My great grandma, or Mia, as we knew her, was 100 when she decided she was ready to die. I found this out through a nonchalant conversation with my granny, her daughter, just after Christmas. She was eating a bowl of porridge at the breakfast bar, and said: “Mia wants to go, and that’s legal in Canada.”
Was I shocked? Not really. Although I didn’t actually know that Canada, where she had lived all her life, offered medically assisted dying (MAiD), my family are the type to take things into our own hands.
It’s a weird thing, euthanasia. It’s something you’re taught about in RE lessons at school, debating whether we have a right to ‘play God’. It’s something I agreed with as a faraway idea that I’d never have to consider. Something I thought was good in theory but hadn’t ever put any serious thought into the practice.
When I learned about Mia, I agreed with it still. Everyone I told did too, commenting on how brave her decision was and how amazing it was that she had this ‘opportunity’. They may have been thinking about the procedure itself rather than offering support but that was okay, because this was, overall, A Good Thing.
Meanwhile, with my family, talk swiftly turned to logistics. Timetables detailing who would be where and when were emailed around and the bank split Mia’s estate equally, with cheques ready to be collected by her children on the ride home from the facility. It helped the Canadian side of the family to deal with it Monica Geller-style, working pragmatically through the practical elements of her life.
“We’re more open to things that are predictable,” says Dr Anna Janssen, a psychologist specialising in palliative care. “There’s something safer about it, and that means we can be more flexible in our thinking and more open with ourselves and each other.”
But while they were handling the logistical side, it became very clear that we needed to introduce this flexibility into the emotional side of things, too.
The ‘five stages of grief’ ends with ‘acceptance’. The problem here was that for Mia to go with our blessing, we needed to accept her death before she actually died. That’s an unchartered process; grieving while someone is still alive and well(ish) feels weird. My auntie Penny summarised it perfectly, saying she felt she was going through grief sideways, like a breech birth.
Feeling emotion with a deadline meant we had to sprint through the confusion, the sadness, the relief of it all. If we had been Monica about the logistics, we Chandler-ed around the feelings part somewhat chaotically. But we still all felt weirdly…lucky? “With assisted dying, everyone involved has choice in the death,” explains Judy Tatelbaum, author of The Courage to Grieve. “That makes a great difference. Anticipatory grief is very healthy.”
But I was worried about what the minutes and days after she died would bring, seeing as we had already ‘grieved’. “Maybe the grief afterwards is easier, as some feelings have happened already,” said Dr Janssen. “But eventually there will be something new, because the context has changed, and you can’t feel it until the person has actually died.”
And so the 9th of January came. I asked not to know the exact time she was meeting her doctor, because what do you do in the minutes that someone you love is dying? In the most extreme version of the Schrödinger’s cat experiment, I went into a meeting, curious about whether she’d still be alive when I came out. She wasn’t. But there was an email telling the whole story, including how she had greeted the doctor by asking if he was the nice man who was going to help her.
Yes, my experience introduced a new closeness to my family. But it highlighted a flaw in the current MAiD plan. The message from the guidelines, the ethical debates and the psychologists I’ve spoken to is that assisted dying should be about having autonomy. It should make it easier, because you plan and prepare for the place, time, aftermath and even the feelings. But MAiD is such new territory that there are the same unknowns as with ‘regular’ dying.
Up until now, humans have only ever died after suffering through old age or illness or suddenly and shockingly in an accident. Those five stages of grief have been based on these same experiences over thousands of years. Now, suddenly, we’ve introduced a model where death can be scheduled into our diaries, and we can’t just apply the same rules. There are no history or self-help books to teach us how to navigate a brand-new type of grief that brings up a totally different, sporadic, rushed and uncertain feeling.
While there are articles and research papers discussing ethical, religious and legal boundaries, all the conversations have forgotten the people, families and feelings. And maybe that’s because, as Dr Janssen pointed out to me, it’s easier to discuss facts and figures than it is to discuss emotions.
For my family, MAiD was the first time we all properly discussed dying. Perhaps this is the taboo-breaking policy the world needs? You can’t send out a ‘save the date’ without telling people what for, after all. But to stop the turbulence, there’s still a grief taboo that needs to be broken. “We need to talk about the psychology of death and grief, but also the psychology of living. We talked about the death, but not about how we’re then meant to live well,” said Penny.
For families going through MAiD this year, in five years, or further in the future, when it could be a global policy, the system will benefit if we open up. “At the moment we don’t talk about it enough to know whether that [five stages] model requires more thought,” agrees Dr Janssen. “In my academic brain, I’m thinking we need to ask what MAiD means for people, but really, we’ll simply hear more if we take the time.”
My granny has since told me not to be shocked if she asks for MAiD. Is that a conversation she would have had with me if it wasn’t for Mia taking the plunge? Probably not. And while I haven’t yet applied my newfound skill for discussing death with anyone else, I’ll no longer hold back – especially when talking about my own.
The death of a child may be considered the worst trauma that any human can experience. Though it’s not a terribly common experience in the United States—about 10,000 children between the ages of 1 and 14 died in 2016—the horrific potential for childhood mortality looms large. While reassuring, the numbers also make plain why this one specific type of loss is so feared, so painful, and so stigmatized.
“The death of a child is considered the single worst stressor a person can go through,” says Deborah Carr, chair of the sociology department at Boston University. “Parents and fathers specifically feel responsible for the child’s wellbeing. And they’re not just losing a person they loved. They’re also losing the years of promise they had looked forward to.”
Although parents mourning the death of a child are, in many ways, experiencing classic grief responses— usual battery of psychological, biological, and social repercussions—there are many unique challenges. The trauma is often more intense, the memories and hopes harder to let go of. As such, the mourning process is longer and the potential for recurring or near constant trauma is far greater. “The death of a child brings with it a range of different and ongoing challenges for the individual and the family. Everyday questions such as ‘How many kids do you have?’ can trigger intense distress.” explains Fiona MacCullum, a professor at the University of Queensland. “Some people do find ways of living with the loss. Others struggle to find meaning in life.”
Psychological Impacts: How The Trauma Of Child Loss Harms The Psyche
Interestingly, very few studies have delved into the nightmare of the death of a child. Most of the research on the psychological response to death focuses on the loss of a spouse or a parent. Presumably this is in part because of the difficulty of finding subjects for study and also in the potential difficulty of recruiting participants in anything longitudinal.
“While there have been significant advances in our scientific understanding of grief, we have a long way to go,” MacCullum says.
That’s not to say we are without literature. One 2015 study of 2,512 bereaved adults (many of whom were mourning the loss of a child) found little or no evidence of depression in 68 percent of those surveyed shortly after the tragedy. About 11 percent initially suffered from depression but improved; roughly 7 percent had symptoms of depression before the loss, which continued unabated. For 13 percent of the bereaved, chronic grief and clinical depression kicked in only after their lives were turned upside down. (If those numbers seem low, it’s worth remembering that it is entirely possible to be deeply sad without being depressed.)
Unfortunately, the research suggests that psychological damage done by a child’s death often does not heal over time. One 2008 study found that even 18 years after the death of a child, bereaved parents reported “more depressive symptoms, poorer well-being, and more health problems and were more likely to have experienced a depressive episode and marital disruption.” While some parents did improve, “recovery from grief…was unrelated to the amount of time since the death.”
“The first year after losing a younger child, a parent is at an increased risk for suicide and everything from major depression to complicated grief,” Dr. Gail Saltz, a psychiatrist at the NY Presbyterian Hospital Weill-Cornell School of Medicine, told Fatherly. Complicated grief differs from expected, normal grief, in that “there are more intense symptoms, alternating with seemingly no symptoms—a numbness—which potentially impairs their ability to function.”
“A parent who grieves without any type of serious complications, such as suicidal thoughts or self-harm behaviors, would be the best-case scenario,” says Dr. Kirsten Fuller, a physician and clinical writer for the Center of Discovery treatment centers. “Worst-case scenarios would be experiencing suicidal tendencies, psychosis or developing a mental health disorder or an eating disorder.”
Biological Impacts: How The Death Of A Child Changes A Parent’s Body
The impacts of this tragedy are not solely psychological. In 2018, Frank Infurna and colleagues looked the general health and physical functioning of 461 parents who had lost children over the course of 13 years. “We did see some decline, followed by a general bounceback, or recovery, over time,” Infurna, who studies resilience to major stressors at Arizona State University, told Fatherly. Physical functioning was focused on one’s ability to complete various everyday tasks, and “we didn’t see much change in this,” Infurna recalls. But when he reviewed bereaved parents’ self-reports—whether they felt they got sick often, or whether they expected their health to improve or decline— he found poorer perceptions of health.
As with all major grief responses, the mental health trauma of losing a child can kick off physical symptoms, including stomach pains, muscle cramps, headaches, and even irritable bowel syndrome. A handful of studies have found more tenuous links between unresolved grief and immune disorders, cancer, and long-term genetic changes at the cellular level.
One surprising impact, often seen among parents mourning the loss of a child, is known as broken heart syndrome—a condition that presents oddly like a textbook heart attack. Symptoms include “crushing chest, pain, ST-segment elevation on electrocardiography, and elevated cardiac enzyme markers on lab results,” Fuller says, citing her previously written work on the subject. “As a reaction to emotional or physical stress, the body’s natural response is to release catecholamines, also known as stress hormones, that temporarily stun the heart muscle.”
Chronic stress can even impact how the brain functions, as long-term exposure to the stress hormone cortisol has been linked to the death of brain cells. And in a cruel twist of neurobiology, the regions of the brain responsible for grief processing, such as the posterior cingulate cortex, frontal cortex, and cerebellum, are also involved in regulating appetite and sleep. This may explain why grieving parents develop eating and sleeping disorders in the aftermath of the loss.
“There are many many studies that have looked at the ongoing health effects of high levels of chronic stress,” Saltz says. “And when you look at lists of stressful life events, this is at the top.”
Social Impacts: How Child Loss Strengthens (Or Ruins) Families
Major life stressors naturally take a toll on marriages. But divorce in the aftermath of a child’s death is not inevitable. “It’s really important to underscore that the death of a child is not going to ruin a marriage,” Carr says. “It generally makes a troubled marriage worse, and a strong marriage better.” When dealing with illness or addiction, spouses who disagreed over the best course of treatment are at particularly high risk. “If one spouse blames the other, or feels the other did something to hasten the death, that’s almost something that cannot be recovered from.”
There are also factors, beyond the couple’s control, which may sour or save the marriage. “Grief, trauma, and depression impact one’s ability to participate in all meaningful relationships,” Saltz says. “But I have seen couples where the opposite is the case. They become closer, they support each other. This is the only person who can really understand how you feel.”
Mothers and father who lose a child often must also contend with surviving siblings. Figuring out how to parent after losing a child is a unique challenge and here, too, experts agree that the outcomes for both the surviving children and parents largely depend on the state of the relationship before the trauma. The death can both bring a family together or tear it apart.
When dealing with terminally ill children, one particular risk is that other siblings may feel neglected, or find too many responsibilities foisted upon them while the parents shift their focus solely to the suffering child. A sick kid “is going to consistently get more attention, because they have to,” Carr says. “Sometimes the other children’s needs aren’t met, or they are treated like little adults, given more chores to do, or expected to provide emotional support to the parents.”
“That can be really troubling for them. Or it can be empowering, but difficult.”
Predictors: How Age Of The Child And Other Factors Impact The Trauma
A handful of studies have tried to pinpoint key factors that influence how well parents adjust in the aftermath of losing a child. One 2005 study found that the child’s age, the cause of death, and the number of remaining children was strongly linked to the levels of grief displayed by parents, while depression was linked to gender, religious affiliation, and whether the bereaved sought professional help. Subsequent studies have uncovered other predictors of lower grief responses: a strong sense of purpose in life and having had the opportunity to say goodbye.
“It depends on the psychological makeup of the parent, whether they have a history of mental illness, what coping skills and what social supports they have,” Saltz says. Outside factors can play a role, too. Suicide is often more difficult but a terminal disease can present recurring traumas over a long period of time. Saltz also suspects that gender may be part of the puzzle. “This will undoubtedly shift, but historically mothers have been the primary caretakers and more likely to have their identities wrapped up in being mothers,” he explains, adding that this may result in stronger responses among women who lose their children
One of the most salient predictors of trauma is the age of the child. Miscarriages and stillbirths are devastating, and made worse by the fact that the loss is often diminished by public perception that a fetus is not a fully-formed child. But “is it as devastating as the death of a child who has been alive for many years? Not to diminish this experience, but I think not,” Carr says.
Once a child is born, however, the script flips. Older adults who outlive their children generally have an easier time coping than parents who lose very young children. “The age of the child is really important, because it speaks to promise,” Carr says. When a young child dies, that promise dies with them: “the graduation, the grandbabies, the marriages—that’s lost, too.”
Nonetheless, even older adults may suffer intensely after the death of an adult son or daughter. “You can meet someone who is 75 who loses a 50-year-old child, and it’s still devastating,” Carr says. “There’s this belief in the natural order. A parent should die first. So even though age matters, older parents still are quite bereft. They’re just losing less of that long-term promise.”
Coping: How to Provide and Seek Comfort
After a child dies, those who are left behind may experience depression, biological and neurological changes, and a destabilization of the family and marriage. “If you’re in this situation, and it is impairing your ability to function, you need to seek treatment,” Saltz stresses. “Parents who fall into major depression will be unable to parent other children, or be in a marriage. Psychotherapy can be helpful and medication can too, at least in the short run.”
The best thing that friends and loved ones of bereaved parents can do is be present, available, and supportive. If the bereaved speaks of suicide, take them to an emergency room; if the situation is less dire, but the grief does not seem to abate over time, help them make an appointment to speak with a professional or attend a self-help group with other bereaved parents. Because even the most sensitive souls are seldom equipped to help parents cope with a loss of this magnitude—and no matter how hard you try, you’re unlikely to really understand.
That’s where a self-help group’s value really shines through. “The one thing that people who have lost a child hate hearing from others is ‘I know what you’re going through,’” Carr says. “They cannot possibly know.”
After his own addiction-related loss, one man created a tool to help others heal.
Family members embrace in a cemetery on March 6, 2016, in Plantsville, Conn., to commemorate the first anniversary of the fatal heroin overdose of a loved one.
Jeremiah Lindemann’s “Celebrating Lost Loved Ones” project is a map of lost lives, a moving collection of crowd-sourced tributes from family and friends to those who have died of drug overdoses.
A digital mapmaker by training, Lindemann understands the geography of grief. More than a decade ago, he lost his kid brother to a drug overdose. Jameson Tanner Lindemann – J.T. to his family and friends – may have been introduced to opioids not by a dealer on the street, but by the well-intentioned dentist who removed his wisdom teeth.
J.T. died Sept. 13, 2007, shortly after finishing his second round of drug rehabilitation. He was 22.
Lindemann, seven years older than J.T., was away pursuing his career as his brother sank deeper into addiction. After J.T.’s death, Lindemann mourned but kept his feelings to himself. He couldn’t shake the stigma associated with drug abuse that might have led others to think of J.T.’s life as squandered in a desperate stew of escapism and dependency.
“It was nothing I wanted to talk about,” Lindemann says.
But as time passed, he became increasingly distressed at the opioid crisis’ mounting death toll, often ensnaring celebrities and other public figures. It became startlingly clear that many of the victims come from good homes and loving families, and that the vortex of addiction was sucking in individuals from every walk of life.
Around three years ago, Lindemann, a geographic information systems engineer for the digital mapmaking firm Esri, decided to tap into his expertise and create a crowd-sourced map to serve as an outlet for the scores of people who were grieving alone, reluctant to share their feelings with others who had experienced similar tragedies.
The goal: to celebrate the lives of those now gone.
Lindemann’s map enables loved ones to post pictures of absent friends and relatives, along with a brief tribute. Alongside the photo gallery is a map that displays where lives were lost, as well as a tally of the death toll in a given community. So far, more than 1,900 people have posted photos and shared stories of loved ones who have died, most of them in the United States, but a few in farther-flung locations such as England, Ireland, South Africa and Australia.
“These deaths are the tip of the iceberg,” Lindemann says. “There are so many more people now that are going through this. There’s got to be hope for them, too.”
Before long, Lindemann found himself overwhelmed by the number of people who regarded him as someone to whom they could pour out their feelings. He wanted to offer comfort, he says, but he didn’t know how. Plus, he had a day job, providing a variety of client support services for Esri.
A reprieve came when the National Safety Council offered to take over hosting the website as part of a comprehensive effort to curb opioid addiction and support those who have suffered losses from it.
“We realized that that in addition to pushing for legislative and policy changes – and changes around prescribing practices – we also needed to connect families so that they know they’re not alone,” council spokeswoman Maureen Vogel says. “That was one of the things that drew us to the map. There are stories behind each one of the data points.”
It is reminiscent, she says, of the AIDS Memorial Quilt, a massive folk-art memorial made up of festive, grave-sized panels commemorating those who have died from HIV/AIDS.
Jeremiah Lindemann’s map enables loved ones to post pictures of absent friends and relatives, along with a brief tribute.
Among those with a spot on the opioid map is Salvatore Marchese, 26, whose courtship with drugs began at 13 when he began smoking marijuana.
“We never knew, because he played sports and had friends,” says his mother Patty DiRenzo, of Blackwood, New Jersey. But on the inside, something wasn’t right for Sal. “I guess he was probably medicating himself.”
Soon, DiRenzo says, Sal began taking pills: “When he couldn’t afford the pills, or steal them from us, he tried heroin.”
DiRenzo, a single mother, did everything she could to help her son, who was in and out of rehabilitation programs. In the end, heroin triumphed.
“He had been sober for 90 days,” DiRenzo says. “He probably thought he could use whatever amount he had been using previously, and overdosed.”
Marchese’s last months were a roller coaster of hope and despair. “In June 2010, he was in a very dark place, using very heavily, 20 to 30 bags of heroin a day. He called his sister from a parking lot and said, ‘I’m scared, I’m sick, I can’t live this way anymore,'” DiRenzo says. His sister took Sal to a local emergency room to flush the drugs out of his system. The next day, after a mad scramble to find an available bed, he was admitted into a treatment facility. Seventeen days into the program, he was released.
“He cried,” DiRenzo says, “‘I’m not ready to come home.'”
That summer, Sal got into an intensive outpatient program. He got a job working for a heating, air conditioning and ventilation company. “He started looking like himself again,” DiRenzo says. “His face looked healthy, he was healthy. We had a great summer with him.”
Then, on the night of Sept. 22, Sal didn’t come home. “It was devastating to me,” DiRenzo says. “What happened when he walked out that door? Did he hear a song on the radio? Did he go to Wawa to get coffee and meet someone he knew?
“When the police knocked on my door, I couldn’t believe what had happened,” she says. “They woke me up at 2:30 in the morning. My daughter said, ‘Oh, crap, the police are here.’ We thought he’d been arrested. Now I’d give anything for that news.”
Sal is survived by his mother, sister, longtime girlfriend and a 9-year-old son, also named Sal, who lives with his mother in his grandmother’s house.
“When I saw Jeremiah’s map, “I said, ‘Oh my God, it’s amazing.’ I can look at the other pictures and know I’m not alone. And Sal wasn’t alone. There are other people going through it,” DiRenzo says. “My son was a beautiful person, and so are all the other people’s children who are struggling with this disease.”
On the map, underneath Sal’s photo, there’s this written reminder of how such tragedies echo through generations:
“Sal gave us one of the most precious gifts that anyone could give, his beautiful son. Baby Sal is a piece of his dad that will continue to shine his light and give his love to everyone around him, for the rest of his life.”
Any pet owner will tell you that losing them is as great a pain as losing any member of the family. It’s in these moments we’re at our most vulnerable. One brave photographer has taken on the task of capturing such fragile moments in a series that documents owners struggling to cope in the last moments of their animal’s life.
Ross Taylor’s powerful new series is one that’s sure to bring a tear to the eye of any pet owner. His inspiration came after being “profoundly moved” by witnessing a friend struggle with the deteriorating health of her pet and her subsequent decision of euthanasia. The collection of images, he says, explores the intimacy of the human-animal bond, specifically “the last moments before and after the passing of a pet at home with their owner.”
Leigh Zahn fights back tears as she lays with her dog, Spencer, in her lap a final time, just moments after Spencer passed.“She’s always been my companion. Coco was there for me when he was on deployment,” said Rebecca Cassity, as she fights back tears. Her husband, Drew, was in the military. Dr. McVety reassures her with a hug and consoling words: “This is better treatment than any one of us would get.”
The images were taken in Tampa Bay, Florida throughout 2017-18 and involved working closely with the families involved. The pet owners seen in the images were aided by veterinarians from Lap of Love, a pet euthanasia service that allows for a peaceful passing at home. Founded by Dani McVety, the organization has been working with Caring Pathways, all of whom Taylor expresses utmost gratitude for. “It couldn’t be done without their willingness to participate and belief in the project… They have my respect,” Taylor said.
In one of the most intense moments I’ve ever witnessed, Wendy Lehr cuddled beside her dog, Mimosa, shortly after she passed. The muffled sounds of her cries filled the empty room as she nuzzled against her face. She cried out: “Oh my baby, oh my baby. What am going to do without you?”“It’s tough saying goodbye,” said Carrie Peterson after she dropped sunflowers over the grave of her dog, Asia. The smell of freshly turned earth is what I remember and how peaceful Asia looked within it.
While difficult, the at-home euthanasia process can be one that mitigates some of the painful reality of the end of life. It’s worth noting that the vets I’ve worked with are some of the most compassionate people I’ve met and always offer the families a chance to have a respectful moment afterwards with their beloved pet. It’s in stillness of these moments that I sometimes felt the most emotional for everyone involved.
Bob Zahn touches his dog, Spencer, just moments after the dog passed. His wife, Leigh, left the room immediately, as it was too much for her to take. “She’s going to take it harder maybe than the loss of her parents. Your parents can tell you when something’s wrong, but your dog can’t.”Vanessa Gangadyal consoles her son, Ian, 8, while her husband, Michael Gangadyal, pets their dog, Ally, shortly after its passing.“When I was sick, she knew something was wrong,” said Bob Lutz about their dog, Heidi, who looked up at them moments before she was euthanized due to recent substantial declines in health. His wife, Cindy, added: “she helped take away our pain.” At right, watching, is their other dog, Winnie.
If you were as moved as we were by this powerful series, you can see more of Taylor’s work (some of which saw him nominated for a Pulitzer Prize) at his website and Instagram.
An adolescent experiences the death of his mother after a lengthy illness.
When I ask what services he would like to receive from the school, he initially says he didn’t expect special treatment, would be embarrassed by counseling from the school mental health staff and wouldn’t feel comfortable if many of his teachers asked to talk to him about his grief.
At the same time, the student felt as though the school should somehow take his situation into account.
“I don’t know what the school should do,” the student told me. “But I just lost the person I love most in my life and they act as if nothing happened.”
In my many years as a developmental-behavioral pediatrician who specializes in school crisis and child bereavement, I believe this dilemma – that is, the need to do enough but not to overwhelm the grieving student or the adults who are trying to help – represents a major challenge for America’s schools.
The need for recognition by trusted adults of their loss, a genuine expression of sympathy and an offer of assistance is often what students seek after a major loss – but too often don’t receive.
A common experience
Loss is very common in childhood – 9 out of 10 children experience the death of a close family member or friend and 1 in 20 children experience the death of a parent.
In contrast, teacher preparation to support grieving students is uncommon. In a recent survey conducted by the American Federation of Teachers and the New York Life Foundation, 93 percent of teachers reported that they never received any training on how to support grieving students. They identified this lack of training as the primary barrier that prevented them from reaching out to grieving students in their class and offering the support they knew they needed. Worried that they would do or say the wrong thing and only make matters worse, some educators chose instead to say and do nothing.
In recognition of this problem, I offer a series of insights and recommendations that teachers can adopt to make the school experience less stressful for students who have recently lost a loved one. Although the advice is aimed at educators, surviving parents or caretakers or anyone who cares about how to help bereaved students can use this advice to advocate on their behalf.
The consequences of inaction
Saying nothing says a lot to grieving children. It communicates that adults are either unaware, uninterested or unwilling to help. It leaves children confused about what has happened and how to react. It leaves children unsupported and forces them to grieve alone. Adults should reach out to grieving children and let them know that they are aware and concerned and are available to provide support and assistance.
What not to say
Anything that starts with “at least” should probably be reconsidered – “at least she’s not in pain anymore” or “at least you still have your father” are generally not helpful comments. It suggests that the adult is uncomfortable with the child’s expression of grief and is trying to “cheer up” the grieving child in order to limit the adult’s own discomfort. Don’t encourage children to hide their feelings or reactions, and don’t feel that you have to hide your own emotions. Be genuine and authentic. Tell grieving children that you are sorry about their loss and ask them what they are feeling and how they are doing.
There isn’t anything you can say that is going to make everything right again for a grieving child. So, listen more than you talk. Other guidelines of what not to say – and what to say instead – to grieving children can be found in “The Grieving Student: A Teacher’s Guide.”
Engage peers
Peers want to – and can – be an important source of support to grieving children, but often are unsure what to say or do. Provide them advice on what to say and practical suggestions on how to be helpful. This will help grieving children obtain critical peer support and decrease their sense of isolation. It will also reduce the likelihood that peers will instead ask repetitive and intrusive questions or tease grieving children.
Offer academic accommodations
Grieving children often experience a temporary decrease in learning ability. They may be tired from not being able to sleep, have difficulty concentrating and learning new material, or may be experiencing significant disruptions in their home environment that make it difficult to study or complete homework.
Grieving children should view school as a place of comfort and support, especially at a time of loss. If they are worried about failing, school becomes instead a source of additional distress. Teachers should offer educational support before children demonstrate academic failure. Check in more frequently to make sure that they are learning new material and are able to keep up with the workload.
Talk to other teachers, instructors and coaches and try to help grieving students balance all of their responsibilities. If the student needs to prepare for an important concert, then maybe academic teachers can lessen some of their assignments. Grieving students may need to have their workload decreased or modified temporarily. If a major report seems overwhelming, substitute with shorter and more manageable assignments. If it’s hard for them to stay on task to complete an individual project, consider a group project that might promote peer support.
Be more sensitive
Teachers can also introduce activities with more sensitivity. For example, if you are going to do a project for Mother’s Day, introduce the activity by telling students that you realize some children may not have a mother who is alive or living with them. They can still complete the activity remembering their mother, or can choose to focus on another important female family member. This will also help students whose mothers may be deployed in the military or incarcerated, or away for other reasons.
Help children manage grief triggers
Many things may remind grieving children about the person who died and cause them to temporarily feel a resurgence of their grief. It may be a comment made by a teacher or a peer, such as “I went shopping with my mother this weekend,” or a portion of a classroom lesson, such as a health education lesson that references a similar cause of death.
Holidays such as Thanksgiving or the winter holidays tend to involve spending time with loved ones and may accentuate the sense of loss. Let students know that these triggers may occur and set up a safety plan. Students may be given permission to step out of the classroom briefly if they are feeling upset and worried that they will not be able to contain their emotions. Work out a signal to communicate when this occurs that doesn’t draw attention to the student. Make a plan for where the student will go and who they can talk with. If students know that they will be able to leave, they often feel less overwhelmed and will be more likely to remain in class and stay engaged in the lesson.
One thing never ceases to strike fear into the heart of parents: the idea of our kids dying before us
The idea that someone could be in your life one day and gone the next was incomprehensible to Jo Davies’ sons.
By Jo Davies
I was at the grocery store the other night when my younger sons and I ran into my next-door neighbour toting his six-week-old son.
After cooing over Junior’s beautiful blue eyes and his adorable expressions for a bit, one of my boys asked to touch the little one’s cheek. My neighbor hesitated for a moment and then declined, saying the baby hadn’t yet had his second round of vaccinations.
I was shocked for a moment, then smiled, reminding myself we were dealing with that most nervous of Nellies: the first-time parent.
Whether you have kids or not, you’ve likely heard the stereotype of the hyper-responsible first-time mom or dad jumping to boil the baby’s pacifier the second it touches the floor or rushing to the ER for every uptick in temperature.
Undoubtedly, this initial hyper-vigilance serves a purpose: it’s Mother Nature’s way of ensuring the survival of the species. All parents go through it, and most get over it.
There’s one thing, however, that never ceases to strike fear into the heart of parents: the idea of our kids dying before us.
A few weeks ago, my sons’ classmate died at the age of 15.
He was a nice boy — quiet and respectful and kind. His death was unexpected, shocking and a heartbreaking introduction into the ways of grief not only for my two sons, but their school community as well.
At this point in their young lives, my sons haven’t experienced the death of anyone close to them except for their grandparents. That was obviously upsetting for them, but their father and I were able to help them to rationalize it, because their grandparents were much older than them; they’d lived a good life and left a legacy for which their many friends and family would remember them fondly.
When their friend died, however, it was virtually impossible to come to terms with it.
Despite the best efforts of their teachers and school counsellors, my boys were at a loss. The idea that someone could be in your life one day and gone the next was incomprehensible to them.
I asked myself: knowing what I know about death (my father died suddenly when I was 24), how can I make the death of their friend make sense to them? I came to the conclusion that I can’t.
There is no way to make sense of such a tragic circumstance, to find a silver lining. All I can do is try to help them cope with what’s happened.
To that end, I’ve done my best to read up on teenage grief, so I can be useful to my sons.
I’ve learned that, as with adults, teenage grief is as unique as each individual who experiences it. It can’t be dictated or forced to fit someone else’s conception of what’s appropriate.
I’ve also realized that for teenagers, grieving is just one more complication in an already turbulent period of life. The death of a close friend can cause them to question their own, newly formed identities as young adults; to ask questions they might never have considered before about life and mortality.
What’s been hardest for me in this process is watching my sons come to the realization that life, at its core, is uncertain. There are no guarantees of happy, long lives for the ones you love, even if you wish there were.
Up until now, their teenage brains (with their still-developing sense of consequences) have helped to make them feel invincible, or if not invincible, at least unconcerned with thoughts of dying — which seemed to me to be as it should be. Kids should be able to live their lives without constantly thinking about death and dying.
Now they know words like “hearse” and “pallbearer” and “condolences.” They have witnessed the depths of a parent’s grief as they listened to their friend’s mother describe all the ways she will miss him.
They’ve also been surprised by kindness from unexpected quarters; friends they didn’t know cared who gave them a hug or a tissue.
They have learned a lot of things over the past few weeks, as have I.
Mainly, I’ve learned that there was still a part of me that thought I could keep them safe from the harsh realities of life. I can’t, and that hurts.
However, just as I taught all three of my sons to use a spoon, to tie their shoelaces and to say “please” and “thank you,” I can teach them other things that are even more useful.
I can teach them to value each day they have on this earth, to be grateful that they knew their friend, and to be happy they were good friends to him during his short time here.
Bobbi Manka, right, works with her colleague Jen Gallois, left, at Tyson Fresh Meats on Dec. 11, 2018, in Elgin. Manka’s co-workers helped her following the death of her husband, Dan Manka, in January 2016.
Bobbi and Daniel Manka were settling into bed after a night out dancing when Daniel stood up, clutched his chest and gasped, “911.”
Just like that, Bobbi Manka lost her husband of 44 years and gained “a hole in my heart that will never be replaced.”
But she has found comfort where she didn’t know she would: at work.
Grief after the death of a loved one inevitably follows people to work, where employers and co-workers often are unprepared to handle the immediate sorrow or the surges of pain that ambush mourners at milestones like birthdays and holidays.
Some of the shortcomings can be linked to insufficient bereavement leave policies, but often what fails is the human response to a suffering colleague.
“We have become an increasingly death-denying society,” said Amy Florian, CEO of Corgenius, a Hoffman Estates-based organization that trains businesses on how to help grieving clients and employees. “And when we don’t talk about it, we don’t know how to do it well: how to accompany people through grief.”
Florian said employers would be wise to prepare for the impact of grief on business as aging baby boomers, who are staying in the workplace longer, move toward the end of life.
“We are in for a death boom, we are in for a dementia boom,” said Florian, a fellow in thanatology, the study of death and bereavement. “All of these things are going to happen but firms are not prepared for it.”
Being prepared includes understanding that grieving individuals will cope differently, and employers should accommodate their unique needs, Florian said.
Nearly 90 percent of employers say they offer paid bereavement leave — usually three days for an immediate family member — but that’s not nearly enough time for many people, especially when the death is sudden, she said. Employers might want to consider more generous policies as well as expand them to accommodate deaths beyond immediate family, as losing an aunt or friend can be just as devastating if the relationship was close, Florian said.
No federal law requires employers to give workers time off to grieve, though Illinois has a law, which went into effect two years ago, that provides up to 10 working days of unpaid leave for the death of a child at companies with at least 50 employees.
Florian said employers also should not expect grief-stricken employees to function normally when they return to work, as their concentration is shot, their minds are disorganized and they may be prone to making mistakes. Some employees will need additional support for a month or two once they’re back on the job, such as flexible work schedules, more breaks, adjusted expectations and someone to catch errors, with the assurance that their performance reviews won’t suffer, she said.
Educating co-workers on how to best support a grieving colleague can also help. Many people fumble awkwardly as they try to express sympathy, or avoid the topic altogether because they don’t know what to say, Florian said.
“What is often very shocking for people to learn is that ‘I am so sorry’ is not the best thing to say when someone dies,” Florian said. “The focus is all wrong, it’s on the comforter and not the griever.” Better to ask about the person who died — what they were like, how it happened, making sure to use his or her name, she said. If someone doesn’t want to talk about it, they will close the door on the conversation, she said.
Bobbi Manka pokes her head into Scott Leckrone’s office at Tyson Fresh Meats on Dec. 11, 2018 in Elgin. Leckrone, Manka’s boss, and other colleagues provided emotional support to Manka after her husband died in January 2016.
Manka, 64, who lives in Genoa, a town about 65 miles northwest of Chicago, said she was surprised to discover how often people didn’t ask how she was doing after her husband died suddenly of a massive heart attack two years ago.
“They are afraid that they might trigger something and you might start crying,” she said. “Even if I did, it would have been a good thing.”
But Manka, an administrative assistant in the Tyson Foods sales office in Elgin, was pleasantly surprised at how her colleagues stepped up during her crisis, even though she’d worked at the company only two years at the time and no one from the office had met her husband — the kind of guy “who would take his shirt off and give it to anyone,” she said.
Her boss and a colleague not only attended his “celebration of life” but stayed through the event and got to know her family, she said. When her three days of bereavement leave were up and she couldn’t bring herself to return to work, she was given an extra week off unpaid. She was eager to return when she did.
“My world had been rocked so incredibly hard that coming back to work helped me, because the house was so empty,” Manka said. “Work was my safe place for a long time.”
As she struggled to adjust to her new reality, Manka sought counseling from Tyson’s chaplaincy program, a network of 100 chaplains employed by the company to help Tyson workers navigate life challenges. She found solace in the Bible verses she was given and the advice about how to help her children through their grief as she dealt with her own.
Small kindnesses in her office of 12 have made a big difference, she said. On Manka’s first birthday after her husband’s death, her co-workers presented her with a big cake and card, and told her “we want you to know you’re part of the family,” Manka said. On her wedding anniversary, or when anything happens that triggers memories, her boss can detect a shift in her mood and urges her to take a walk and clear her head.
Such accommodations pay off in the long term, Florian said.
“People who felt they were treated compassionately during times of grief are incredibly loyal to their employer,” she said.
Grief last year cost employers an estimated $113.27 billion in reduced productivity and on-the-job errors, a calculation that takes into account not only the deaths of loved ones but also other traumatic losses such as divorce or home foreclosures, according to the Grief Recovery Institute, an organization based in Bend, Ore., that trains therapists and counselors in grief recovery.
That estimate is up from $75 billion the last time the nonprofit released its Grief Index in 2002, a increase driven by inflation as well as changing workforce demographics as the population ages, said Operations Manager Ed Owens.
Yet employers are rarely proactive about addressing grief in the workplace, and typically only seek help when an employee has died and co-workers need support, said David Fireman, executive director of the Center for Grief Recovery and Therapeutic Services in Chicago’s Rogers Park neighborhood.
“If I had my druthers, (grief training) would be a built-in component to employee orientation,” Fireman said.
While the aging population is one source of workplace grief, another is the city’s violence. Fireman’s organization last year counseled students and faculty at the Chicago Waldorf School after a teacher at the school was killed by a stray bullet while she waited at a nearby Red Line station. He continues to be available to them because “grief is a process and there might be delayed reactions,” he said.
GrieveWell, a nonprofit in Ann Arbor, Mich., that provides grief training to employers and peer-to-peer support for grieving adults, is trying to raise the profile of grief as an “unspoken public health issue” with dangerous consequences if it is not addressed, said Amy Milanovich, former executive director.
Unresolved grief, a clinical term that refers to intense mourning that persists for a long time and interferes with daily functioning, has been linked to an increase in heart disease, stroke and cancer, she said.
The workplace has become increasingly important as a source of support as community traditions that used to surround people in mourning have been cut short amid a social expectation to get back to life as usual, she said.
“Everyone around is someone who could be in grief and everyone needs to be someone who can support them,” Milanovich said. In addition to conducting business lunch-and-learns on the topic, GrieveWell offers a deeper training in active listening for employees who want to be the designated ear colleagues turn to in time of need.
ComPsych, a Chicago-based provider of employee assistance programs, has seen a steady increase in crisis counseling calls about bereavement, likely because employers have become more aware of the need for mental health support, spokeswoman Jennifer Hudson said. Employees over 60 are the most likely of all age groups to seek bereavement help, the company’s data show.
Eric Freckman, a certified financial planner in Palatine, said grief training at his firm has led to improved relationships with clients, who often find themselves navigating unfamiliar bank accounts and investments when a spouse or parent passes away. Increasingly, grief strikes even before death as more people live longer with diminished capacity, he said.
People tend to make emotional decisions around money, especially when they’re grieving, so it takes empathy to guide them to the best decision, Freckman said.
“There’s the answer in Excel of what they should do,” he said. “But getting people to actually do that is very difficult.”
Financial adviser Eric Freckman, left, meets with Keith Leust, of Barrington, at the Guillaume & Freckman office on Dec. 27, 2018, in Palatine.
Freckman said he used to be “sort of terrified” of talking with clients about their loved one’s death, and would avoid it by sticking to discussing numbers. But after training with Florian at Corgenius he feels comfortable engaging in conversations about the loss — “How did you find out?” he asks. “What was it like for you?” “Are there phone calls we can make for you?” — and leaving the paperwork to later meetings. Ninety percent of clients want to talk, and the care shown has helped solidify trust, he said.
“We keep track of people’s birthdays, we try to call and let them know we’re thinking about them, that we know it’s a hard day, the first Christmas alone,” he said. “It’s all relatively simple stuff when you think about it.”
The simple stuff can make a big difference, Florian said. She knows from experience.
Florian was 25 and a new mom to a 7-month-old boy when her husband, John, went to a business meeting and never returned. A farm insurance agent, he was killed when his car was struck broadside on a rural Iowa road on a sleety February night.
“I felt like my future had simply evaporated in an instant,” Florian said. “And nobody knew what to say to me.”
Florian, a stay-at-home mom at the time, felt “every breath was different” after that day, as she adjusted to the empty pillow, the coffee for one, the realization that “anyone could die at any time.”
She felt alone as many people avoided talking about her husband after the funeral. She was grateful to those who did, especially when they said his name.
“It’s such a comfort to know that John’s life made a difference, that someone remembers besides me,” she said. “That his death left a void in the world, not just my life.”
Florian noticed the various ways well-meaning people’s support was insufficient. They’d ask if she needed anything, but she felt bad taking advantage of those offers, worried she’d be a burden. More helpful, she said, was when people identified what needed doing and offered to do it, such as shopping for groceries, weeding the garden or babysitting her son.
Florian recalls working with a financial professional who would change the subject when she started to tear up. So she was impressed when another financial planner, on their first meeting, looked at her file and said: “I see that you are widowed. Tell me about John.”
Her experience propelled her to get a graduate degree in pastoral studies and advanced certification in grief counseling, and she taught ministry courses on death and grieving at Loyola University for 11 years.
Decades after John’s death, Florian is remarried, and her sadness lives alongside her joy. She can still be sent into a sobbing fit in the grocery store aisle when she hears a certain song – and that’s OK.
“The point of healing is not to forget,” she said. “The point is to remember.”
