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HomeMy WebLinkAboutThe Goderich Signal-Star, 1981-04-01, Page 35- page 5 How to cope with grief caused by cancer deaths BY VIRGINIA BARCKL,EY, R.N.,M.S, Cancer has many distinguishing • characteristics, one of which is to be equated in the popular mind with death. American Cancer Society statistics give this hypothesis a certain grim support, since two out of three patients with cancer still perish. Those who are not cured often relinquish their hold on life slowly, in great anguish. Few other diseases involve as many body parts, affect every age and have such emotional im- pact, yet no other illness is as involved in every aspect of living. Cancer patients frequently have medical, nursing and religious ex- periences of tremendous novelty and intensity. When cancer reaches the irreversi- ble stage, the time of firsts and lasts begins, with every fact and feeling assuming the sharpest emphasis. In the fierce and protracted sty i-ggie for surVivai both families and friends, as well as professional people, are involved. One part of this period when life is invested with greater value because it is soon to end, is grief. Although most nurses are familiar with death, the many faces of grief may elude., them. A kind of grief often observed in cancer and significant to doctors and nurses is the mourning that occurs over a lost body part. When the body image is altered, patients need great ego strength to combat the threat to their sense of wholeness. More than the fear of rejection or feelings of guilt and a sense of shame plagues them— they are grieving, too. The lost eye, limb or breast is often seen as part of a happier life; the possession of these organs was synonymous with belonging, activity and wor- thwhileness - now ir- reparably impaired. The resultant mourning depends on the value invested in the lost part, an individual reac- tion. For example, one woman may perceive mastectomy as the ultimate disaster, while another feels that wearing orthopedic shoes or a brace spell the end of youth and attraction. This informative publication is brought to you with the kind co-operation of the following WEST END STEREO- (FORMERLY MR. STEREO1 524-9344 40 WEST STREET, GODERICH fall JfunrraL dome Michael S. Falconer 153 HIGH STREET CLINTON 482-9441 , ROYAL BAN K Ball & Mutch Ltd. Home Furnishings 71 Albert St., Clinton 482-9505 This •'grief may be manifested by withdrawal, lack of appetite, insomnia, difficulty in concentration and disinterest in people and things. If the patient has nightmares, sweating and palpitation, her grief is tinc- tured with anxiety. Any of these signs will have an adverse effect on the pa- tient's ability to profit from health teaching or to par- ticipate in rehabilitation. Motivation, never easy, becomes increasingly dif- ficult when grief for a lost body part . persists. Nurses can be helpful by their own attitudes toward amputation- that is by handling dressings or stumps or prostheses without repugnance, and by accepting the patient as still interesting and pleasant to know. Patients of any age res- pond to the attitudes of those they most admire and who are around them— their husbands, doctors and nurses set the tone for the woman who has had mastec- tomy. There are some "nots" for nurses, too— we must not expect patients ab- sorbed in grief to move for- ward or blame •-ourselves when they cannot learn, but rather recognise the forces at work, repeating our teaching or timing it dif- ferently. If the mourning is extravagant or lasts too long, nurses refer the patient to an appropriate resource. Little understood is the grief of the dying patient because he is., leaving all of the places, all of the people and all of the things that he has held dear. His sorrow is overwhelming because it in- volves so many objects and moreover it affects him when his physical strength is depleted. There are some periods of life when we can solve many of our problems by sheer stamina alone, but this blessing is denied the pa- tient. His is the bleak com- bination of a loss,of love, health and energy, nor, in most cases, will he have distraction to help him. He cannot find relief in atten- ding a concert, a play or a religious service. Often he feels he must conceal his distress from those around him. Few people will say to him as they will to his widow, "Cry - it's good for you". The injunction, spoken or implied, seems to be, "You must be courageous for your family. Don't make it worse for thein.". Nurses, who frequently feel there is much they would like to do and little they can do in these situa- tions, have a valuable.con- tribution to make to the grieving cancer patient. They can interpret to family members the mourning pro- cess that is engulfing the pa- tient. They can give an op- portunity pportunity to the patient to ex- press his feelings. With more knowledge and understanding, the family can sometimes share their grief with the patient and this may be the means of drawing them closer together. Pretense can be dropped and in their last days together they can be real people, not actors speaking lines. After the pa- tient dies, the recollection of this intimacy of thought and feeling will be im- measurably comforting. One reminder: patients are always individuals and some, to the end, must deny their suffering and the im- minence of death. Nor are all families loving. If the only acceptable pattern for the patient is stoicism, and the family has never been warm or close, unless the nurse has some powerful substitute for these props, it is best not to tamper with them. In some situations the most we can do Is to withhold judgment, and support families in their accustomed roles, . Some people believe it is cruel to discuss death with the people most concerned. There is an old adage. "There are no atheists in fox holes", nor are there many cancer patients who spurn sincere overtures from another human being when they are dying. The sensitive nurse never forces speech on the inarticulate or taciturn, but she does keep the avenues of communication open for many patients yearn to talk about their last great venture. Speech reduces guilt. It provides an opportunity for expiation—to explain, to apologize; to forgive and be forgiven.. Speech comforts as patients plan for the future, reflect on their- philosophy and religious convictions and sometimes find the words to tell a loved one what his presence has meant. Speech dissipates loneliness and it can be the vehicle through which inspiration and beauty are derived. With rare ex- ceptions, it makes the dif- ference between life and death of the spirit, which can occur long before the cessa- tion of body functions. Grief often starts at the time of diagnosis. It may continue and be completed before the patient expires, or it may be interrupted at remission, to be resumed later. Families receiving the diagnosis of cancer should be treated with the utmost thoughtfulness. The same protections used against X- rays— time, shielding and distance— will soften the blow of cancer. The news should never be delivered abruptly; some professional person must give the patient time to react, to ask ques- tions, to sense the beginning of a relationship of trust and warmth. Time is essential, not to describe remissions and treatments, for the patient cannot absorb this, but to establish a climate. It may only be direly felt, but this is of prime importance. Shielding is accomplished by the manner in which the doctor gives the patient his diagnosis. The truth can be so gentle that the patient's principal perception is that he has an enormously -interesting il- lness, one of terrific challenge to him and his doc- tor, who is neither dismayed nor defeated. The truth can also be curt and cruel. Nurses, by their expres- sions, convey a great deal to the patient. They can rein- force the words of a thoughtful doctor, or by some subtle gesture, vitiate them. Distance means that the family having a momentous interview, such as that oc- curring at diagnosis, needs privacy, or distance from others in a ward or clinic. Grief will be greater when these precautions are ig- nored. Whatever form grief takes, nurses can be helpful to those who mourn by giv- ing them time to adjust to new ways of living. We have not always done this in the past, indeed, this is a failure of our society. Perhaps it has something to do with the trappings of grief. Widows no longer wear. veils, and one seldom sees a mourning band on a man's sleeve. Since family members who are grieving look exactly like the rest of us, it becomes very easy to expect them to become absorbed back into the mainstream of life im- mediately after a painful loss. Emotional disaster. however, has its patterns andrhythms just as the heal- ing process' after physical trauma does. We can't hurry grief any more than we can speed tfp the stages of discoloration that follow, bruising. Therefore we must not-- -make u-n-realist-ic demands on those who have suffered severe loss. While it is true that all human beings must reinvest their emo- tional reserves and that life cannot remain static, this cannot be accomplished without regard to individual needs and time mechanisms, and certainly not at the well meant urging of any nurse. For example, Mrs. Allen and Mrs. Warner may each have lost a child at approx- imately the same time, but the circumstances of their lives, their personalities and their backgrounds are so dif- ferent that one mother is back at PTA meetings while the other oneis going through the most ,routine of household tasks as an automation many months later. Both of these grieving parents are in the normal range of feeling. Time is always required to reduce ° grief, and in some cases much more than in others. We have no precise, criteria against which all people may be measured. But even flex- ibility has its limits. There is one outside in-- stance of which nurses must be aware. When grief per- sists in immensity and inten- sity, the person so afflicted needs help beyond the purlieu of nursing. An exam- ple of this wpuld be the devoted wife who two years after the death of her hus- band still maintains his workroom, his bedroom and his wardrobe as he left it. Such a woman often speaks of her husband as though he were still alive. an absolute faultless human being-.-- Ob- - viously, although we must allow time for all kinds. of grief, this is an exception.- Prolonged xception.Prolonged and unresolved grief may be the prelude to a psychotic break. Nurses should refer these people to their family physicians, who will see that they get specialized attention. All grief must not be Turn to page 6 What's happening in Canada? Yearly deaths from lung cancer per 100,000 people. 1940 1950 1960 197O Yearly consumption of cigarettes per person over 15 years 1940 1950 1960 1970 WHAT MORE CAN -WE SAY?