Monday, March 6, 2017

Dealing with Loss


 I lost my mom this week.
Earlier in the week our office lost a patient one day and a mom the next. Those were tragedies. An 86 year old woman, who was able to peacefully pass away in her own bed with her family around her is not.
Not a tragedy, but oh so sad. No one is ever really ready.
My mom was pretty amazing. She was a force of good. She routinely wrote letters to strangers who were kind and good at their jobs. She actively reached out to lonely friends, family, and acquaintances to let them know that someone was thinking of them. She was the second mom to all of my childhood friends. She was the kindergarten teacher who remained beloved by all of her students. She was incredibly charitable. I was incredibly blessed with both of my parents.
A wise friend once shared a theory with me that the world is like a scale that is a precarious balance between good and evil.  The smallest act of kindness might be the essential spark that is making the difference in tipping the scale in the right direction.
It is going to take a lot of kindness and good deeds to make up for her loss.
In her memory I am rerunning this post about loss:

Dealing with loss/helping your child cope
 
Laughter/Crying/Happiness/Sadness. Life is such a balance.


Assuming you are lucky enough to have people, pets, or even objects that you care about, then dealing with loss is inevitable.


If you have a child, you need to be prepared to know how to approach the subject.
Parents, it may be helpful to ask yourselves the following questions:

  • How do you, yourself deal with loss?
  • What do you believe? Some folks have a deep faith that there is  “More to it than this,”  and others think that “this is it.”
  • Are you comfortable sharing your belief system with your children?
  • How do you find comfort?
  • What can your friends and family do for you when you are grieving? Do you need hugs or space??

There is not one simple approach for every person, child, or family. My mother-in-law liked to say that there is no right or wrong way to grieve. There are no rules. It is important to be supportive of the different paths that people take. There are also many cultural factors that may impact the situation.


If your family is hit with a loss, sudden or anticipated, unless we are talking about a goldfish, likely the death is hitting you just as hard, if not harder, than it is impacting your child ,though don’t minimize the loss of that goldfish as a valuable opportunity for ritual and conversation.( My husband managed to delay the "goldfish conversation" several times with a visit to the "24 fish store" where Goldie was replaced several time with no one the wiser)


The routine losses that the families in my practice deal with most often are the passing of a grandparent or beloved family pet. Those are the lucky ones. An anticipated loss is no less devastating, but this is the cycle of life that is sad but not shocking. Others are flattened by the loss of a partner, friend, sibling, child.


Parents don’t usually have the luxury of collapse. How do you help your child when you yourself are dealing with all the grief?


There are factors to keep in mind for each age that you are dealing with.
  • ages 2-4 generally don’t grasp the concept of death as permanent
  • ages 4-7 may feel responsible for the death because of their thoughts, actions, or lack of action
  • age 7-11 just starting to see death as something irreversible
  • over 11 has a better understanding about the loss


Not to make light of the subject, but here is a classic family anecdote:


When Lauren was between 3 or 4, she went through a phase of obsessing over several musicals and movies that were centered around orphans. Annie and Disney's The Rescuers are ones that comes to mind, but I know there were others. One day she asked, “what is an orphan?”

We discussed that an orphan was someone who didn’t have any parents. We immediately went on to say that she was very lucky that she had both mommy and daddy, but if in the very unlikely event that anything ever happened to both of us, her aunt and uncle, Barbara and Richard, would be her guardians. She was quiet for a moment and then said, “ I had better have their phone number.”

Hmmmm.


Do's and Don't s


Do NOT say that an animal was “put to sleep” or use any phrase that can confuse your child. The words “passed away” are also fairly passive and confusing. They might wonder if that could happen to them at any time. Do NOT lie. Find a way to convey truth that you are comfortable with. Your child will know that you are very upset. Shielding them from honesty and communication is not doing them a favor. It is okay to be sad. It is okay to cry.


Find a ritual that you feel comfortable embracing. Take comfort in happy memories. Celebrate the life of the one you lost! Tell wonderful stories. Don’t be afraid to laugh.
Honor the memories with kind gestures.


Finding a good therapist to help you or your child give you coping tools is often a good idea. Check to make sure that the therapist has experience dealing with bereavement issues.


Books and stories can be an excellent launching off point for discussions. If you can’t come to terms with how you feel about death, you might be able to turn the spotlight  away from you with lines like:

“Some people believe…”
“Other people think……”

In my search for further local resources I reached out to my old friend Dr. Nancy Iverson.
Nancy has not only written several published articles about the grieving process, but has been involved in facilitating various support groups for many years. She pointed me towards Josie’s Place. (It was a bit of a treasure hunt.)

This is a small but wonderful center here in San Francisco that offers support groups and other services for families and children who have experienced loss.

Josie’s Place:
415-513-6343
Groups meet in the Inner Sunset

If you scroll down to the bottom of the home page on their website in the "Articles on Grief/Grief Resources" tab, Pat Murphy, the director has cobbled together a list of other local resources that might be useful.


Janet Jaskula, RN, MS, A pediatric hospice nurse, also shared her list of resources:


This is a great book about what loss and grief can do if one does not deal with it.  Kids and adults.


"Fall of Freddie the Leaf" by Leo Buscaglia  


"Velveteen Rabbit" by Margery Williams


"There is a Rainbow Behind Every Dark Cloud"  written by a group of children with leukemia who attended The Center for Attitudinal Healing.

A Lion in the House Movie that follows several children and teens and their families through illness and loss, grief and death. Though not all of the kids in the film die, they are certainly affected by their illnesses and loss of their "normal" childhood and teen years.

The Giving Tree Shel Silverstein. 


For parents, check out the the website of Barbara Karnes. Barbara Karnes is the author of  "Gone From My Sight."  She has some excellent combo coloring/story books about loss for kids.


Dr Nancy Iverson recommends the book:
"Never Too Young to Know" by Phyllis Rolfe Silverman


The very helpful children's librarian Liesel Harris-Boundy at the San Francisco Public Library West Portal Branch did some research for me and came up with some good choices for kids. Scroll down to the end of the post for her list.

*****************************************************************************************

I saw the following gem circulating around the internet and it resonated with me. I thought it worth sharing.

Someone put out a post asking for help dealing with grief. This answer was the response from a fellow in his late 70s:


I'm old. What that means is that I've survived (so far) and a lot of people I've known and loved did not.


I've lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can't imagine the pain it must be to lose a child. But here's my two cents...


I wish I could say you get used to people dying. But I never did. I don't want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don't want it to "not matter". I don't want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it.


Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can't see.


As for grief, you'll find it comes in waves. When the ship is first wrecked, you're drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it's some physical thing. Maybe it's a happy memory or a photograph. Maybe it's a person who is also floating. For a while, all you can do is float. Stay alive.


In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don't even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you'll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what's going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything...and the wave comes crashing. But in between waves, there is life.


Somewhere down the line, and it's different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O'Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you'll come out.


Take it from an old guy. The waves never stop coming, and somehow you don't really want them to. But you learn that you'll survive them. And other waves will come. And you'll survive them too.


If you're lucky, you'll have lots of scars from lots of loves. And lots of shipwrecks.

*****************************************************************************************

Liesel Harris-Boundy's recommended reading list:

Life Is Like the Wind by Shona Innes - 2014 Written by a clinical child psychologist, Barron's "A Big Hug" series offers a gentle and direct approach to the emotional issues that children face. This book introduces the concept of death to young readers by likening life to the ever-moving wind.






Missing Mommy by Rebecca Cobb - 2013


Ben's Flying Flowers by Inger M. Maier - 2012 Emily introduces her younger brother, Ben, to butterflies, which he calls "flying flowers," and when his illness makes him too weak to go see them she draws him pictures, but after his death she no longer wants to draw happy things. Includes note to parents.


Harry & Hopper by Margaret Wild  - 2011 Harry is devastated when he returns home from school to find that his beloved dog, Hopper, will no longer be there to greet him.


The Blue House Dog by Deborah Blumenthal - 2010 A boy whose beloved dog has died, and a dog whose owner also died, find each other and slowly begin to trust one another.


Always by My Side by Susan Kerner - 2013 A rhyming story written to help children understand that a dad's love is forever. Even if they grow up without his presence in their lives.

Rabbityness by Jo Empson - 2012 Rabbit enjoys doing rabbity things, but he also loves un-rabbity things! When Rabbit suddenly disappears, no one knows where he has gone. His friends are desolate. But, as it turns out, Rabbit has left behind some very special gifts for them, to help them discover their own unrabbity talents! Rabbityness celebrates individuality, encourages the creativity in everyone and positively introduces children to dealing with loss of any kind.


The Scar by Charlotte Moundlic. When his mother dies, a little boy is angry at his loss but does everything he can to hold onto the memory of her scent, her voice, and the special things she did for him, even as he tries to help his father and grandmother cope.


Remembering Crystal by Sebastian Loth - 2010 Zelda the goose learns about death and loss when her turtle friend Crystal disappears from the garden one day.


A Path of Stars By Anne Sibley O'Brien - 2012 A refugee from Cambodia, Dara's beloved grandmother is grief-stricken when she learns her brother has died, and it is up to Dara to try and heal her.


I Remember Miss Perry by Pat Brisson - 2006 When his teacher, Miss Perry, is killed in a car accident, Stevie and his elementary school classmates take turns sharing memories of her, especially her fondest wish for each day.
Dealing with loss/helping your child cope

Laughter/Crying/Happiness/Sadness. Life is such a balance.


Assuming you are lucky enough to have people, pets, or even objects that you care about, then dealing with loss is inevitable.


If you have a child, you need to be prepared to know how to approach the subject.
Parents, it may be helpful to ask yourselves the following questions:

  • How do you, yourself deal with loss?
  • What do you believe? Some folks have a deep faith that there is  “More to it than this,”  and others think that “this is it.”
  • Are you comfortable sharing your belief system with your children?
  • How do you find comfort?
  • What can your friends and family do for you when you are grieving? Do you need hugs or space??

There is not one simple approach for every person, child, or family. My mother-in-law liked to say that there is no right or wrong way to grieve. There are no rules. It is important to be supportive of the different paths that people take. There are also many cultural factors that may impact the situation.


If your family is hit with a loss, sudden or anticipated, unless we are talking about a goldfish, likely the death is hitting you just as hard, if not harder, than it is impacting your child ,though don’t minimize the loss of that goldfish as a valuable opportunity for ritual and conversation.( My husband managed to delay the "goldfish conversation" several times with a visit to the "24 fish store" where Goldie was replaced several time with no one the wiser)


The routine losses that the families in my practice deal with most often are the passing of a grandparent or beloved family pet. Those are the lucky ones. An anticipated loss is no less devastating, but this is the cycle of life that is sad but not shocking. Others are flattened by the loss of a partner, friend, sibling, child.


Parents don’t usually have the luxury of collapse. How do you help your child when you yourself are dealing with all the grief?


There are factors to keep in mind for each age that you are dealing with.
  • ages 2-4 generally don’t grasp the concept of death as permanent
  • ages 4-7 may feel responsible for the death because of their thoughts, actions, or lack of action
  • age 7-11 just starting to see death as something irreversible
  • over 11 has a better understanding about the loss


Not to make light of the subject, but here is a classic family anecdote:


When Lauren was between 3 or 4, she went through a phase of obsessing over several musicals and movies that were centered around orphans. Annie and Disney's The Rescuers are ones that comes to mind, but I know there were others. One day she asked, “what is an orphan?”

We discussed that an orphan was someone who didn’t have any parents. We immediately went on to say that she was very lucky that she had both mommy and daddy, but if in the very unlikely event that anything ever happened to both of us, her aunt and uncle, Barbara and Richard, would be her guardians. She was quiet for a moment and then said, “ I had better have their phone number.”

Hmmmm.


Do's and Don't s


Do NOT say that an animal was “put to sleep” or use any phrase that can confuse your child. The words “passed away” are also fairly passive and confusing. They might wonder if that could happen to them at any time. Do NOT lie. Find a way to convey truth that you are comfortable with. Your child will know that you are very upset. Shielding them from honesty and communication is not doing them a favor. It is okay to be sad. It is okay to cry.


Find a ritual that you feel comfortable embracing. Take comfort in happy memories. Celebrate the life of the one you lost! Tell wonderful stories. Don’t be afraid to laugh.
Honor the memories with kind gestures.


Finding a good therapist to help you or your child give you coping tools is often a good idea. Check to make sure that the therapist has experience dealing with bereavement issues.


Books and stories can be an excellent launching off point for discussions. If you can’t come to terms with how you feel about death, you might be able to turn the spotlight  away from you with lines like:

“Some people believe…”
“Other people think……”

In my search for further local resources I reached out to my old friend Dr. Nancy Iverson.
Nancy has not only written several published articles about the grieving process, but has been involved in facilitating various support groups for many years. She pointed me towards Josie’s Place. (It was a bit of a treasure hunt.)

This is a small but wonderful center here in San Francisco that offers support groups and other services for families and children who have experienced loss.

Josie’s Place:
415-513-6343
Groups meet in the Inner Sunset

If you scroll down to the bottom of the home page on their website in the "Articles on Grief/Grief Resources" tab, Pat Murphy, the director has cobbled together a list of other local resources that might be useful.


Janet Jaskula, RN, MS, A pediatric hospice nurse, also shared her list of resources:


This is a great book about what loss and grief can do if one does not deal with it.  Kids and adults.


"Fall of Freddie the Leaf" by Leo Buscaglia  


"Velveteen Rabbit" by Margery Williams


"There is a Rainbow Behind Every Dark Cloud"  written by a group of children with leukemia who attended The Center for Attitudinal Healing.

A Lion in the House Movie that follows several children and teens and their families through illness and loss, grief and death. Though not all of the kids in the film die, they are certainly affected by their illnesses and loss of their "normal" childhood and teen years.

The Giving Tree Shel Silverstein. 


For parents, check out the the website of Barbara Karnes. Barbara Karnes is the author of  "Gone From My Sight."  She has some excellent combo coloring/story books about loss for kids.


Dr Nancy Iverson recommends the book:
"Never Too Young to Know" by Phyllis Rolfe Silverman


The very helpful children's librarian Liesel Harris-Boundy at the San Francisco Public Library West Portal Branch did some research for me and came up with some good choices for kids. Scroll down to the end of the post for her list.

*****************************************************************************************

I saw the following gem circulating around the internet and it resonated with me. I thought it worth sharing.

Someone put out a post asking for help dealing with grief. This answer was the response from a fellow in his late 70s:


I'm old. What that means is that I've survived (so far) and a lot of people I've known and loved did not.


I've lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can't imagine the pain it must be to lose a child. But here's my two cents...


I wish I could say you get used to people dying. But I never did. I don't want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don't want it to "not matter". I don't want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it.


Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can't see.


As for grief, you'll find it comes in waves. When the ship is first wrecked, you're drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it's some physical thing. Maybe it's a happy memory or a photograph. Maybe it's a person who is also floating. For a while, all you can do is float. Stay alive.


In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don't even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you'll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what's going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything...and the wave comes crashing. But in between waves, there is life.


Somewhere down the line, and it's different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O'Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you'll come out.


Take it from an old guy. The waves never stop coming, and somehow you don't really want them to. But you learn that you'll survive them. And other waves will come. And you'll survive them too.


If you're lucky, you'll have lots of scars from lots of loves. And lots of shipwrecks.

*****************************************************************************************

Liesel Harris-Boundy's recommended reading list:

Life Is Like the Wind by Shona Innes - 2014 Written by a clinical child psychologist, Barron's "A Big Hug" series offers a gentle and direct approach to the emotional issues that children face. This book introduces the concept of death to young readers by likening life to the ever-moving wind.






Missing Mommy by Rebecca Cobb - 2013


Ben's Flying Flowers by Inger M. Maier - 2012 Emily introduces her younger brother, Ben, to butterflies, which he calls "flying flowers," and when his illness makes him too weak to go see them she draws him pictures, but after his death she no longer wants to draw happy things. Includes note to parents.


Harry & Hopper by Margaret Wild  - 2011 Harry is devastated when he returns home from school to find that his beloved dog, Hopper, will no longer be there to greet him.


The Blue House Dog by Deborah Blumenthal - 2010 A boy whose beloved dog has died, and a dog whose owner also died, find each other and slowly begin to trust one another.


Always by My Side by Susan Kerner - 2013 A rhyming story written to help children understand that a dad's love is forever. Even if they grow up without his presence in their lives.

Rabbityness by Jo Empson - 2012 Rabbit enjoys doing rabbity things, but he also loves un-rabbity things! When Rabbit suddenly disappears, no one knows where he has gone. His friends are desolate. But, as it turns out, Rabbit has left behind some very special gifts for them, to help them discover their own unrabbity talents! Rabbityness celebrates individuality, encourages the creativity in everyone and positively introduces children to dealing with loss of any kind.


The Scar by Charlotte Moundlic. When his mother dies, a little boy is angry at his loss but does everything he can to hold onto the memory of her scent, her voice, and the special things she did for him, even as he tries to help his father and grandmother cope.


Remembering Crystal by Sebastian Loth - 2010 Zelda the goose learns about death and loss when her turtle friend Crystal disappears from the garden one day.


A Path of Stars By Anne Sibley O'Brien - 2012 A refugee from Cambodia, Dara's beloved grandmother is grief-stricken when she learns her brother has died, and it is up to Dara to try and heal her.


I Remember Miss Perry by Pat Brisson - 2006 When his teacher, Miss Perry, is killed in a car accident, Stevie and his elementary school classmates take turns sharing memories of her, especially her fondest wish for each day.

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