A Grieving Ode to Tina

With the recent loss of my 17-year-old dog just under a week ago, I am, of course, quite conscious of the issues of loss and grief once again. Whether it's human loss or the loss of a beloved pet, the pain can run deep as we ride the waves that grief delivers to our doorstep.

Recovering From the Shock Of Suicide

Losing a close friend to suicide is like having the fabric of one's life torn open without warning. It is a shocking loss, a bitter and horrific loss. What could be more disruptive to the normal trajectory of life?

Having lost a friend to homicide (by police) in 2001 and now a friend to suicide in 2009, there is a continuum of grief and mourning along which I continue to travel. Ironically, it is only quite recently that I feel I've made significant progress in accepting and coming to terms with my friend's 2001 murder, so perhaps I have been handed this newest challenge in order to further sharpen my skills of recovery.

Suicide, that most self-centered of acts, removes a person's physical presence in a sudden, unexpected and brutal way. This self-inflicted disappearance sends ripples---or perhaps shockwaves---throughout multiple communities and layers of relationships, and each individual impacted by the news must grapple with their own messy constellation of feelings, be it guilt, remorse, anger, disbelief, shock, or any number of normal reactions in reaction to an abnormal circumstance.

For myself, I question what I said or didn't say, what I did or didn't do, the invitations not offered, the times I gave up or pulled back. I used the word "brutal" in the previous paragraph for a reason, in order to more fully illustrate the painful significance of a suicide in relation to those left behind. It is indeed a brutal reality when the phone rings and the news that a close friend has taken his own life is communicated across the ethers. It is gut-wrenching and maddeningly brutal, a harsh slap in the face, an iron fist to the solar plexus. It is exhausting.

For those of us left in the wake of suicide, it is a process of recovery and acceptance, and we do what we can to make it through the days in the wake of unwelcome news that painfully and irrevocably changes our lives.

The Dance of Sudden Loss and Grief

Today I am reeling from devastating news of the sudden and tragic death of a very dear friend. Death frequently seems to visit when least expected, and this lack of ability to prepare for loss is one of the factors that can make it so difficult to cope when death pays a call.

Eight years ago, another dear friend died unjustly at the hands of the police, followed by the death of my great-aunt, my beloved dog, and my step-father. Digesting this recent history, one of my personal themes for the majority of the last decade has been recovery from grief and traumatic loss.

Now with another friend suddenly gone, the list of losses suffered over this last decade has lengthened, and my personal resiliency vis-a-vis grief and loss is challenged once again. In one respect, I am at a loss for words, but on the other hand I have a deep need to reach out across the ethers and ask for support and prayers.

Death has visited our house, and we dance the dance of grief once again.

Here With the Lord Beside Me

She sits on the double bed in her studio apartment with great dignity, the early morning light streaming in the window. Gospel music plays on a small CD player on a table by the kitchen door. This is our first meeting since I'm just covering for her usual nurse.

"How are you this morning, _________?"

"Oh, I'm OK. I'm here with the Lord beside me," she says with a nod of her head towards the CD player. The music plays on.

"Did you sleep well last night?" I ask.

"Well, I only slept a few hours. I can't sleep much since the doctors killed my daughter last year."

I look her in the eye, and she stares back. Her gaze makes me slightly uneasy, but I hold it.

"I am so sorry for the loss of your daughter. That must be so hard."

"Yes, but He sees me through."

We listen to the gospel music for a moment.

"The music is really beautiful," I say sincerely.

"Can I give you your meds now?"

"Sure, honey," she replies.

I put her morning meds together, prefill her evening meds to take with dinner, and ask if she needs anything else.

"No, I'll be alright. My PCA will be here in a few hours."

"OK. I hope to see you again some time, my dear."

"God bless you, and thanks for coming."

She stares at me with that unsettling gaze again. Sometimes the chronically mentally ill can be socially awkward or unaware of how they look at people or how they speak. But in this case, I just feel like she's looking at me very deeply, and I simply try to meet her gaze.

"God bless you, too, and I'm very sorry about your daughter."

"Thanks you. Bye bye, dear," she says as I close the door.

Walking to my car, the ubiquitousness of loss and grief hits me, and I take a deep breath as I open the car door.

Just another day on earth.

The Pain of Reentry

How does one reenter daily life following a life-changing event like a death? Beyond that, reentering the workplace is perhaps the most challenging of all. Woe to the grieving worker who has not neatly sown up the grieving process before the following Monday at 9am!

Returning to work after a three-week absence to tend to my step-father's dying process and death, I gingerly returned to work and was immediately dizzied by the frantic comings and goings of my colleagues. Standing in the office on my first day back to work, it seemed as if I was a reluctant swimmer poised on the edge of a raging river, considering touching my toe to the water yet highly aware that the undertow would drag me under at my first sign of surrender to its horizontal power.

Of course, my compassionate colleagues welcomed me with hugs and kisses and offers of assistance. Several individuals went out of their way by offering concrete tasks which they could shoulder: filling med boxes for my more dependent patients, making phone calls I was reluctant to place. Still, as I sat at my desk, the cobwebs of absence began to clear, and the onrush of details needing attention quickly filled my brain which until that moment had been busy with other processes of a more personal nature.

Stepping (however reluctantly) into the rapids of the workplace, I realized quite readily that my colleagues' stress and my patients' neediness neither lessened nor took a break while I was otherwise engaged with family. Our "disability care management" office is without a doubt a rushing rapid of information and nursing care which has a laudable goal of keeping the most disabled and chronically ill inner-city patients aligned with the overarching pursuit of preventive health, self-care, and crisis management. In pursuit of that goal, we nurses, nurse practitioners, and medical assistants bend over backwards, often pulling out our hair in order to deliver the quality care which we see as necessary to the well-being of our patients. That said, in order to accomplish this goal, it seems widely accepted that our workplace must function like a battleship at full bore, the ammunition (of health) at the ready, and the crew in a constant state of hypervigilant combat against disability, addiction, disease, and poverty. In delivering such care, the caregivers wear themselves pretty thin.

So, in walks the bereaved nurse, fresh from a parent's illness and ultimate death, still reeling with emotion and saturated with stories of my own family's newest evolution. At 9:00 on Monday morning, I again took on the yoke of the needs of more than eighty people, fifty of whom consider me their first line of defense for most any situation related to their health and well-being. And a yoke it seems.

For more than two weeks, the travails of my patients (and my colleagues who cared for them in my absence) were shadows which would flit across my consciousness, yet danced on the periphery of my mind. With the care of my step-father and coordination of his own care team as a top priority, the worries of the workplace slowly sank to the bottom of my cognitive well. However, even as my enfeebled brain again made attempts to grasp the enormity of the task before me, this first week back was an enormous challenge, and the journey from Monday to Friday seemed at first Herculean, but ultimately felt most Sisyphean.

The boulder is now at rest during this blessed weekend, balanced delicately on my desk some twenty-one miles from our home, patiently awaiting my return. Come Monday, it will again be time to shoulder that burden, and also to continue to seek ways which will decrease said burden's impact on my physical health, grieving process, and emotional well-being.

Yes, the reentry is difficult. When the Space Shuttle is reentering the earth's orbit, the fires of the atmosphere will put the Shuttle's outer layer of protective skin to the ultimate test. That skin is all that protects the astronauts within from the searing and destructive heat of the earth's gaseous envelope. And so for me, my emotional "skin" is what similarly protects me from the vicissitudes of nursing practice, the double (and at times paradoxical) challenge of embodying the noble goal of self-care while I deliver care to others in need.

This Saturday evening, I am grateful for the weekend, for the winds of late summer, for the fickle September weather, for the peace that home affords, for the love that buoys me in times of trouble. I also give thanks for the skin which protects me from the elements, be they emotional or physical in nature.

Dying is hard work, but the dying person is eventually (and thankfully) released from that process, moving beyond all notions of corporeal suffering. But here on earth, the grieving must release themselves from their suffering, all the while maintaining the activities which keep home and hearth upright and functional. And here is the challenge: grieve, move beyond the loss, enter a new relationship with the dead, and embrace life anew.

The Tool-Box

Following a life-altering experience, how does one reintegrate back into one's former life? When one has been living in an altered state, with "normal" daily life in suspended animation, how does one comfortably fit back into that daily routine? Superimpose the grieving process on that reintegration, and all bets are off.

Many of us are aware of the five classic "stages" of the grieving process: denial, anger, depression, bargaining, acceptance. But nothing is ever so cut and dry, and our emotional lives are varied and complex. For me, in this moment, there are various layers of exhaustion coloring my experience, my body slowly coming into some semblance of equilibrium. Powers of concentration and focus remain relatively unreliable, but hints of the balanced self peek through the haze. Patience is a virtue at this stage, both with others and one's self.

Grief comes in many guises, and it manifests in so many ways throughout the day. Circumspect self-care and self-awareness seem to be the best tools at my disposal. But the first step in using those tools is at least opening the tool-box. As Sogyal Rinpoche has said, "Our present condition, if we use it skillfully and with wisdom, can be an inspiration to free ourselves from the bondage of suffering."

The Dividends of Grieving

A brief quote from a line written in an email to my beloved siblings with whom I share the bittersweet burden of mourning:

So, now for the work of grieving. The hourly pay is poor, but the dividends will be worth every moment invested. Remember, "unshed tears will make other organs weep."

The Universe of the Grieving

And now the grief settles into our bones. Mary and I have been complaining today of profound aches and pains, an experience which my sister shares. Our muscles are like stones which have lost the long-ago suppleness of soil. Our joints ache and creak like wintry tree limbs. We move through a syrup of feeling, even as we unpack the car, wash clothes, and attempt to resume "normal" life following the experience of a death.

Today we avoided a neighborhood picnic, lacking all motivation for superficial conversation and pleasantries. At the supermarket, we ducked in order to not encounter someone who we knew would only drain us with her narcissism. Tomorrow, I work from home, and Mary enjoys one more day of bereavement leave. Tuesday, we re-enter the proverbial rat-race, even as we continue to feel like we're still in a parallel universe, the Universe of the Grieving.

This special universe is inhabited by many, and even as some of us lose sight of it as we become enshrouded in the everyday world once more, a part of our heart remains in the Universe of the Grieving, holding the memories of our departed loved one in a special and tender place.

Pieces of my soul dwell permanently in the Universe of the Grieving, holding a spirit candle for my beloveds who have since left this earthly plane. The candle I burn for my step-dad glows most brightly, having only recently been lit. Some day another beloved's candle will be the newest one to grace my spirit altar, but for now his soul occupies the center of that most sacred space, and I send love and light to him as he claims his most righteous prize.

Ashes to Ashes

This afternoon, I went to the funeral home and picked up my step-father's ashes. A small, compact container wrapped tightly in cardboard and sealed with official notification of its contents weighed heavily in my arms as I carried it down the steps.

Once in my car, I sat in the driver's seat and hugged that box to my chest, breathing quietly, feeling its weight in my lap. When I was ready, I placed the box gingerly on the passenger seat, and began to drive back towards my mother's house, where I would deliver her beloved husband's remains into her trembling hands. During that ride, I rested my right hand on top of the little box, just as I might rest my hand on my son's shoulder.

About half-way home, I realized that I was carefully avoiding bumps and pot-holes, gingerly taking turns, as if a fragile and easily damaged cargo sat beside me. Perhaps that fragile cargo was actually my own heart, heavy with grief, relieved that his suffering was over, and worried for my mother's future and well-being. Carrying those ashes was like being a solitary pall-bearer, shouldering a container whose contents were undeniably heavy, but whose ultimate goal was lightness and the shedding of the physical body's weight.

Resting that box on the piano in the living room after everyone had a chance to feel its weight, it was so very apparent that he is not actually in that box. What is in that box is simply the remains of a body, a vessel, a vehicle that propelled that soul through this life for eighty years. That soul, that spirit, is now free, roaming a world of which we can only dream. Blessings on that soul, even as the ashes and dust and bone fragments which remain with us are scattered to the winds of the earth.

Tomorrow, we celebrate that soul's accomplishments and that body's life on earth. And then we move on without him at our side, but with him always in our hearts.

Unfolding the Days of Mourning

When someone dies, we take a breath and realize that a new chapter has begun. Where before we cleaned the commode and wiped a sweaty brow, now we sift through memories and personal effects. Where before we concerned ourselves with medications and symptoms, now we examine legal necessities and paperwork. While our loved one was living while dying, we were also living through their dying process, slowly letting go of the old earthly relationship as we opened to a less corporeal connection which loomed large in our future. As our loved one's eyes began to focus beyond us in their softening gaze, we looked more and more closely for the subtle changes that might portend the end being near.

Once the body has been removed from the home and the hospital bed and other equipment as well, one must take stock of the space where the loved one lived and died, and accept that their physical presence in that space is now a thing of the past.

Next come the personal effects. A watch. A money clip. A ring. A necklace. The trousers hang in the closet, pockets still filled with the normal flotsam and jetsam of a life: wallet, keys, change, mints, candies usually carried for bank tellers and cashiers in stores, a handkerchief.

And then there are the clothes that hang in the closet, bereft of the body which once filled them. The shirts pine for a beating heart. The pants wish for legs to crease and bend them. The socks sit alone alongside the underwear and undershirts. The ties and belts dangle sadly like plants in a hanging garden. But a new life awaits them.

Food begins to arrive from caring friends and family. The phone is rarely at rest. Arrangements are made, and plans created. Activity is a welcome relief from the heaviness of mourning, yet too much activity can also preclude one's feelings being actively felt.

On the physical side, one must ask simple questions. Are you eating? Are you hydrating? Can you sleep? Would exercise be a benefit to you now? A fine balance must be struck, whether it be emotionally, physically or spiritually. You walk a tightrope of emotional balance, and living friends and family offer guiding hands along the way.

Laughter, smiles, moments alone, moments in motion, the awareness of loss---they are all part and parcel of the unfolding of the days of mourning.

Death's Labor Pains on Labor Day

Today at 4:10pm, my beloved step-father left this world as we surrounded his bed to witness his final breaths. As he moved through the stages of the dying process over the last 48 hours, I became more and more certain that the end was drawing ever closer, perhaps more rapidly than I originally surmised it might. His struggle to allow his spirit to leave his body was truly like labor, and we were the midwives and cheerleaders along his triumphant road to freedom.

Just as it happens around the world at every hour under the sun, people came and went from my parents' home over these last days, and we all played our parts in the unfolding drama according to our individual roles and skills. My step-father's lovely daughters, sons-in-law, granddaughter, and great-grandchildren all added to the quality of the times shared under this roof, and his final days were filled with loving visits and calming energy. One visitor, a Stephen Minister by vocation, remarked that Spirit was "just pouring through the house", and he praised our little home hospice with words of benediction.

Losing myself in the minutiae of my step-dad's hourly care, I realized that my grieving process was being (somewhat necessarily) truncated by my self-imposed duties of conductor, coordinator, choreographer, and caregiver. Even as others found moments to cry, my reservoir was seemingly dry. But when the moment came and he took his final breath, we all huddled around the bed, and the tears and sobs came in torrents, releasing days of unexpressed stress and grief. It is said that "unshed tears will make other organs weep". I wrung some organs dry today, so to speak, and now I can sleep the rest of the exhausted along with the rest of our family.

His death was a fine one, navigated with grace, dignity, and a collective benevolence of spirit. Now we can be certain that our dear loved one is winging his way to a place of deserved beauty and peace, and our efforts here on Earth sent him with enormous love to fuel his journey.

Grief, Mourning, Life and Death

Today we visited a former neighbor whose dog, Amos, was good pals with our dog Sparkey when we lived in their country neighborhood a few years ago. Sparkey died last September (see his blog, Latter Day Sparks), and now Amos has cancer in his front leg and is not long for this world. It was a sweet visit, and Amos was as loving as always, excitedly greeting us and our little dog Tina, Sparkey's surviving "sister" who herself is nearly thirteen.

As my step-father enters the final stages of metastatic pancreatic cancer, grieving and death remain subjects which inform my every day life. Also, as a nurse, death is always in the wings and periodically pays a visit to our office, whether expected or not.

I am currently reading Joan Didion's The Year of Magical Thinking, the chronicle of Didion's life as it was effected by the sudden death of her husband of forty years only several weeks after her daughter had lapsed into a coma from a sudden viral illness. Losing her daughter two years later, her entire immediate family had been claimed by death, and Didion used this book as a means to describe both her grieving, which she calls a passive process that simply happens to an individual, and her mourning, the act of dealing with grief.

Sparkey's death last September 2nd, my best friend's murder in 2001, my step-father's cancer, the aging of Mary's and my parents in general----this all adds up to a fact of life: that death, and the grieving and mourning therein, are inescapable. Additionally, death and death-related processes only become more common as one grows older, facing the loss of family members, friends, colleagues, and other individuals in one's general orbit.

Still, in the face of death, life goes on, and we forge ahead in spite of it all. Life and death are not mutually exclusive, and we must face death and grieving as courageously as we face life and living. Death is neither convenient nor welcome at any time, but we all must accept that it is as inescapable as the wind.