I was 16 when my maternal grandfather died. It was 5:00 a.m. on Christmas Eve when the phone rang, awakening my whole family. Through my closed bedroom door, I heard my father walk down the hall, answer the phone in a muffled voice and then call out to my mother. My stomach knotted: I knew no one called with good news at this hour.
As I shuffled into the kitchen, I saw my mother sitting at the kitchen table, a handkerchief held to her eyes. My father cast me a stony look. “Your grandfather died in his sleep last night,” he said.
My uncle Bruno, who’d spent the night in my grandparents’ Brooklyn apartment—a snowstorm had prevented him from commuting back to Long Island—had been awoken by my grandmother, who’d been jarred awake by the shocking chill emanating from her husband’s body. Bruno then called our house.
Grandpa, who was 52, died because his lungs filled with fluid while he slept. I knew that he’d worked in the Pennsylvania coal mines from age 14 through his mid-20s to help support his family. I also knew from times I’d slept at my grandparents’ apartment that each morning he spent what seemed like an eternity coughing and spitting behind the closed bathroom door. That worried me, but I never thought it would kill him.
Grief: The Way It Was
In her groundbreaking book On Death and Dying, first published in 1969, Elisabeth Kübler-Ross identified a process that she believed individuals pass through when confronted with death. It begins with denial of the loss, moves through anger, bargaining, and depression, and ends in acceptance.
My initial reaction to my grandfather’s death certainly was denial. I’d heard what my father told me, I’d seen my mother’s tears, but on some level, it didn’t register. The last time I’d seen my grandfather, on Thanksgiving, I hadn’t noticed anything out of the ordinary. Not a big talker, he tended to stay on the edges of other people’s conversations. But you could tell he was listening, because every once in a while, he’d chip in with a comment that was right on target. That was exactly how he was that day. Also, as was his custom, he dispensed a silver dollar to each of my brothers and me as we departed.
If the kind of grief that Kübler-Ross wrote about represents what we could call “traditional” grief, it stands in stark contrast to what could now be called “contemporary” grief.
I insisted on accompanying my father from our Long Island home to Brooklyn later that morning, ostensibly to help Bruno and my grandmother in whatever way we could. But looking back, I realize I also needed to see Grandpa with my own two eyes. It wasn’t until I stood in the doorway of my grandparents’ bedroom and saw him, lying on his side motionless under a blue blanket, his face ghostly pale, that my loss started to become real.
I remember my anger. I moved through the entire wake and funeral in a quiet, clenched fury. My grandfather had been snatched away from me, and I was outraged by the theft. During the calling hours at the funeral home, a friend of my father’s approached me with hand extended, smiling. I returned the gesture, but I also distinctly remember that I didn’t—couldn’t—smile back at him.
Long Day’s Journey into Night
Today, the story of death and dying is often different. After my grandfather died, my grandmother lived for another 48 years. Many of those years were reasonably healthy and happy. But at some point, Grandma—and my family along with her—entered an unfamiliar territory of protracted suffering, for which we had virtually no preparation or guidance.
Soon after my grandfather’s death, Grandma moved in with Uncle Bruno, his wife, Aunt Irene, and their three children. Their split-level Long Island home became a bit cramped, but my grandmother seemed glad to be living in the midst of her family. Things went along smoothly for several years, until my grandmother was diagnosed with a large, fast-growing (but ultimately benign) brain tumor, which was then surgically removed. That was my first encounter with the kinds of advances in medicine that can extend life: if this type of tumor had invaded her brain even 15 years earlier, it likely would have been fatal.
The surgery saved my grandmother’s life, but it changed her. She sank into a state I can only describe as a mild melancholia, spending more and more time in the former family room, which Bruno had converted into a bedroom for her. She’d venture out when we visited, but cautiously. In contrast to the outgoing woman I’d known as a child, she was now much more like my grandfather—standing on the outskirts of social interaction, looking in.
Years later, after Bruno had died and Irene’s children had moved on, Irene and my grandmother moved into a retirement community in Connecticut. For major holidays, the two of them usually joined me, my wife, Terri, and our two children at our home nearby. Though Grandma seemed happy enough during these visits, she never recovered her former exuberance.
Then, as she passed age 85, she began to decline steadily. The mild melancholia spiraled into depression. She became more and more lethargic and uncommunicative. When I’d ask her how she was, she’d just shrug and murmur, “I don’t feel so good these days, Joseph.” If I asked why, she’d just shrug again. We all felt bad for her, but none of us had any idea what to do, and no one seemed to want to talk about it much.
In time, it became painfully apparent that Irene could no longer take care of Grandma by herself. Irene was approaching 70, as were my parents. One afternoon, when Irene was out at a church social event, Grandma put a pot of soup on the stove to cook and left it there for three hours, until Irene returned to the smell of scorched metal. On another occasion, Grandma went out to get the mail, only to be brought home an hour later by the police: she’d wandered off the condo grounds and gotten lost.
So Irene and my mother placed Grandma in a nursing home. It was nice enough, as such places go. The staff was caring, the building featured bright day rooms and a nice dining area, and everything was decorated with cheerful floral wallpaper. Residents were encouraged to participate in activities like playing Bingo and watching movies. My grandmother didn’t lack for visitors, as my mother and Irene worked out a rotation in which one or the other went to visit her nearly every day.
Nonetheless, Grandma hated the place. She complained about it every chance she got. The food was bland, she said. Her roommate got on her nerves. The “help” didn’t respond fast enough. In retrospect, I wonder whether these issues bothered her as much as the overall feeling of confinement and finality that lingered in the air—a feeling I certainly experienced when I visited. Although some residents greeted me with a smile and a friendly hello, plenty of others sat silently in wheelchairs, lining the hallways or the walls of the day rooms. A smell of disinfectant hung in the air. Though I could never bring myself to talk to her about it (for I, like everyone else in the family, was too busy trying to convince Grandma that the nursing home wasn’t so bad), I felt that I understood her distaste for the place. It was the gut knowledge that, to borrow from rocker Jim Morrison, “no one gets out of here alive.”
My grandmother made it to 100, but I don’t think you could say she “lived” to be 100 in any meaningful way. For the last six months of her life, she slipped in and out of consciousness. Many times when I’d visit, she’d be asleep. The staff always insisted on waking her. “She’ll be glad to see you!” they’d say, gently patting her awake. Yet when Grandma opened her eyes and looked at me, I wasn’t sure she even recognized me, much less was glad to see me. I found myself wondering whether she wouldn’t be better off just slipping away. Naturally, that thought made me feel guilty.
Toward the end, she lay semicomatose in her bed, heavily dosed with painkillers as her organs successively shut down. The staff had to strap her into some kind of lift to give her a bath and rub her body with lotion. They were kind enough, and the physical environment remained as clean and cheerfully decorated as ever, yet the place was imbued with deterioration and impending death.
Then, one afternoon, as I sat quietly with my mother in my grandmother’s room, Grandma stirred. Her eyes opened and her head moved. Suddenly, to no one in particular and in a voice filled with pain, she asked: “Am I dead yet?”
I got up and left the room, fighting the urge to scream.
The New Grief
My grandparents’ experiences speak to the changes that have occurred since On Death and Dying first appeared. If the kind of grief that Kübler-Ross wrote about represents what we could call “traditional” grief, it stands in stark contrast to what could now be called “contemporary” grief. The two are accompanied by different circumstances, just as my grandparents’ deaths differed greatly. My colleague psychologist Barbara Okun and I have come to refer to these changes as the new grief.
The grief we experience today results directly from the increasing ability of modern medicine to arrest or slow terminal illness and stave off death, even as the body and mind progressively shut down. I lost my grandfather whole, in one fell swoop; I lost my grandmother piece by piece.
The essence of the new grief is the gritty business of living with slow death. For those of us in developed countries, this experience represents a historic shift: never before, for so many, has death been such an extended process, rather than an event. Of course, people still die suddenly and unexpectedly, but with recent advances in surgery, drugs, medical devices, and other high-tech treatments, many more people die slowly. Protracted death creates special challenges for both patient and family.
The new grief is a twisting journey, which begins with the diagnosis of a terminal illness, proceeds through a period of treatment, may include a remission and a later return to illness, which possibly spurs a new round of treatment, and ends, finally, in death. This process may go on for months, or it may unfold for years. The ill or dying person is an integral part of the process—which creates protracted upheaval in the lives of the patient and loved ones alike.
The new grief is an emotional rollercoaster. At times, we may seem to be gliding smoothly, only to find ourselves moments later strapped into a car with bad gears, threatening to leap its tracks. We lurch from dread (the diagnosis) to elation (remission), from anger (at having no good choices or facing mistaken diagnoses) to helplessness (as we watch our loved one become weakened by the treatment and suffer painful or disfiguring side effects). Emotional pressure is continuous, either in the foreground (when a diagnosis is rendered or a new treatment option is being considered) or in the background (during times of remission or apparent progress). Whether or not a loved one recovers, we find ourselves in a prolonged state of stress, which can gravely threaten our own emotional and physical health.
In our interviews with people who are struggling with the new grief, a common theme is a profound feeling of isolation and a lack of guidance about how to handle their thoughts and feelings. As one man put it: “Throughout my sister’s illness, we were catapulted into crisis time after time, with no one to turn to other than whoever the doctor-of-the-moment happened to be.”
A Road Map for the New Grief
As psychotherapists, how can we help clients who find themselves in the underworld of terminal illness? We can try to help our clients make some sense of a profoundly bewildering experience. By constructing even a rudimentary road map of the new grief and developing some understanding of what to expect, we may be able to help clients find a measure of peace and agency during a harrowing time.
Out of interviews with hundreds of men and women facing terminal illness in a loved one, Barbara Okun and I have constructed a multiple-stage model for family grief. (The term family refers to blood relations as well as all those who have a significant connection to the ill person.) These stages are fluid, blending into one another much the way developmental stages merge into one another. We’ve found that each stage can vary greatly in length and intensity, depending, for example, on the length of the terminal illness and whether significant periods of remission occur. What follows is a rough guide to the new grief, encompassing both its challenges and its opportunities.
Stage 1: Crisis
The new grief begins when we learn that a loved one has a terminal diagnosis. Some people are able to handle—and communicate about—this crisis better than others. A man who described his sister as “the life force” in his family described how she “went out of her way to make it as easy as possible on the rest of us” after learning that she had a malignant brain tumor. “The day after she told me about her diagnosis, she called back to apologize if she’d made me upset,” he said. By contrast, a woman told us that her husband’s mother “couldn’t handle” his diagnosis of advanced colon cancer, and hung up on her when she called to report the bad news. Throughout the next three years of his survival, the mother refused to acknowledge that her son was terminally ill. Whether the diagnosis is expected in some way or springs from a doctor’s visit like a ghoulish jack-in-the-box, the journey of learning to live with death and uncertainty has begun.
The new grief process typically starts with a sense of sadness and dread. But if a relationship with a terminal family member has been strained or alienated, the reaction may be more complicated. Consider the man who’d long harbored resentment toward a father who he believed had strongly favored an athletic brother while ignoring him. On learning of his father’s advanced prostate cancer, this man found himself feeling furious: “Now I’ll be expected to feel sorry for him!”
George, a public-interest lawyer, remembers the moment when the crisis struck home for him. After several days in which his wife, Claire, felt bloated and vaguely nauseated, she awoke to severe cramping in her abdomen. A quick visit to her ob/gyn led to a quick referral, which led to a quick biopsy, which ended some days later with a quick “see me in my office” call from her doctor. She phoned George from the doctor’s office to give him the news: she had Stage 3 ovarian cancer.
With that phone call, George’s life changed forever. He struggled to absorb the terrifying information. He found out that in Stage 3 ovarian cancer, the tumor has already spread from the ovaries to the abdomen, and that the five-year survival rate was 42 percent. Because George was several years older than Claire, he’d always assumed he’d predecease her. “It had never occurred to me—not once—that she might die first,” he said. “I was filled with dread.”
In the days immediately following the diagnosis, he did his best to support Claire, but when he was alone, he thought about how the loss of his wife would throw his own life into chaos. If Claire died, how would he raise three young children? How would he pay for everything? How could he and the kids go on without her? George felt deeply guilty worrying about such things, but he couldn’t help it. By the time they arrived for the first appointment with the oncologist, George could barely contain his anxiety.
Fortunately, the doctor was friendly and clear-spoken. George mostly listened, though on the advice of a friend, he’d brought along an old-fashioned steno book. “I took a ton of notes,” he said. He learned that his wife’s treatment plan would include everything he’d read about: surgery, a significant period of recovery from surgery, and then repeated chemo treatments. “The full catastrophe,” he said. The process would take up to six months to complete.
The oncologist was cautiously optimistic. Claire said she was confident. “I crossed my fingers and found myself wondering if they still lit candles in churches, the way they did when I was a child,” George recalled. “I wanted to light one.”
Stage 2: Unity
The potential death of a loved one typically nudges us to put complaints or grudges on hold and pool resources to address the crisis. Early on, many family members can pull together reasonably well; however, after an initial flurry of familywide support, one or two people usually emerge as the primary caretakers. Sometimes, this “stepping-up process” lets other family members “step down” from responsibility, frequently leaving the primary caretakers to carry a bigger load than they can handle. If the family can’t create a viable, ongoing support network, caregivers may suffer health problems, deep resentment, and eventual burnout.
In my grandmother’s case, the main caregivers were Aunt Irene and my mother. Both nearly 70 years old, they drove several miles each way to the nursing home to see Grandma. My mother rarely complained about going to the home every other day (my aunt covered alternate days), other than to say that listening to Grandma’s constant complaints was sometimes trying.
I suspected that Mom was understating how she felt, as her visits were not only frequent, but lengthy. The first time my mother and aunt tried to leave after an hour, Grandma reportedly turned nasty, accusing them of abandoning her. Somehow, they were vulnerable to that accusation, and their visits soon stretched to two hours or longer. Each day, one of them would either sit in Grandma’s room and try to make small talk, or accompany her to the day room and watch a succession of soap operas.
I wasn’t particularly helpful to my mother and aunt. Because Grandma complained so much, I recall feeling somewhat irritated when I visited. I pretty much tuned out and left as soon as possible, leaving my aging mother or aunt to carry the burden. I imagine they suffered in ways I’ll never know.
Stage 3: Upheaval
A hallmark of the new grief is its length. As the treatment and caregiving processes stretch onward, pressures build, both within patients and the family members who love them. Consider, for example, the experience of Ellen, a 49-year-old woman who was diagnosed with Stage 4 breast cancer:
“In 2003, I started chemo and simultaneous radiation—a horrid combination. The chemo left me bald, nauseous, with no appetite, dry mouth, neuropathy, and incredible fatigue. No one told me that without eyelashes, dust and dirt fly into your eyes—or that my nose would run constantly and often bleed. The radiation was worse. For three days, I lived in a Star Wars movie, with beams of light shooting across a cold room where I was half-naked, forced into uncomfortable positions, and told not to move while strangers drew lines on my chest with markers and placed little black dots, like tiny targets, on my skin. And this was just the prep work.
“The physiologists taking measurements had a tough job aiming their radiation at a malignant node under the chest bone while avoiding my heart and working around my implants. The radiation itself was okay for a while, but then my skin started to burn. I was then told to go to the hospital burn unit for ‘burn baths’ until I healed enough to continue the treatments. That was my entry into the world of metastases.”
Following these treatments, Ellen’s doctor put her on a two-drug combo that’s kept her stable for five years. “Stable is good. Actually, stable is great!” she wrote me. But the process goes on. As she recently wrote, after starting yet another treatment, “This recent cancer treatment is very hard on me . . . and I suspect the remaining chemos won’t be much different. I want to spend the years I have left on a healing spiritual quest. . . . I have bone metastases, and massage is not advised due to pressure on the bones that are already weakened. I have lymphedema in my arms and chest, which leaves just my legs, feet, back, face, and ears for acupuncture needles. In the earlier stages, I did get relief from acupuncture . . . not so much now.” Ellen has taken up meditation, and says that this seems to calm her and lessen her physical discomfort.
The stress of the disease and its treatment for the patient is often apparent to others, as in the case of a cancer patient who loses her hair and becomes visibly frail; however, the impact for the caregiver may be invisible to the outside world. George, whose spouse had been diagnosed with ovarian cancer, remembers the chemo experience as so dramatically up-and-down that he never quite got his bearings. “On good days, Claire was still vibrant and energetic, able to get herself and the kids dressed while I served up breakfast, and then ready to help load the kids into the car for their ride to school as we both headed off to work,” he recalled. “A good day for me was pretty much a replica of the way life had been before the diagnosis. Sometimes I’d allow myself to fantasize that everything was fine.”
But on bad days, he was slapped back into reality. “Some days—typically after a chemo treatment—Claire was totally drained. On the evenings after a treatment, I tried to make her comfortable, see to it that the kids were fed and bathed, and try to strike a balance between allowing them to hang out with their mom and not tiring her too much. I usually prepared a separate dinner for Claire and me—something simple like soup and bread, since her appetite on those nights usually wasn’t great.” By the end of the day, George often felt exhausted by near-single parenting, caring for Claire, and a grinding worry about whether his wife would survive.
This period of upheaval was when Claire gradually lost her hair—“all of her hair, including eyelashes, eyebrows, the works,” said George. “For me, that was frightening, because it made Claire look so vulnerable, and reminded me that she really could die.” Fortunately, there were a few moments of comic relief. “I have a vivid memory of going with Claire to a special salon to pick out a wig. I watched her try on variations from platinum blonde curls to Gothic jet black, and then turn to me for my opinion, her neck swiveling around like a runway model’s. We cracked up the whole time.”
George kept his darker feelings to himself. He had friends and colleagues he might have turned to, but didn’t. “For quite a while, I’d been in the habit of meeting a couple of guy friends for wings and beers at a local pub every two weeks,” he said. “But once Claire got sick, I found myself wanting to stay close to home. I wasn’t in the habit of sharing anything serious with these guys, anyway.” He paused, considering. “It’s not that people weren’t sympathetic. Most people I knew would ask how things were going—but mostly in terms of Claire’s treatments. Rarely was I asked how I was doing, though occasionally, someone would ask about the kids.”
George was grateful that, throughout the ordeal, his relationship with Claire remained strong. “We didn’t talk about her illness at length, but we felt that we were in it together, regardless of the outcome,” said George. “We still laughed together, watched the news together before going to bed, and did family things on weekends. We were still intimate. But as much as we were bonded as a couple, on another level, I felt completely alone.”
Before our interview, George had never told anyone about his experience of being with Claire before surgery. As she lay in a bed in the pre-op area, George by her side, her surgeon strode toward them. He was a handsome, energetic man, who’d been dressed in Armani during their two office visits. Now he was wearing scrubs, and the surgery suddenly became real. “When he pulled up a stool next to Claire and made eye contact with her, I saw her lips start to tremble,” George said. “The surgeon must have seen it, too, because he reached out and took her hand. ‘This is going to go just fine,’ he told her. Claire nodded, but her eyes welled with tears. It was all I could do to keep from breaking down.”
The surgery was deemed successful, marking the end of the first stage of upheaval that would go on and on. At each juncture—surgery, chemo, follow-up testing—there’d be more declarations of success. Each time, Claire and George experienced great relief, followed by renewed wariness. “We both know that ‘success’ is, in fact, only a statistical statement,” said George. “I’m aware that our family is among the lucky ones. Claire has now been in remission for nearly two years. But ovarian cancer is aggressive. For both of us, the fear of relapse—and possible death—lurks in the back of our consciousness. I’ve come to think of Claire as being ‘a survivor, so far.’”
Stage 4: Using the Gift of Time
The experience of grief rarely comes to a neat and tidy end, but, under the right circumstances, there’s the opportunity to address, and perhaps resolve, family issues that may have been avoided for a long time. Unlike sudden death, which presents shocking, instantaneous loss, the new grief can give us the gift of time—if we’re prepared to use it.
Such preparation is no easy task. If the loved one’s health continues to deteriorate and the prognosis is poor, everyone gets ground down. In my own family, as my grandmother’s downward slide continued, the strain on my mother and aunt became more apparent. I could see it in my mother’s face when I’d walk into Grandma’s room and find her sitting there, looking gravely at my grandmother as she slept. Her face was drawn, and there seemed to be more lines around her cheeks and forehead. Grandma, I noted, looked uncomfortable—in pain, even when she was asleep.
When she was awake, my grandmother didn’t always recognize my mother or aunt. Then she began to complain of chronic pain in her legs. None of us had any idea what to do about all this. Nor, I discovered, was there anywhere to turn.
By then, I’d become aware of the limitations on care to the elderly provided by “entitlements” such as Medicaid, which paid for my grandmother’s stay in the nursing home. Under the limitations of her coverage, onsite doctor visits were virtually nonexistent. When Grandma needed to see her doctor, we had to figure out a way to take her to the doctor’s office. This is no small task when a patient is cognitively feeble, fairly heavy, and frequently uncooperative. She fell on three occasions, and because no treatment was available at the nursing home, she had to be transported by ambulance to a nearby hospital each time.
The nursing home was unable to provide even simple relief measures. When Grandma developed leg pain, we made another trek to the doctor’s office, where we learned that massage was the only thing that might help. None of the nursing home staff had time for that, so regular leg massages became yet another responsibility taken on by my mother and aunt.
If there was any kind of “resolution” in my family as a result of my grandmother’s protracted deterioration and death, it was that, over time, my mother and aunt became more empowered. The timidity and deference that had once characterized their relationship with my grandmother was gradually replaced by quiet assertiveness. For example, they insisted that the staff take Grandma to the day room for a couple of hours every day for a change of scene, even if she said she wanted to stay in bed. A minor victory, perhaps, but an important change for my mother and aunt, who’d spent a lifetime bowing to their mother’s demands. The good news, then, is that sometimes terminal illness can be a crucible that allows individuals to move forward in their relationships and enlarge their own sense of self.
A New Conversation
Since what might be called “extreme medicine” now often determines how our mortality unfolds, most of us, perhaps the vast majority, can expect to experience a slow, medicalized dying—our own, that of family members, or both. The new grief has become the new reality to a degree unimaginable just a few decades ago. What used to be, for the most part, a fairly straightforward and often quite sudden event is now more likely to be a wrenching, lengthy, often emotionally, physically, and financially ruinous ordeal, which can whipsaw us back and forth between fear and hope, euphoria and despair, resentment and guilt, belief and doubt, with numbing exhaustion usually a constant. For the first time in human history, we’re participating in the unprecedented social transformation of the way we die, much of which seems to take place in a no-man’s-land between life and death.
In spite of what’s clearly a massive social shift in the way we now enter and exit the domain of death, we still really don’t know how to talk about it. We haven’t yet begun to have the difficult, honest conversations—person to person, family member to family member, doctor to patient, therapist to client—that would help us better understand what to expect of this harsh landscape, and how to pick our way through it. It’s true that there’s been some attempt to get genuine dialogue going between medical providers, patients, and their families about end-of-life planning. In fact, the Affordable Health Care Act had included provisions enabling patients with or without terminal diagnoses to meet with their physicians once a year and review their overall treatment program, consider options, and make rational decisions. I say had included because politicians who opposed this healthcare legislation immediately referred to these provisions as “death panels.” What this hypersensitivity to any discussion of end-of-life issues suggests isn’t just an irrational fear of “Big Government,” but a far more widespread, insidious feeling of fear and dread, even denial, of what’s now, directly or indirectly, a reality for all of us.
But just as important as conversations between patients, their families, and doctors about practical and medical end-of-life issues is the general conversation we all need to have about what the emotional experience of slow dying is really like, for both the ones doing it and those who must stand vigil. As is obvious in several of the examples above, isolation—often self-imposed—and feelings of guilt and shame about one’s own reactions to the long dying of a relative prevent genuinely compassionate and helpful conversations from taking place. We need to help people, particularly caregivers and family members, break out of their isolation and talk in an open, candid way about the untoward—not to mention unwanted and deeply ambivalent—feelings that inevitably arise during the grueling slog through a loved one’s terminal illness. These feelings include, but aren’t limited to, grief and fear; unwelcome anger at the person dying; resentment of other family members that so much of the burden of care falls on us; guilt about our own unfulfilled family duties; self-horrifying wishes that the long-dying person would just complete the job; and moments of sudden, perverse, not-fit-for-prime-time hilarity, which can erupt, sometimes as easily as tears, often signifying an emotional release from otherwise unbearable tension.
Everybody dies, and every culture develops an implicit manual defining socially and morally appropriate feelings and behaviors for the occasion. But those old manuals, based on models of dying and death that are increasingly out of date, often aren’t much help, and we’re only just beginning to develop newer, better manuals, more in line with this new world order of death. We’re just beginning to find the vocabulary and the courage to give speech to this process.
As therapists, we’re uniquely well placed to engage people in this emerging conversation and bring this topic into the light of shared experience. Although we can’t protect our clients from the new, protracted process of grief (nor would we want to), we can help them seize opportunities to finish unfinished business. We can help people approach the end of life with dignity and a sense of control. For clients who walk the long, twisting road toward loss, we can offer informed compassion, comprised of unconditional acceptance of the messiness of grief, some understanding of its newly crooked course, and a gentle way forward.
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