[Narrator]

Grief is our natural response to loss. It involves physical, emotional, social, and spiritual reactions. The end of life includes many losses before, during, and after death, both for the person nearing the end of life, and their family and others who care about them.  Losses for the person who is dying may include the loss of health and strength, of work and other daily routines, of one's social network, of faith or beliefs, and of dreams for the future.

When death occurs, saying goodbye is necessary. It is possible for your loved ones to say goodbye and bear the pain with the support of family or friends. There are tasks called "the tasks of mourning," that are part of the normal grief process.

• The first task of mourning is accepting the loss (which means to fully understand that the loss has occurred, not that the loss is acceptable);

"Some days it is just so hard to believe that Dave is gone. I actually pick up the phone to call him at work, or sometimes set two places at the table. Day by day I am getting a little stronger, and I realize he isn't coming back."

[Narrator]

• The second task is working through the pain of grief; 

“There are days when I feel overwhelmed by pain. My body hurts and my arms and legs feel too heavy to lift. On days like that, I go around in a fog. I wonder if my life will ever stop hurting as much as it does right now.” 

[Narrator]

• Third is adjusting to the new environment without the loved one who has died;  

“After my wife died, I had too much time on my hands. I decided retirement without her wasn't all that great, so I got a part-time job. It helps to have something to fill my days, and it's nice to be around people.”    

[Narrator]

• The fourth task is emotionally relocating the loved one who has died and moving forward;  

"Joe and I were married for 25 years. We had a wonderful life and wonderful children together. He will always be my husband. But, I think it's time I start moving forward on my own. My oldest daughter is expecting a baby next spring. She's asked me to move to her town so I can be a bigger part of my grandchild's life. I think that might be a good idea – a new beginning."

[Narrator] 

• The final task: rebuilding your faith or belief system if it was challenged by, and during, the loss.

"It was hard watching Bill go through all those treatments and then die anyway. For a long time I was angry at God. I stopped going to church. My faith has always been important to me, and I think it's time I talk to my pastor about my anger."

[Narrator]

Sadness, anger, guilt, anxiety, loneliness, helplessness, numbness, shock, and even relief (in cases such as the prolonged illness of a loved one or the end to a strained relationship) are all feelings that are normal and expected following a significant loss. Physical reactions such as sleep problems, poor appetite, fatigue, stomach distress, and anxiety are also often part of normal grief.

Children and grandchildren grieve, but differently than adults. Adults grieve in a linear fashion, and their ability to enjoy activities returns gradually over a period of months or years. Children grieve cyclically. They can be sad and upset one moment and off playing the next.

Children do need the opportunity to express their grief, and they need to be talked to in a direct and simple way that answers their questions. Children are like adults in that they, too, like to have some sense of control in their lives; keeping as normal a routine as possible can help your child feel safe. Warning signs that a child may need more help with his or her grief include falling grades, self-destructive behaviors, acting out, or regression to more "babyish" behaviors, like bedwetting or thumb sucking.

Many people ask how long grief lasts. Others ask if it ever ends. The answer is somewhere in between. Death ends a life; it does not end a relationship. However, after a death, that relationship must change. It's important to note that people do not "finish grieving" or "resolve the grief" or "get over the loss." Rather, they learn to adjust to the loss and to life without their loved one.

During the first year, all of the anniversary dates with the loved one missing for the first time must be experienced. These dates include holidays, birthdays, weddings and other anniversaries, and finally, the anniversary of the date of the death. Those grieving probably will have more difficulty during these periods, and should recognize that this is normal. Even years after the death, "surges of grief" may be experienced during special times such as a graduation, wedding, or the birth of a child.

A sign that acute grieving is coming to an end is when a person can think about their loved one without feelings of intense pain. One woman described the pain she felt when her daughter died. She said at first it felt like total body pain. Everything about her hurt. Eventually, she could think about her daughter without being completely consumed by painful feelings. She said now (several years after the loss) she keeps the pain in a special place in her heart. It is always with her; it just doesn't hurt quite so much anymore.

Perhaps the most important thing others can do to help friends or loved ones experiencing grief is to recognize their right to express grief in their own ways and encourage them to do so. Each person needs to find his or her path through grief. For some, it may mean talking to trusted family or friends. For others, it may mean taking time alone to sort through feelings and thoughts.

In the midst of grief, it's sometimes difficult for those grieving to believe they will ever be happy again. Allowing time and space to grieve is important. There are also many resources that can help. The National Association of Social Workers, on its Web site, has helpful information on grief, as do the National Hospice and Palliative Care Organization, the National Cancer Institute, the AARP, and many funeral service providers. These Web sites are listed in the Resource Booklet.

Some people who lose loved ones benefit from grief counseling. Almost all hospices provide programs and support for grieving persons who have lost loved ones. Support groups are also an option. Teens, who often find it most helpful to talk to their peers, can find support groups either in person or on the Internet. Many counseling and family service agencies offer individual or family grief counseling that can be especially helpful when there are complicating factors such as financial stress or family conflict after a loss.  Your doctor or other members of your healthcare team or your faith community may be able to recommend a counselor who specializes in helping people deal with grief; your local hospice is another good resource. 

In the Cancer Survivor Almanac and other resources published by the National Coalition for Cancer Survivorship, Dr. Elizabeth Clark reminds everyone who has experienced the death of someone close to remember several things:

• Be gentle with yourself – it will take time to recover physically, emotionally and spiritually.
• Do not expect too much of yourself or other family members who are grieving – allow time and healing before making major decisions.
• Recognize that grief cannot be postponed. Anger, sadness, and all the mixed emotions, thoughts, and reactions of grief are normal and can be expressed in many ways.
• Allow for variations in your own and others' grief reactions. Each loss and each grieving person is unique.