Handbook for Mortals : Enduring Loss : The cycle of grief

Several decades ago, Elisabeth KŁbler-Ross described the five stages people often experience when coming to terms with a terminal illness: denial, anger, depression, bargaining, and acceptance. Because these stages portrayed a common response so well, people began to think of the stages as the five stages of grief. Unfortunately, grief does not move along in an orderly fashion, according to a specific order or timeline. Some people may not go from one stage to another. Others find they cycle from anger to acceptance to depression again and again.

Grief is characterized by unexpected changes. People move from one point to another on the circle, then back again, depending on where they are in their lives, and the events going on around them. New losses may trigger old grief. Unexpected moments may give rise to sadness. One man described bursting into tears on a busy street when a passerby tipped his hat, reminding him of his own late father.

When you are living with dying, you know how grief feels: lonely, cut-off, isolated, sad, abandoned, angry, or lost. Grief can feel over-whelming, especially in the immediate aftermath of a death. It can begin to feel like a constant part of your life.

Counselors have noticed that people often follow a pattern of grieving:

  • The loss and acceptance of it being real
  • Adjustment to loss
  • Reinvestment in life

At some point, a survivor will find himself or herself gradually reinvesting in life. That investment might be taking care of the survivorís interests, praying or finding meaning each day, or getting up and going to work. Somehow, people do find a way to survive, and eventually to thrive again.

All his life, Gordon wrote poetry, which he shared with friends and family at special events. A distant cousin asked him to tape-record some of his poems, which he did. Now, a decade after Gordonís death, those poems remain, not only as a legacy of his life, but also as a way to capture his voice, his emotions. Gordon wrote this poem about his own approaching death. It was used on a prayer card distributed at his funeral.

As I walk this last trail
And come to the last high pass
I step to the other side
Into the sunshine glow
Waiting there to greet me
Are all the ones I know

July 1991, In loving memory of John Gordon Hamilton, "Gordie."

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Keywords: stages of grief, stages of dying, Elizabeth Kubler Ross, Elisabeth Kubler-Ross
Handbook for Mortals book cover Copyright © 1999, 2006 by Joanne Lynn. This extract from the Handbook for Mortals by Joanne Lynn, M.D. and Joan Harrold, M.D. is used with permission. To learn more about improving care at the end of life visit the main web site for Americans for Better Care of the Dying.
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