"Our soul must perform two duties. The one is that we must reverently wonder and be surprised. The other is that we must gently let go and let be." Julian of Norwich

...Cancer teaches both!!!

Showing posts with label Palliative Care. Show all posts
Showing posts with label Palliative Care. Show all posts

Thursday, July 29, 2010

Stages of Grief - Elisabeth Kubler Ross


I first started working with Kubler-Ross's "stages of grief" back when I began my life as a minister in Port Simpson in 1992.  I've returned to it often and still find it to be a helpful way of understanding grief and loss.  Kubler-Ross dedicated her life to working with the dying, the ill, the lost, and the bereaved.  She has left a great legacy of wisdom.  Wisdom which is helpful when "Living on The Edge".



The following interpretation is with thanks to Alan Chapman. 

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Five Stages of Grief
(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969. Interpretation by Alan Chapman 2006-2009.)

            Also known as the 'grief cycle', it is important to bear in mind that Kübler-Ross did not intend this to be a rigid series of sequential or uniformly timed steps. It's not a process as such, it's a model or a framework. There is a subtle difference: a process implies something quite fixed and consistent; a model is less specific - more of a shape or guide. By way of example, people do not always experience all of the five 'grief cycle' stages. Some stages might be revisited. Some stages might not be experienced at all. Transition between stages can be more of an ebb and flow, rather than a progression. The five stages are not linear; neither are they equal in their experience. People's grief, and other reactions to emotional trauma, are as individual as a fingerprint.
            The model recognizes that people have to pass through their own individual journey of coming to terms with death and bereavement, etc., after which there is generally an acceptance of reality, which then enables the person to cope.
            Again, while Kübler-Ross's focus was on death and bereavement, the grief cycle model is a useful perspective for understanding our own and other people's emotional reaction to personal trauma and change, irrespective of cause. 

1 - Denial         
Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defense mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely.

2 - Anger          
Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep us detached and non-judgmental when experiencing the anger of someone who is very upset.

3 - Bargaining              
Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example "Can we still be friends?.." when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.

4 - Depression             
Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.

5 - Acceptance             
Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.

(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969.  Interpretation by Alan Chapman 2006-2009.)

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Personally, I live in and out of all of these places, and more, on a regular basis.  My cancer journey began in August 2004 with a diagnosis of stage 4 colon cancer, I've had a couple of serious recurrences, and now live with a persistent and painful presence of cancer in my very bone.  Alas!  There seems to be no escaping it!  

Not to stay focused on the negative.  My journey has been, and continues to be, filled with many experiences of great joy, deep peace, and real hope.  These things go hand in hand with the otherwise "afflictive" emotions that together form the complex emotional climate of my heart and soul. I find that I can be more authentic in my experiences of the many good things in life when I am also honest and authentic with my very real grief. 

Peace and blessings... Rob; in Vancouver

"For those who seek to understand it, death is a highly creative force. 
The highest spiritual values of life can originate from the thought and study of death."
Elisabeth Kubler-Ross


Tuesday, October 27, 2009

To Everything There is a Season

"To everything there is a season and a time for every matter under heaven…A time to be born and a time to die…” Ecclesiastes
 


In the course of my life as a minister I have spent much time in the presence of the dying and the bereaved. The names of those I have accompanied through these stages are written in my journals and their stories inspire my life and ministry. I believe that to walk with someone through the final stages of life is one of the most sacred experiences we can have.

From a spiritual perspective, "palliative", or "end-of-life", care is very much a service of “accompaniment”. The word accompaniment really names it well when you look at the Latin roots com-panis, "with bread". To accompany is to “break bread with”. It is to walk the journey with another as a companion for a particular and significant stage of life. When I remember those who have accompanied me in the difficult stages of my journey, I think of the following qualities that I value in them:
  • availability and commitment;
  • an ability to be a “non-anxious" presence;
  • honesty, humility, and compassion;
  • a capacity to both listen and reflect;
  • a comfort level with silence;
  • a sense of humor; and
  • a certain wisdom that comes from experience.
It is also important to me to have a person who shares somewhat of my spiritual orientation. In that way we can use a common language of symbol, story and prayer.
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A particular challenge for the person living in the advanced stages of cancer is, “knowing when to let go”.  It seems to me that in the cancer journey there is a time to fight the "dragon" with all of the weapons we can muster. I've also seen that there can come a time when it's helpful to "let go", so that the final stage can be one of peace and dignity and not one of prolonged pain and suffering.

"Letting go" is not giving up. Death is not defeat or failure. It’s not about winning or losing, but rather about accepting the very imminent reality of our mortality. My experience has been that when the terminally ill reach the place of "letting go" a deep peace follows for the individual, their family, and their friends. Discerning the time of this transition is deeply personal and needs to be respected by caregivers and family alike.
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End-of-life care belongs to the family. It is another area of medicine which is being reclaimed through patient and family empowerment and education. Many hospitals and communities now have progressive Palliative Care programs that help our loved ones through the final stages of life with dignity and respect.



In Canada, Dr. David Kuhl has written an insightful book on palliative care. “What Dying People Want: Practical Wisdom for the End of Life” is an excellent account of David’s 15 year experience of palliative care in Vancouver. In it he addresses such issues as: Time and Anxiety; Bad News; Physical Pain; Life Review; Speaking the Truth; Self-Realization; and Transcendence.

In the US, Dr. Ira Byock has written and advocated extensively on end-of-life care. His website, http://www.dyingwell.org/, has numerous helpful resources and an excellent synopsis of the “Developmental Landmarks and Taskwork for the End of Life”. It is helpful reading if you, or a loved one, are facing end-of-life issues.

In peace... Rob; in Vancouver

"I wanted a perfect ending. Now I've learned, the hard way, that some poems don't rhyme, and some stories don't have a clear beginning, middle, and end. Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what's going to happen next. Delicious Ambiguity". Gilda Radner
originally posted in July 2007