Patients: #9, Two Ways with Grief

           Grief is an adaptive, universal, and highly personalized response

           to loss....The symptoms of grief may overlap with those of major

           major depression;  however, grief is a distinct entity.  Feelings of 

           hopelessness, helplessness, worthlessness, guilt, lack of pleasure, 

           and suicidal ideation are present in patients with depression, but 

           not in those experiencing grief....Physicians are encouraged to

           support patients by acknowledging their grief and encouraging

           the open expression of emotion.

                                           American Family Physician, August, 2012

     Mr. H. and Mr. Y. both lost their wives after sixty-one years of marriage.  As happens with physicians who follow patients through the various stages of life, I had become enmeshed with these couples--men and women who had weathered a series of marital tempests and, in the last decade of coupledom, left those inclement zones to reside in the temperate clime of contented appreciation of one another--foibles, memory lapses, untidiness, irritability, all of it.
     These two couples did not know one another.  My involvement with them was ten years apart.  I assisted them, in the meager yet indispensable ways a doctor is able to do, side by side, lending a hand on the slow, downhill  footpath strewn with pebbles and flint, to keep them from losing their bearings and falling into the briars, or forgetting the destination in a place where love is the only compass.
     When Mr. H.'s wife died, he seemed to free-fall from the edge of a cliff.  I shouted to him, "Pull your parachute!" but he couldn't find the cord.  His friends--the few who could bear witness to his grief--said, "Pick up your life!" and he replied, "I have no life."
     He didn't cook, he stopped eating, he lost muscle mass and turned pale.  But he came to see me every week in the beginning--then, after a while, every few days.  We spent each hour together doing what he wanted, which was to recall his wife, their happy moments, their time in the flower garden, the scenes at the end, when she was dying and he spoke his last words to her.  He seemed most animated at these times, almost lighthearted.  But then he went home and lay on the couch.  I know, because I visited him there in Cross Creek, when he was too tired to make the drive to my office.  The forlorn house was scattered with debris that his wife would have picked up.  Her belongings had not been moved:  the reading glasses next to her bible, her hairbrush tangled with stray gray strands, a pair of terrycloth slippers where she had unslipped them one last time, a footprint of farewell at her side of the bed.
     Mr. H. faded into his own death, caused by a broken heart, for which no one and not a single pharmaceutical agent, could provide a cure.  In his grief he heard the siren call of his wife from the other side, and he wanted to go there to meet her.  It took six months, during which I felt, at times, his utter desolation, and his desire to fall straight into the gash this wound had inflicted.  It seemed to me that there was nothing wrong with his response to loss.  Isn't it the case that certain birds, like doves, who mate for life, waste away when the other half dies?  His friends' exhortations to "get over it"--spoken out of their own terror of such grief--seemed to have no merit against his weight of his sadness and the way in which he was coping with it.
     Mr. Y. loved his wife just as much as Mr H., but after a few weeks of mourning, he came to life.  He cleared out her clothes, musing over how many pairs of brand-new shoes remained stacked in boxes in her closets.  He presided over a beautiful memorial service, scattering her ashes, and enjoyed the company of the fifty-odd attendees.  He accepted their friends' invitations to take fishing trips with them, or accompany them to dinner, golf, and concerts.  He enjoyed the casseroles and potpies they left on his doorstep.  He joined a gym, gained muscle mass, lost the slouching shoulders and protruding belly of the past, and looked quite the dapper fellow in the new clothes he bought--styles I had never seen him don when his wife was alive.
     What happened?  Mr. Y. felt somewhat guilty, at first.  He, too, visited me every week for many months, perhaps seeking affirmation.  He kept repeating what I had told him, in his sadness, after cancer finally cozened his wife from the comfortable dyad within which they had enjoyed private jokes, played rummy, shopped for shoes, and sang in the church choir.  When I visited him at home, immediately after his loss, I saw on the kitchen table the scorecard for their ongoing card game.  "She still owes me nine dollars!" he said.
      My advice was simple. "There is the Mr. Y. before you married, there is the Mr. Y. who lived with Mrs. Y. for sixty-one years, and now there is the Mr. Y. after her death. You have been presented with the third phase of your life.  It's your choice whether to take it on, or die," I had explained.
     "I choose to live," he said, "even if my life is completely different."  He acquired a new persona, perhaps an alter-ego that had been dormant all those years.  It germinated and bloomed.  He wined and dined a pretty girlfriend, joined a social club, took two road trips to mingle with distant friends and eat lobster in Maine, and allowed his personality to expand into realms he hadn't known were his to explore.
     He even scheduled a sky-diving expedition.  "It's a gift to myself for my eightieth birthday," he pronounced one day.  When I alluded to his history of angina, he dismissed me with a wave of his hand.  "Can you think of a better way to go?"  I didn't suppose I could.
      As I was reading the article quoted above, I reflected on the many patients I have lost, whose lives came to a natural end--and wondered, as I'm sure all physicians do, whether I did the right thing.  We held onto one another at the end, arm in arm, and looked across the threshold of the no-man's land we'll all, sooner or later, pass into, frightened, adventurous, bewildered, emboldened, and carrying our own particular grief.