Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

And No Birds Sing

And No Birds Sing

Imagine a world where no birds sing…ever!  One of the most joyless images I know is a repeated line in a poem by John Keats, La Belle Dame Sans Merci: “The sedge has withered from the lake, and no birds sing.”  It conjures a bleak, lifeless, silent landscape.  In the years since I studied Keats’ ballad of unrequited love in Charles Clark’s high school English class, this haunting image has become my metaphor for grief.  In the land of grief there are, indeed, times when we, immobilized by our sorrow, might lament that birds will never sing again.

 

There are different forms of grief, but each form involves loss.  Loss of independence, loss of function, loss of a job, and disintegration of an important relationship all create grieving where  a piece of wholeness is torn away.  In this article, I specifically consider bereavement—the grief that engulfs us after the death of a loved one, often a family member.

 

1n 1969, Elisabeth Kübler-Ross published “On Death and Dying,” and over the years it has become the guidebook for grieving.  In it, she proposed the now-famous 5 stages of grief: denial, anger, bargaining, depression, and acceptance, as a pattern of adaptive emotional adjustment.  What many people do not know is that the complete title to this influential book is “On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and Their Own Families.”  Kübler-Ross was interviewing and studying people with terminal illness who were facing their own deaths.  Though her 5 stages of grief applied to many dying patients, they were not the model for all persons experiencing grief.  People facing death may remain angry until the end—witnessing a legitimate future usurped by illness.  Similarly, there are terminal patients who remain in denial.  The false sense of immortality that modern medicine can create deserves credit for much of this magical thinking.  Even for dying individuals, these stages are neither exact nor universal.

 

In his book, “Getting Grief Right,” Patrick O’Malley contends that just as a relationship between two people is unique, so the grieving process that each person experiences for a loved one who has died is also unique, and that the intense sadness is a direct reflection of the intense bond of love.  Additionally, using the phrase, “The cage of the stages,” he cautions against trying to fit the mold or follow a prescribed grief journey, because such effort limits one’s ability to own and embrace one’s own story, and might actually make people feel ashamed about how they are grieving and how long it’s taking.

 

I reflect on two singular grief journeys of my own in this regard.  The death of a dear friend and my father’s death affected me quite differently, and I grieved their deaths in very different ways.  My friend and mentor died suddenly and unexpectedly.  It took me months of processing and immersing in memories to reach peaceful acceptance.  My father died of Alzheimer’s Disease after an extended, multi-year illness.  As my unique relationship with him died by degrees, I grieved his loss incrementally over time.  When his peaceful death ultimately did occur, it seemed a blessing.  In each case, I grieved authentically, but my emotional processing and mourning contrasted dramatically because the relationships and natures of death were so different.

 

There is no single right way to grieve; despite common threads, the fabric of loving and loss that we weave is uniquely ours.

 

Additionally, complicated relationships can lead to complicated grieving.  Author and friend Julie Yarbrough uses the phrase “scrappy grief” to describe such grief.   In her words, it’s scrappy because, “It feeds on the fragmented, disconnected, emotional odds and ends of incomplete relationships and unfinished love. Sometimes we feel this way when our affections have been misused or even extinguished by duty, responsibility, overbearing demands, or disappointed expectations.” http://www.beyondthebrokenheart.com/blog/view/31/scrappy-grief

 

 

O’Malley cautions about the notion of closure which seems to have become imbedded in our culture of grieving.  Closure connotes completion, an end, something finished and done.  While acceptance of a loved one’s death might become a reality over time, the story of love and loss will remain for a lifetime.  Accordingly, a restaurant, a particular fragrance, a glorious sunset, an anniversary, a favorite book, a phrase, a piece of music each might elicit a wave of wistfulness years after a loved one’s death—for very understandable and appropriate reasons.  The story may never end because the environmental triggers continue, and nostalgia reignites the story whenever our minds and hearts summon memories. Rather than a defeat or failure, such waves are poignant reminders of the depth of feeling and caring.

 

I propose that closure in grieving is like an open wound that incrementally closes and ultimately creates a permanent scar.  The intense throbbing pain of the fresh wound subsides, and a newly formed scar might gradually soften and becomes less tender over time.  But, it’s always present.  Though the wound of grief can heal with time, the scar remains as an indelible and natural reminder of a loved one, lost to death.

 

Sharing our stories of loss can be a critical piece of healthy grieving.  The stories help us to clarify our own feelings of loss, to normalize the process, and to honor the missing and the loving simultaneously. Hearing each other’s stories helps us to understand both the universality and the unique qualities of bereavement.   I regret that I wasn’t wise enough or mature enough to ask my maternal grandmother, Mabel Mann, to share her stories of grief with me.  When she died at age 89, she had buried her husband and all but one of her five children: Only my Mom survived her.   I can only imagine the waves of grief my grandmother must have endured to outlive four children.  Yet even as I consider the cumulative heartache these deaths must have generated, I remember Mabel as a woman who embraced life and relished merriment even during her own final years of functional decline.

 

Just as illness edits one’s own life and the future each of us has imagined for ourselves, death edits a loving relationship in powerful, permanent ways.  Yet our connection through loving memories does not end with the final breath of someone we hold dear.  Therein lies the magic and the melancholy of grieving.  When we acknowledge the unique sadness and emotional turmoil that each bereaved individual experiences, we share a powerful capacity to normalize and let each person’s grief be what is right.  The stories provide opportunity for shared humanness—a real gift in the bleak landscape of grief.

 

Over time, the wound of grief leaves a scar that will always remain.  And, thankfully, for most of us, color and vitality return to the landscape of life, and birds do sing again.

 

Stephen L Hines, MD

March 2018

 

 

 

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