Sunday, July 08, 2007

When There's Nothing to Say

In August, I'll be co-teaching a seminar on grief and loss for medical students, using writing exercises to help them connect with their own experiences and those of their patients. As a result, I've been thinking about grief a lot lately, which made this article, from the chaplaincy e-newsletter PlainViews, especially relevant. The writer, the Rev. Susan Wintz, cautions chaplains and other caregivers to be very sensitive about what language they use with the recently bereaved. In general, saying "I'm so sorry your husband died" is better than saying "I'm sorry you lost your husband." The widow standing in the ED code room next to her husband's body -- still with all the tubes in place, waiting for the coroner -- is likely to think, I haven't lost him. He's right here: that's his body. I know exactly where he is. Euphemisms may make the comforters feel better, but rarely have the same effect on those who feel eviscerated by the death.

One of the most common "How to Help Grievers for Dummies" genres, in fact, is the List of Things Not to Say: for instance, The Top Five Things Not to Say at a Funeral. Here's The Top Ten Things Not to Say at the Funeral of a Disabled Person. (The BBC has an entire page of links to similar lists around disability issues.) Here are two excellent lists of what not to say to grieving people, from a hospice volunteer. There's an entire book of Things Not to Say, beginning with the dreaded "Please call me if you need anything," which I'm still guilty of saying too often myself.

You'd think that hospital staff and volunteers, who see more than their share of death, would know what to say and what not to say, but we're as uncomfortable with the subject as anybody else. The two most emotional conversations I've had with nurses have been around the subject of grief. A year or so ago, I arrived at the hospital just as a chaplain was being paged to the surgery waiting area. When I found a staff chaplain already there, I went back downstairs -- only to have an ED nurse literally grab my arm and demand, "Where were you? Where were you? I was paging a chaplain and nobody came!" I tried to tell her that the staff chaplain and I had both responded, but I got drowned out in the torrent of her words. "The dad has cancer! The mom never told their teenage son the dad was sick! They opened him up and it's inoperable, and this is the first that kid knows of it! His father's going to be dead in weeks, if not days! Where were you?"

During my shift this past week, a nurse said, "I wish you'd been here yesterday! A patient died, and his wife was inconsolable. They'd been married sixty years. She didn't know how she was going to get up in the morning." That nurse told me how difficult the conversation was for her, because the wife's description of her spouse sounded so much like the nurse's husband. She listened to the wife for about half an hour, got her calmed down enough to let go of her husband's hand, and then went home and told her own husband how much she loved him.

She did exactly the right thing -- listening instead of talking, and bearing witness to pain instead of trying to erase it -- and I told her that. But while she did a wonderful job, she'd rather another chaplain or I had been there to do it instead. (Evidently none of the staff chaplains were there, either; the hospital tries, but it hasn't achieved anything approaching 24/7 chaplaincy coverage.) As puzzled as doctors and nurses sometimes seem about the less dramatic things chaplains do, they all know that we're the people to call if someone dies. We're the people they look for when they don't know what to say themselves.

So what do I say when someone's died? Well, mostly I try to shut up and listen, like that nurse did. When I'm really at a loss in secular situations, I say, "I'm so sorry, and I know there's nothing else I can say." But in my capacity as a chaplain, I've learned that one of the things grieving people are most anxious about is, oddly, whether they're doing it right. I've heard a lot of people describe their feelings or reactions and then ask, "Is that normal?"

And so I have come up with three things I often (not always) say.

1. There's no "right" or "normal" way to grieve. Everyone's process is different, and the only "wrong" one is violence. If your response to a death is to harm yourself, someone else, or property, then yes, you need to talk to a professional. Almost anything else, though, is well within the ballpark.

2. In line with number one, don't let anyone tell you how you should or shouldn't grieve, and especially don't let them tell you how long it should take. The human heart has very little use for timetables.

3. Take very good care of yourself. A disproportionate number of ED patients I see have been bereaved within the last three years. Grief is hard, stressful work, and it will exacerbate any underlying medical conditions.

If the people I'm talking to are religious, I'll encourage them to use the resources of their faith community: Jews, for instance, have the very healing tradition of sitting shivah. Ritual can be a great help, offering the refuge of order during a time of chaos. I wish our society still had cultural, non-religious traditions like wearing black for a year after a death, if only as a way of alerting other people that the wearer is in a bad place and won't always be able to maintain social decorums.

Grieving people are fragile, and we all need to learn ways to care for them -- and ourselves, when we too are grieving -- gently.


  1. Yes, yes, yes. Also be there for the rage. I remember one family; the patient and spouse had only been married a few years and now, patient was dying. Spouse did NOT want to hear ANYTHING "positive" about the situation, and so I said to them both, "This is unfair and awful, what is happening to you. You have done nothing to deserve this, and I too would be angry, in your shoes." So I became one of the people spouse could hang onto and say, "I am," and I would just say, "Yes." I did facilitate one conversation in which patient shared that spouse was the love of patient's life, and spouse shared how many people loved and respected patient, and also patient talked about concerns about how spouse would do after patient's death, and spouse had the chance to respond. That seemed important. Sometimes you can't tell someone God's love is with them. Sometims you have to BE it. As much as any finite human can do.

  2. I think, "Please call me if you need anything," is sometimes okay. Specifically if it's: "Please call me if you need anything. I'll be by Tuesday evening with some soup and some fresh fruit, and I'll call before I come in case there's anything else that would be useful, but if you need anything between now and then, let me know." I tend to use firm, specific deadlines when I am dealing with someone who is grieving: "I will call at 3:00 this afternoon," or, "I'll talk to you on Saturday and see how you're doing," but letting them know that I can do other stuff sometimes really does seem to help. I think the commitment to something else specific makes it clear that "please call" is neither insincere nor the limit of what I'm willing to deal with.

    But I'm not formally trained in this, just a very stubborn friend.

  3. Not only was your post right on, but the comments are great too. I'm writing an article now on grief and I'd like to link to this article.

  4. This is so right. Thank you, Susan! I wonder if this is part of what is taught in Community of Hope. That's a course of study that lay ministers in my diocese take before they are allowed to carry communion out to the sick. I'm glad you are helping others learn how to do this tactfully.


  5. Anonymous2:44 AM

    Ha. YES. I'm fighting metastatic breast cancer for my fourth year, and I hope to beat the terrible odds, but it's been so hard. I was randomly Googling the phrase I found the most discouraging, the most empty, "call me if you need anything," and here you are. Good, good stuff. Thank you.

    Please continue trying to get this vital point across, from those of us who are IN catastrophes, to those trying to help, or perhaps trying to extricate themselves, or somewhere in between: "IF YOU NEED ANYTHING" means NOTHING. It puts another burden on an already overwhelmed person. It's the ultimate cop-out, followed closely by "take care," a baffling instruction to, what? Take care of what, now? Take care not to die? Take scrupulous care of what's left of my life? Take care not to bother you with my reality? Take care not to fall apart now that my world has fallen apart? Utterly meaningless phrase.

    But "if you need anything" and all the variations on "call me," AS IF these people EVER respond to calls, HAHAHAHAHHAHAHA. I have actually tried calling some of 'em. Guess what? "...who? Oh. Are you okay?" Uh, well, NO, I have cancer and I'm too weak to go to the store or cook, and I... I'm calling. "Well, it's good to hear from you. Take care now!" Right. I'll "be good to ME," if I can stagger from the bedroom to the kitchen and get some... oh, no food. All righty then. Yes, "taking care" and "calling," and it's one more for the blithering insincerity files. If I need any platitudes, I'll be sure to call. I mean I'll TAKE CARE to CALL! Yes!

    Thank you so much for saying what needs to be said.
    It's not all ribbons and teddy bears. Thank you.


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