From our first breath in this lifetime until the split second the heart clock stops ticking away the moments of our incarnation, we are on call to this concept called death. Avoid it though we try, deny it, though we attempt, dance away from it, though we insist, it beckons us with finger crooked in our direction. For some it is a blessed relief, at the end of an illness, for others, wracked with serious mental illness, a seductive force to which they may succumb. For others, still, it arrives unbidden, quite by surprise.
We use language to describe the experience, such as:
- Kick the bucket
- Angel of death
- Give up the ghost
- Buy a one-way ticket
- Shuffle off this mortal coil
- Call off all bets
- Down for the count
- Cash in the chips
- At death’s door
- Go to sleep
- Pass away
- Cross over
- Push up daisies
- Bite the dust
What is it that prevents people from speaking the words “death and dying” and instead use these euphemisms? Somehow, we are convinced that if we don’t talk about it, or even contemplate it, The Grim Reaper won’t know where to find us; much like a child hiding under a blanket, teasing that since, “You can’t see me,” s/he must be invisible.
When people fear death, it may be because they have apprehension about not existing or not being remembered. The unknown, even for those with solid spiritual faith can shake beliefs. When my mother, who was on hospice for the last six months of her life, was first diagnosed with end stage kidney and heart disease, she cried, saying she didn’t want to die. In a later conversation, I asked her what she thought would happen when she did pass, her response was that she didn’t know. She had no sense of certainty that loved ones would be greeting her (including both her parents, brother and my father) when her time came.
Elisabeth Kübler-Ross, M.D., was a pioneer of the study of death and dying, called Thanatology. Her groundbreaking book On Death and Dying (1969), was where she initially discussed what is now known as the Kübler-Ross model. She presented the Five Stages of Grief as a means of adapting to the reality of end of corporeal existence. These are denial, anger, bargaining, depression, and acceptance. Although individuals experience most of these stages, they are not in any particular order. As a matter of art imitating life, it has been included in the 1979 semi-autobiographical film about the life of legendary producer, director and choreographer, Bob Fosse, called All That Jazz. In an irreverent clip, a comedian modeled after Lenny Bruce, was offering his take on the topic.
My own journey into this realm commenced as my beloved grandmother died when I was four years old. At the time, I had no way of directly processing her passing and to this day, have no conscious recollection of her death, nor do I recall attending her funeral, although, when I asked as an adult, my mother insisted that I had been there. Not a surprise that shortly thereafter I was diagnosed with asthma, as it seems I somaticized the loss. A similar reaction occurred many decades later when both my parents died in close succession. My father lost his battle with Parkinson’s in 2008 and my mother succumbed to Congestive Heart Failure in 2010. As the social worker who was the liaison with hospice for each of them, the minister who officiated at their funeral services and my mother’s Power of Attorney and the Executor of her estate, the grieving daughter was sequestered in the back room waiting for her turn to be acknowledged. On the third anniversary of my mother’s death, I developed shingles on the left side of my head. By mid- year, 2014, I had a heart attack at age 55 and a month later, kidney stones. A few months after that, adrenal fatigue was diagnosed. It wasn’t that I didn’t cry over the losses, but that I compartmentalized them so that I could continue to keep up the pace I erroneously believed I needed to maintain, to stay one step ahead of the grief. It eventually caught up with me and I allowed myself to fully feel whatever emotions arose. Even after all this time, there are still days when experiencing their absence is surrealistic.
Even therapists are not immune to the knock-you-on-your-butt emotions that arise when a loved one dies. If we are not able to process and accept the realities of death, how can we be of support to our clients when they face it, either for themselves or others in their lives? In classes I have offered to social workers, I have been amazed at how many cringe, when they consider their own mortality. One thing that my own series of health crises have shown me, is that my time had not yet arrived to cross over to whatever awaits. I’ve learned not to fear death. I have come to accept that everyone is on loan to us and that someday they will die and leave us or we will die and leave them. It is merely a question of when.
Dying is a gradual process, death is an instant event. From the moment we are born, we are on a trajectory to the end of life. When someone has an end stage condition, the reality becomes more vivid and present. There is time to prepare for the journey, acclimating to the inevitability of it. A life review can be beneficial as the person who is dying is encouraged to share the narrative by which they experienced daily existence. It is also a means of loved ones hearing their stories. It allows for time to say goodbye as well as to say what might not have been expressed. When there is an ongoing illness, time for anticipatory grief exists and even though it is still painful, some sense of reconciling to the reality is present.
An octogenarian therapist/bereavement counselor with more than half her life spent in these fields lost her husband a few years ago. He had been ill for at least 50% of their marriage. She was his ‘care-sharer,’ as she describes it. She has said, “Even though I was prepared for his death, I wasn’t prepared to live without him.” Turning to family and friends, maintaining an active life, using her spiritual and therapeutic resiliency skills, honoring his memory, oh and getting six tattoos since his death, have assisted her in continuing to move through this experience with as much grace and grit as possible.
When someone dies without warning, other factors come into play.
- Resiliency/coping skills
- Immediate support (emotional first aid)
- Current mental and physical wellbeing or illness
- Whether there have been multiple losses (such as more than one person dying at a time, as in an automobile accident, fire or storm)
- Loss layers (one loss following another in close succession)
What helps you face death?
Who are your supports?
How do you rebound?
An organization called Trauma Intervention Programs is comprised of specially trained citizen volunteers who tend to those who are facing the death of loved ones in the immediate aftermath.
There are numerous support groups available to meet the needs of survivors.