An abnormal reaction to an abnormal situation is normal behavior-Viktor Frankl

I hadn’t been exposed much to death before I was a nurse. AIDS was in full force, having just been upgraded from GRID. I knew several people who died, but none of them well. Although I attended their funerals, I wasn’t involved in their dying. When I went to work on the telemetry unit, most of the patients who died fell into two categories: unexpected codes and the really elderly, who were usually DNR’s. Occasionally, we’d get someone up from the ER who didn’t have long to live, sometimes they barely had a blood pressure. I guess the feeling was that since they were a DNR, they weren’t going to send them to the ICU, but they didn’t want to send them to a med/surg floor, either. They always seemed to die alone. That, more than anything, really bothered me. Then would come the phone call to a relative, usually in the wee hours, to tell them. Almost always they seemed to have already come to terms with the news. I guess when the nursing home calls and says that your 92 year old mother is being admitted to the hospital and isn’t doing well, it’s not a total shock when she dies.

It wasn’t until I hit the ER that I saw grief in its raw and potent state. One night, we coded a hospital employee who had been electrocuted. It was the first time I had seen someone prostrate with grief. His wife threw herself on the ground, clutching her hair and screaming. Now, I look back on ten years of experience and, although I’m not stupid enough to say I’ve seen it all, I’ve seen a lot. I’ve been with a wife who, when told of her husband’s death, just sighed and said, “I knew something was wrong when he didn’t come home for lunch.” I’ve seen people throw themselves on top of the dead person, as if they could wrestle him away from Death. I’ve seen a lot of anger which, personally, I don’t mind. To me, anger seems like the most normal reaction to death. It’s an affront to our ego, that no matter who we are or what we do, we can’t escape it.

I hate those cop shows where they use the person’s reaction to a love one’s death as a clue to their guilt or innocence. Yeah, I know you learn to “read” people. It reminds of the book, Rubyfruit Jungle, by Rita Mae Brown. The main character loses her dad and she goes through the funeral numb and silent. A few weeks later, she’s reading a book and suddenly, something reminds her of him. Her mom walks in to find her sobbing. I don’t have the book anymore, but basically her mom reprimands her, “You can cry over some stupid book, but you can’t cry for your father?” Sometimes, even those close to us don’t get it.

Nursing has come a long way in addressing the needs of dying patients and grieving families. I do feel the information learned is useful, but sometimes a little too static for dealing with real life situations. Yes, many Asians may appear stoic in their grief, other cultures may be more vocal. So, is the openly wailing Asian person abnormal? No. Take my little household, for example. We live in a town with a large population of Orthodox Jews, including our landlord. Their ways are a mystery to my husband. Since I dated a few Jewish men, including my eldest daughter’s father, I have become the family expert on all things Jewish. A little like putting John Wayne in charge of the feminine protection aisle, but there you have it. He wants to know why we can’t pay our rent on Saturday. “But Shabbos was last night.” Yes, and it lasts until sunset today, just like last week. He wants to know why our one neighbor wears a yamaka, but drives his car on Friday night. I don’t know. Why do some Catholics eat meat on Fridays during Lent? Because they choose to, that’s why.

My point is, people come as individuals. Knowing their cultural context for grief is a tool, not a diagnosis. Recently, Kim at Emergiblog said that one of the key ingredients of a nurse was flexibility. She didn’t mean you should be able to touch your toes. Having an open mind is useful and combined with the nursing process and a good dose of life experience can help you help the grieving family. People Living With Cancer has a good page that explains how to best assess someone’s grieving needs.

Susan Palwick has a great post over on her blog, Rickety Contrivances of Doing Good, about working with grieving families. Be sure to check out the links and also the comments, both of which have some great tips. Susan brings up a good point, that in order to be comfortable with another’s strong emotions, we need to be comfortable with our own. Above all else, we must lose our assumptions about what constitutes “normal” grieving. When you feel like your heart is breaking, nothing is normal.