Today’s post is in honor of National Grief Awareness Day that falls on August 30, 2021. I want to start by saying that there is no right or wrong way to grieve. We all have our own stories and experiences which truly makes grieving a unique process. Our personalities, our culture, our religion, and our supports all impact us differently. Never let anyone make you feel like you’re grieving in the wrong way.

When thinking about grief in cancer, the most common thought would be about the loss of someone special, but we should also acknowledge other moments of grief. What does grief in cancer look like? It can take many shapes, such as:

• We grieve our previous and future life
• We grieve for lost time
• We grieve for our family, spouses, or children affected by our diagnosis
• We grieve for our loved ones diagnosed with cancer
• We grieve for childhoods and siblings’ childhoods
• We grieve for life and life lost
• We grieve for cancer friends/family we have met along the way
• We grieve for ________ (fill in the blank)

Grief is defined as “anguish experienced after significant loss, usually the death of a beloved person.” (APA Dictionary of Psychology)

Five Steps of Grief

In psychiatry, we acknowledge five general stages of grief as an expected guideline. There is no timeline for grief, or any required order. Some of us will not experience all these stages, while others will go back and forth on the same stages.

1) Denial

Denial can be viewed as our body’s natural defense mechanism. It protects us during the initial shock and minimizes feeling the larger impact all at once. Life feels overwhelming, scary and unmanageable. During this time, we might deny the facts, assume there was a mistake, or find the diagnosis incorrect. We might feel numb, and judge reality to be false.

2) Anger

Anger is a necessary emotion to grieving. It is often thought that anger is an unhealthy coping mechanism; however, it has been found that suppressing anger is worse for our mental health. During this stage we might think, “Why me?” “Why my family?” “Life isn’t fair.” “What did I do to deserve this?” During this stage we might see misdirected anger or blame towards others. Allow yourself to feel anger.

3) Bargaining

Bargaining is when we hope to avoid a situation by negotiating. It gives us a false sense of hope that we can change the outcome. “I will do anything.”

4) Depression

We might notice feelings of sadness, emptiness, episodes of crying, isolation, numbness, or difficulty eating or sleeping. We aren’t finding pleasure in life or enjoying things we used to. We might have episodes of feeling hopeless or having suicidal thoughts “What’s the point of life anymore?” Grief and depression share many similar symptoms, but the degree and length of time differentiates them.

5) Acceptance

This is the point we reach when we truly begin to heal. There is often never a point in which we feel good about the situation, but we start to recognize this as our true reality. We still feel emotions in waves with ups and downs. There will start to be a few good days and a few bad days, but eventually more and more good days. Depressive feelings often begin to fade, and we start to rejoin life and find purpose.

Give yourself time to grieve and allow yourself to feel the grief through whatever stages make sense. There is no timeline. We live in a world where we are expected to bounce too quickly to normal. Often because mental health, death, and grief are all difficult topics for people to discuss, getting back to “normal” prevents the awkwardness for others. But for those grieving there is never a return to “normal” or what life used to be. Take time for yourself and establish what life will look like now. Do not rush for the comfort of others.

Remember, grief is not linear, and we don’t complete one step and immediately feel better. It involves waves of emotions. Prepare yourself for all the firsts: holidays, birthday, special dates, and anniversaries. Plan ahead for these dates to help improve your control over the grief, but also acknowledge an increase in waves around these times. Other dates or situations will take you by surprise, and these can make it more difficult to handle.

Helping Siblings and Younger Children

Like adults, children grieve. The way they express their grief will depend on their developmental level and the nature of the relationship they had with their sister or brother. It’s important to keep children involved with the family, especially in the early days, even though the instinct might be to shield them from what is going on.

Some helpful tips include:

• tell children the truth about death in terms that they can understand
• answer questions simply and honestly
• use accurate terms to explain the physical facts of death
• allow them to participate as much as possible in memorial events
• give them an opportunity to say goodbye
• ask them what they would like to do to remember a sibling
• take the lead and initiate conversations about the sibling’s death, even at a later date
• find a support group or camp for children

(excerpted from Boston Children’s Hospital)

Some additional strategies to help remember someone during the grieving process is to find ways to make a connection. This can include creating a photo book, finding ways to celebrate their life in a new way, thinking about volunteering in a way that honors them, or sharing their story along with your story. You may find other ways to positively support the grieving process given time and thought. And it doesn’t matter whether it’s a month or two years – whatever works for you.

Remember it’s ok to feel sad.

Courtney, MSN, PMHNP

Osteosarcoma Survivor