nodding, “Gone.”

“To die will be an awfully big adventure” –  J.M. Barrie, Peter Pan

When our grandfather (the Aged P’s dad) passed away, J and Little E were quite overwhelmed by the funeral wake and services, and we had many talks with them about death and dying during that time, and in the months afterwards.

Some of the questions they had were quite difficult to answer, but we always answered them truthfully, acknowledging their feelings and thoughts about the subject and sharing with them our feelings too. Quite often, we tried to gauge their feelings by the sort of question that they asked, and we would try to address their anxieties whilst channeling their thoughts in a different direction.

Like I said in my previous post, kids adjust to news in a different manner that what we might expect, and they take a lot longer to process information. This meant that J and Little E would repeatedly ask the same questions over the course of several months. As they adjusted to the death of their great-grandfather, the frequency of these questions decreased.

Here are some of the difficult questions that they asked and how we answered them.

What is death? 

Death is when life ends. The body doesn’t work anymore. The body cannot move, or eat, or sleep, or think or feel. It is not alive. It is dead.

Will I die? Will you die? Will (insert name here) die?

Yes, one day, you will die. One day, I will die. I don’t think that we will die for a long time. Everything that is alive in the world will die one day. This is why being alive is important. We should be thankful for being alive, and enjoy the time that we have with each other. This time that we have to be alive is a precious thing, a treasure. Now is the time that we have do things to make our lives mean something, something good, something that matters. Now is the time we have to make good memories.

“All we have to decide is what to do with the time that is given us.”  ― J.R.R. Tolkien, The Fellowship of the Ring

Will I get sick and die, just like Great-grandpa? When will I die?

When you get sick, it does not always mean that you will die. A cough, cold or flu may make you feel really awful, but actually, you are only a little bit ill, just for a short while, then you will get better. Great-grandpa was very seriously unwell for a very long time. It is not the same as when you or I get sick.

Sometimes, if you are very old and unwell, like Great-grandpa, you will know that you are dying. An old person’s body doesn’t always work the way it is supposed to. Everything slows down. It takes longer to get well when you are sick, and sometimes parts of your body will not work the way it should and you have to take medicine to make it work.

Nobody knows exactly when they will die. I hope that you and I will not die for a long time. When we are alive, we try not to think about when we will die, or how we will die. We try to think about what we can do with our life now, what we can do today. If we spend all out time thinking and worrying about dying, then we will be wasting all the time that we have, all the time that we have to enjoy being alive.

I know you feel worried about dying. It is okay to be a little bit worried and scared about dying. Sometimes I feel scared and worried about it too, but then I remember that I have other things to think about which are more important, much more important to me than worrying about dying. If you keep worrying about dying, you will not be able to enjoy being alive. That would be a very sad thing, not being about to enjoy being alive.

“It is nothing to die. It is frightful not to live.” ― Victor Hugo, Les Misérables

Is dying a very bad thing? Why are people sad when somebody dies?

Dying is not a bad thing, it is a sad thing. It is sad for us, because we feel left behind and we miss the person who has died, because we cannot see them alive anymore or make any new memories of them. You have many memories of Great-grandpa; some are happy and some are sad, but they are all important because you will not be able to make new memories with Great-grandpa now that he has died.

I feel sad that Great-grandpa has died because he was important to me and I miss him, but remembering his life and talking about him makes me feel a little better. When you feel sad about Great-grandpa, you can always talk to us about it and we can remember him together.

Where is Great-grandpa now?

Great-grandpa’s body is here. But that is just his body. His soul, his spirit, his personality, everything that was Great-grandpa, everything important about him, everything that really matters – all his thoughts, all his memories, the part of him that could think and feel – that is not here. It is gone.

I believe that the part of Great-Grandpa that made him who he was, that part of him has gone to heaven, and the body that you can see in the coffin, is just an empty shell that he left behind.

Where is heaven? Can I go to heaven now?

No. It is not possible to get to heaven. You have to wait until after you die. But you have too many things to do first before you die, you have your whole life to live. You have to patient and wait your turn.

“It’s necessary to have wished for death in order to know how good it is to live.” ― Alexandre Dumas, The Count of Monte Cristo

What are we going to do with Greatgrandpa’s body? What is going to happen to it?

After the funeral is over, we will take Greatgrandpa’s body and we will cremate it. This means that we will burn the body. We will put his ashes into a jar and the jar will be kept in a place called a columbarium. This will be Great-Grandpa’s grave. It is where we will go to remember Great Grandpa. This is what Greatgrandpa wanted us to do.

Not everyone who dies gets cremated. Some people prefer their bodies to be buried in the ground instead. Graveyards are places where people are buried.

Graves and graveyards are quiet places. They are good places for sitting and thinking quietly about the people who have died and remembering what they were like. Sometimes, people will visit graves and spend time tidying it up and decorating it with flowers. They do this because they want to show respect and love for the person that has died, and also so that other people who are walking by will stop and look at the grave and the gravestone. They will read the name on the gravestone and think to themselves, “This person must have been very special to someone when they were alive.”  If you like, we can visit Great-grandpa’s grave together and make sure that it is looking nice.

“But Mother was cremated. This means that she was put into a coffin and burned and ground up and turned into ash and smoke. I do not know what happens to the ash and I couldn’t ask at the crematorium because I didn’t go to the funeral. But the smoke goes out of the chimney and into the air and sometimes I look up and I think that there are molecules of Mother up there, or in clouds over Africa or the Antarctic, or coming down as rain in the rain forests in Brazil, or snow somewhere.” ― Mark Haddon, The Curious Incident of the Dog in the Night-Time

Again, as with kids, their response and behaviour towards death can be unpredictable. It will probably be necessary to brief them on what is expected of them during the funeral or funeral wake. They don’t have to cry or look sad, but they do have to be mindful and respectful of other people who are in mourning.

Which is why on the way to the cremation service, I overheard J and Little E having the following conversation:

J: Hurry up or we’ll be late!

Little E: I’m hurrying, I’m hurrying!

J: If we’re late we’ll miss everything!

Little E: Okay, okay!

J: I don’t want to be late for the demonstration!

Grief, Loss and Small Children (Part 1): Breaking Bad News

Hey Meimei,

Sorry about Clio. It sounds like she was a lovely pet rat and it must have been a tough decision to have her euthanised. I’ll have to tell J and Little E about her – they’ll remember her from when their last visit to Australia.

How could you possibly say no to that cute widdle face?

When we first started this blog, you asked me once about introducing pets to kids. The Barn Owl and I have always thought it important for the kids to be kind to animals so we have always encouraged J and Little E to interact with animals (under supervision, of course) and they have even had the opportunity to keep siamese fighting fish last year.

Well, one of the very important things to remember about keeping pets, is that at some point kids (and parents, too) will have to deal with the eventual loss of their beloved pet.

Two years ago, the Outlaws also had to make the decision to euthanise their cat. Poppy, as she was known, was a wild cat that the Mother Outlaw tamed over the course of several months. Poppy had always been a rather anxious sort of cat, but as she got older she became increasingly more neurotic, often biting her own tail. The tip of the tail became infected, dripping blood and pus everywhere and would only heal after a course of antibiotics and sedatives. The sedatives made Poppy clumsy and she would fall over whilst walking around the house. Without the sedatives, Poppy would start attacking her tail again, reinfecting it.

Eventually, the vet told the Outlaws that Poppy was mentally stressed and that there was no other way to help her other than to amputate her tail and then keep her on sedatives for the rest of her life in order to prevent her from attacking the stump. The Outlaws then made the decision to have Poppy euthanised.

J and Little E had quite a good relationship with Poppy, who was surprisingly tolerant of them despite her skittish nature, allowing them to approach her and stroke her. Whenever we spoke with the Outlaws over Skype, the children would eagerly ask after Poppy who was quite often sitting near the computer on the bed or on the windowsill. Needless to say, when we got the news from the Outlaws, we knew that we had to let J and Little E know that Poppy had died.

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Little E gets up close and personal with Poppy the Cat

Both the Barn Owl and I have had formal training in how to break bad news during our medical undergraduate days, so we employed some of these techniques with J and Little E – with some changes of course.

First, we prep the kids for the bad news by helping them to anticipate what is to come. We put on our most sombre expression and follow it up with a statement like, “Hey, Mummy and Daddy have something serious to tell you so can you come and sit with us in the study once you are done putting away your toys?”. This gives them a little bit of time to steel themselves emotionally.

Next, we choose a quiet, distraction-free place to talk to them. This means that we do not begin our discussion whilst in the car, in the playground or in front of the television. We turn our phones off so that there are no interruptions. We also make sure that the kids are in a safe and secure environment where they will feel comfortable expressing their thoughts and feelings. Usually this means that they are sitting in our lap or cradled in our arms.

When breaking bad news, go straight to the point and avoid using any euphemisms. It’s actually surprisingly difficult to say something as simple as “Poppy is dead.” People sometimes prefer to use terms like, “passed on” or “gone to a better place”. For children, those phrases can be confusing and obtuse, leading to awkward questions such as “Where did they pass on to?” and “Why aren’t we at this ‘better place’ as well?”.

Another thing that we do is that we tell the children the truth, in as much detail as they want to know. This seems a obvious thing to do but it is difficult to resist the urge to make the truth more palatable in order to avoid difficult questions, especially with regards to euthanising pets. Answer your child’s questions as directly as possible, keeping your answers clear and simple and avoiding the use of jargon.

The last thing that we do is to keep the communication channel open so that the kids can ask questions at any time. Kids do not always have an immediate or appropriate reaction to bad news and they take a lot longer to process information, especially emotionally loaded information. This means that your initial conversation may proceed like this:

Debs G: J, you remember Poppy the cat?
J: Yeah.
Debs G: Well, Poppy died.
J: Oh.
(silence)
Debs G: If you want to ask me anything about what happened, go ahead.
J: I have a question.
Debs G: Ok. What do you want to know?
J: Can I go and play with my blocks now?
Debs G: Yes.

This reaction may be surprising to adults, but it is no means an indication that the child is indifferent to the news nor that the conversation is over. If your child reacts in this manner, don’t press them for their thoughts and feelings or continue to repeat yourself in the hopes of eliciting a response (‘DEAD! I said it’s DEAD! Did you hear me?’). It may be necessary to give kids some space, maybe even some time alone while they think about the news. J actually came back to me about an hour later, wanting to talk more about Poppy, and this time he was very sad and tearful, wanting a hug and more information.

Going Over the Rainbow Bridge

When I was on holiday, I received a message from the pet care facility where I’d boarded my rats.  Clio, my black berkshire rat with the sweet personality, was losing condition and wasn’t responding to antibiotics.  The owner of the facility was very apologetic and warned me that Clio did not look anything like she did when she first went to boarding.

Clio greeted me happily upon my return, but she was a lot worse for wear.  The facility owner and I discussed her symptoms and agreed that it was highly likely that she didn’t have a viral condition, but a neurological one – possibly a stroke.  She’d developed a head tilt and could no longer walk straight.  Still, as Clio nuzzled my fingers, I thought that since she was still eating and making happy rat sounds (bruxing), that perhaps we could get her back to her old condition through good feeding and careful care.

Over the next few days, Clio would greet me happily whenever I went to the cage.  She still ate and drank, though her fur remained raggedy and her eyes were often crusted with porphyrin[1].  Every morning, I would clean her eyes and feed her by hand.  When I did so, she always rewarded me by bruxing and nuzzling my fingers.

…But her condition didn’t change.  In fact, she worsened.  She spent more and more time asleep.  When she was awake, she would toddle in circles and fall over.  Sometimes, she would attempt to climb the cage walls to greet me, but would always fall over after the third or fourth rung.  After a while, she would stretch out her legs involuntarily whenever she was picked up because of her balance issues and possibly because she was having difficulty breathing.  But… she always nuzzled my fingers and bruxed, as if to show willing.

On Thursday, two weeks after I took her home, I realised that Clio wasn’t going to improve.  She was getting worse every day, slowing down and sleeping more.  Some mornings, the porphyrin crusting was so bad that she couldn’t open her eyes.  It was clear that she was dying… and that she was in a lot of pain.

So, we decided to have her put down.  We took her to the vet who told us that yes, Clio wasn’t going to improve, but that putting her to sleep was a difficult decision.  She gave us two options:

  1. Bring Clio home and manage her pain until she died naturally.
  2. Have her put down immediately.

Making the decision to put an animal to sleep is very difficult.  Generally, there’s a gut feeling when it’s time to say goodbye to an animal.  Most of the time, your pet’s behaviour will clue you into how they’re feeling, especially if you’re close to them.  Clio stopped playing with her cagemate and spent most of her days asleep.  Towards the end, she was really slowing down and though she would rouse herself and eat, it took her a long time to wake up.  Though Clio never lost interest in her food or water (something I always take as a sign that an animal is dying, as once they stop eating, the end is almost certainly near), it was becoming increasingly difficult for her to get the food she wanted.

If you’re already asking yourself whether or not you should be putting your pet to sleep, in a way, you sort of know if you should.

However, you should always speak to your vet about your pet’s condition before making any serious decisions.  Sometimes, a pet in a great deal of pain can be treated with hard work.  If your vet is only offering pain management options and has let you know that the disease is terminal, then it’s up to you.  Euthanasia isn’t for everyone, which is why our vet gave us the option of managing her pain until she died naturally.

Either way, losing a pet is hard, so always give it lots of thought before you decide for or against putting your pet to sleep.

Since I couldn’t bear to see Clio suffer anymore, I made the decision to have her put to sleep.  The vet took her away, then brought her back in a little box.

I cried a little.

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Clio’s gravesite.  RIP Clio.

We buried the box in our backyard and planted a blueberry bush over it as a memorial.  Clio had expensive taste and she always loved blueberries.


[1] A reddish oil produced by rats naturally to soften their fur.  A sick rat often overproduces this oil and can’t groom it through the fur properly, leading to it crusting around the eyes and nose.