"Expectant Grief" versus "Tragic Grief"

 

Last month I shared a video link from a patient safety webinar I recorded at LAC+USC Medical Center in Los Angeles, CA.  During that seminar, I shared my initial thoughts on "Expectant Grief" versus "Tragic Grief," and what this topic means for physicians and nurses who are struggling to deal with adverse medical events.  What follows are some deeper thoughts on this important issue...

My father died nearly seven years ago.  Dad experienced some dementia and was noticeably slowing down in the years preceding his death, but he was still very loving, and deeply loved by his family.  Unfortunately, Dad was stricken with c diff, which weakened him and led to a fall and a fractured hip. After a hip replacement surgery, Dad's dementia worsened, and he never shook the c diff.  For over two months, Dad bounced between rehabilitation and the hospital, and he was in constant pain.  The catheter was absolute misery.  The ordeal also drained Mom.  Dad continued to decline, hospice was recommended by our pastor, and Dad passed a week after arriving at hospice.  We knew death was coming, and in many ways, it was a relief.  Yes, we were terribly sad to see Dad go, but we knew he was home with the Lord and no longer in pain. This is what I call "Expectant Grief."  You know death is near, you often have a chance to brace yourself and even say goodbye, and when the end arrives most mentally healthy people can process their emotions in a positive, productive manner and find a new normal in a reasonable time frame.  I believe Expectant Grief is like finishing a good book...you can put it on a shelf and soon smile about what was.  Tears can quickly turn to fond memories and even laughter with Expectant Grief.   

"Tragic Grief," conversely, is like having pages torn from a book.  A car accident, a drowning, homicide, or death (or serious injury) from a medical error typically produces Tragic Grief, especially when the deceased is a young or younger person.  While Expectant Grief is readily accepted by mentally healthy souls, Tragic Grief is not accepted or even believed initially.  Very quickly, questions start forming in the minds of those struck by Tragic Grief, often lots of questions. Typically, mentally healthy people want to know how the death (or injury) happened, how it could have been prevented, and what safety measures are being put in place to make sure no one else is harmed.  These questions need to be answered, or people can literally become stuck or frozen in their grief; they are forever back at that moment in time when their lives changed forever, continually searching for answers, justice, and some type of closure or reconciliation. Mentally healthy people can become mentally ill if answers are not forthcoming. Relationships can fray or even end as family, friends, co-workers, etc cannot understand why the bereaved cannot let go of tragedy and "just move on."  However, the love that one person has for another soul who was taken unexpectedly -- and unfairly -- prohibits most people from "letting go" sans answers to the questions. People need to know what happened.  It's a basic human drive.  And if answers are seemingly hidden, some folks can go wild. It's sad...

Physicians and nurses are in the caring business.  Caring from clinicians often involves diagnoses, prescriptions, procedures, etc, and most often times things work out well.  The patient heals, the baby is delivered, the surgery is a success, or the elderly or terminally ill person dies with dignity.  However, adverse events happen, and sometimes medicine and science offer very little, if any, therapeutic value going forward.  Too often, clinicians abandon patients and families wallowing in unexpectant, Tragic Grief; the excuses range from "I had other patients waiting" to "I was afraid of the family, they might sue me!" or "I was ashamed."  Just because the stethoscope or prescription pad no longer can help, doesn't mean the doctor or nurses cannot help the patient or family.  Being there and being present with appropriate empathy -- not admission of fault! -- in the immediate aftermath can be critically important for patients and families.  Sometimes you don't have say or do anything concrete for folks in these moments other than sitting with them and perhaps offering tissue, water or food, or making other small gestures.  Sending sympathy cards, flowers, or attending the funeral can be important too.  Moving forward, making sure patients/families get answers to their questions ---- even if those answers lead to admission of fault and a monetary settlement --- is essential for people working through Tragic Grief.  Answering questions is an ethical and moral obligation.  Denying those answers to those questions can literally equate to a life sentence of suffering -- and no doctor or nurse should knowingly inflict that kind of hardship on a patient or family. 

The Hippocratic Oath of "Do No Harm" carries over post-event, and the worst harm any clinician can impart on a patient or family is not answering questions connected to Tragic Grief, or covering up the information needed to answer such questions. 

Sincerely,

- Doug

Doug Wojcieszak, MA, MS
President & Founder
Sorry Works!
618-559-8168 (direct dial)
doug@sorryworks.net