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  • Writer's pictureBy April Sage

Grief Often Begins Before Death

Updated: Jan 24


Sunset view over the water with orange yellow and blue sky trees in the foreground

Grief doesn’t always begin at death; it begins the moment a loved one faces challenges or at a dire health diagnosis. Grief has a way of making unconscious decisions for us, making people act in unusual ways. I see a variety of care stories unfold. The most common situations involve a spouse insisting they won’t give up on the patient living at home or the patient insisting they must be with their partner and die at home, even though their caregiver is completely unable to care for the patient at home. Even when faced with numerous falls, loss of momentum in healing, worsened conditions, and their family pleading with them to accept other options, they insist on staying together at home. Their grief for losing their life, their loved one’s life, or their independence is unbearable. While it is agonizing for the family to stand back and accept the decisions made by the couple, it is their right to choose their path, even if their journey isn’t what we would choose.


I worked with a woman whose husband has dementia. He is a large person and requires full assistance for daily activities. She has physical limitations and admits she can’t care for him. We’ve worked through every step of the hospital, a rough experience in rehab, and a transition to an adult family home. Her desire has always been for him to come home, even knowing she can’t care for him. It isn’t the money or quality of care. Her decision is driven by loneliness. They’ve only ever had each other and are deeply in love. She cannot bear being alone. Love is blinding, and she is intensely grieving the future. It’s what keeps her up at night. She doesn’t eat, sleep well or keep track of appointments or other important things. She’s worried all the time. Her family and friends disagree with her decision, but the choice is now permanent. He will stay home with her no matter what.


We don’t talk enough about the cause and effect for the person left behind as they watch their life change before their very eyes. We provide a soft, safe landing for the person needing care, but what about the person who has just experienced confirmation? Their life will never be the same. When their story changes without their approval or consent. It’s out of their control, and it could be a first for them. They are watching things slip away, and it’s terrifying and deeply saddening. I see this most often with couples who do not have children. It was just the two of them all this time doing things their way.


There are a few different types of grief:


  • Uncomplicated grief. This is commonly considered normal grief. The symptoms are intense for about six months but lessen with time.

  • Anticipatory grief. This type of grief is experienced before the loss occurs. This can happen with a terminal illness diagnosis, for example.

  • Inhibited grief. This can happen when someone doesn’t take the time to process grief. People can experience panic attacks or trouble sleeping.

  • Complicated grief. In some cases, someone may not accept the loss at all, and the grief doesn’t get better. The person should seek clinical support for depression and coping.

  • Traumatic grief. This type of grief happens when someone has prolonged difficulties after a loss, making it hard to get on with daily activities. It makes it impossible to have any positive memories of the lost loved one. This type of grief can affect you at any age.


If you are watching someone you care about go through any stages of change due to loss of health and wellness, consider bringing forth the concept of anticipatory grief.


1. Acknowledge your emotions: Recognize and accept your feelings of grief. It's okay to experience a wide range of emotions, such as sadness, anger, confusion, or even guilt. Allow yourself to experience and express these emotions fully. Holding onto emotions alone can cause long-term damage.


2. Seek support: Connect with others who can understand and support you during this tough time. Talk to friends, family members, or a support group. Consider journaling to help you process your emotions.


3. Communicate openly: If possible and appropriate, try to have open and honest conversations with the person you are grieving. Share your thoughts, feelings, and concerns. Express your love and appreciation. These conversations can offer comfort and closure for both of you. Honesty is the best policy.


4. Focus on quality time: Spend quality time with the person, creating meaningful memories together. Engage in as many activities as you can that hold special significance. This can help you find solace and maximize your time together.


5. Practice self-care: Taking care of yourself is crucial during the grieving process. Engage in activities that bring you comfort and peace, such as exercise, meditation, or spending time in nature. Ensure you're getting enough rest, eating well, and seeking help for physical or emotional health needs.


6. Allow for hope and acceptance: While acknowledging and processing your grief is important, finding hope and acceptance is also essential. Embrace the present moment and cherish your time with your loved one. Focus on creating positive memories and finding joy in the present.


7. Seek professional help if necessary: grief can become overwhelming and thus begins to impact your daily life significantly. Consider seeking professional help. As much as you may not wat to, listen to others close to you who might share their concerns about what they see happening with you. They have a lens you don’t. A therapist or counselor can provide guidance, support, and coping strategies tailored to your unique situation.


I spend a lot of time with families, working to find their best pathway. Sometimes, the best path is logical and focused on their needs versus their wants. However, the unknown can play tricks on families. Doubt is heavy, and guilt is its best friend. These emotions can sway and impede many decisions. It’s easy to put ourselves in someone else’s shoes and decide from that standpoint, even if they don’t think the same as we do. What we want and what logically is the best approach often don’t meet in the middle. This approach is hard to grasp. For those who have seen very little hardship or who have never experienced loss, this level of grief can be exceptionally hard to understand, and denial is not a friend that will help you unpack it. I am trained to walk you and your family through this process from a logical, unemotional, educated approach. Let’s find the best solution for you and your loved one together.

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