LETTER TO A WIDOW

By Alex Lickerman, MD
Happiness, Health
2/15/09
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I remember when I first read the pathology report on my patient, Mr.

Jackson (not his real name), my stomach flip-flopped.  “Adenocarcinoma
of the pancreas” it said. A week later, a CT scan revealed the cancer
had already spread to his liver. Two months after that, following six
rounds of chemotherapy, around-the-clock morphine for pain, a deep
vein thrombosis, and pneumococcal pneumonia, he was dead.

His wife called me to tell me he’d died at home. I told her how much I’d
enjoyed taking care of him, and we shared some of our memories of
him. At the end of the conversation I expressed my sympathies for her
loss, as I always do in these situations.
There was a brief pause. “It just happened so fast…” she said then and
sniffled, her voice breaking, and I realized she’d been crying during our
entire conversation.

“I’m so sorry for your loss,” I told her again. She thanked me for caring
for her husband and hung up.

I’d known Mr. and Mrs. Jackson for almost seven years and had always
liked them both. I thought the world a poorer place without Mr. Jackson
in it and found myself wishing I’d done a better job of consoling his wife,
thinking my attempts had been awkward and ineffective. I reflected on
several things I wished I’d said when I’d had her on the phone
and considered calling her back up to say them.

But then instead I wrote her a letter.

Navigating Loss

Dear Mrs. Jackson,

When you called me to tell me your husband had passed away and how
hard a time you were having, I found myself frankly at a loss.
Conventional wisdom about how to console people who’ve suffered
grievous losses includes platitudes like “be there for them,” “listen,” and
“let them know you care”—all valid and useful guidelines that I’m sure
have brought comfort to many suffering people. But inevitably
conversations end, people go home to resume their normal lives, and
the wife or husband or son or daughter is left alone with pain now
occupying the space their loved one used to be. Though I don’t know
how comforting you’ll find this letter, I wanted to share with you some of
my thoughts about grief in hopes of making your journey through it
somewhat more bearable.

Why do we suffer when we lose those we love? I think the true

answer is because we believe we can’t be happy without them. Knowing
how much you loved your husband, I can only imagine how strongly you
must feel this to be true. And yet I often think the only reason the pain of
loss abates at all is that we do become convinced we can be happy
again—just slowly and unevenly.

Certainly, some people find themselves stuck in grief, unable to

move on. Sometimes this happens because we actually become
reluctant to surrender our grief even after it’s run its proper course,
believing the pain of loss is the only thing keeping us connected to our
loved one, or that to feel happy again would be to diminish the
significance of the relationship we once enjoyed. But neither is true.
Even when people we love die, our relationships with them do not. We
continue to have feelings about them, memories of things they did,
imaginings of things they might say were they with us now. Just because
the pain of losing them diminishes with time, their importance to us need
not. Normal grief is like a roller coaster: there are ups and downs,
moments of pain intermixed with relief. If, however, after the first six
months or so there seem to be fewer periods of relief rather than more,
normal grief may have changed into full-blown depression. If you think
this might be happening at any point, please let me know. I can help.

 Everyone grieves differently. Don’t ever let anyone tell you how

to do it. If you want to talk about your husband with others, do. If not,
don’t. There’s definitely something mysterious about the human
psyche, some intrinsic force within us that continually seeks to engulf
pain and suffering the way our white blood cells engulf viruses and
bacteria, an elixir we seem to swallow at the very moment our loss
occurs that immediately begins to work on our suffering without us
even knowing it but which nevertheless somehow eventually cures us
of it. After experiencing a devastating loss, if you’ve allowed yourself
to feel the legitimate pain it’s brought and not sought to avoid feeling
it, things slowly start to improve. We wake one morning to find there’s
something in the day we’re actually looking forward to; or someone
says something funny and we actually laugh; or we find ourselves able
to plan things again, even if only a trip to the grocery store. But there’s
no definite timetable for this. Don’t allow anyone to hurry you along
with their expectations about when your grief should end.
 Just know that it will. It may seem to you now, while in the middle
of the worst of it, that it won’t, that your happier self was only a dream
and that this grieving self is here to stay for good. But that’s an illusion
brought about only by your current life-condition. Nothing is forever,
including the pain of loss.

 Don’t grieve alone. I worry that you have no one with whom to
share your grief (you’ve told me in the past how you were all alone
except for your husband). While you may not have much energy for
this, I find myself hoping you’ll join a support group, either at your
church or by looking online. There’s something often magically healing
about spending time with others who’ve had or are having painful
experiences similar to your own. It may seem an overwhelming
prospect now, utterly beyond you, but often by holding someone else’s
hand, by becoming their support, you’ll find your own pain lessens just
a little bit. When you shine a light to guide others on a dark road, your
own way is also lit.

 Forgive yourself your failures. You said on the phone you “felt

guilty,” but not what you felt guilty about. I wondered about that. I
wondered if you felt guilty about having spent time doing things
like seeing other people or watching television rather than spending
every moment with him; or about feeling tired of caring for him; or
about not always having a positive attitude when you were around
him; or for wishing the nightmare of his illness had actually ended
sooner—or any of a myriad of things family members have told me
have made them feel guilty, too. Or maybe you feel guilt about the
decisions you made when your husband was no longer capable of
making them himself. The end of a person’s life is often composed of
gut-wrenching choices that land squarely on the shoulders of family
members: to put in a feeding tube or not; to use mechanical ventilation
or not; to use heroic measures or not; to decide not to press forward
 with an intent to cure but rather with the intent to palliate. I know you
struggled mightily with the decision to stop treatment and bring him
home to be comfortable, but you must know your decision did not
cause his death. His disease did. His disease is what thrust you into a
situation you didn’t ask for or want, but accepted with grace, making
every decision with as much deliberation and wisdom as you could
muster, even when you were exhausted, and always with an eye
towards his comfort.
Forgive my presumption, but if you feel guilt over any of these things—or
over other things I didn’t mention—you must forgive yourself. There was
never a need for you to be a perfect caregiver—only a caregiver who
cared, and that you most certainly were. The person who gets sick is
never the only one whose life is deeply affected by their illness. This was
your experience, too.

I want you to know that watching the way you were with your husband
always inspired me. I can only hope to face losses in my life with as
much courage, acceptance, and humor as you and your husband did
both.

While no one knows what happens when we die, we can say with
certainty that we lie between two equally inconceivable possibilities, one
of which must be true: either the universe has always existed and time
has no beginning, or something was created from nothing.
Either case makes every one of us a miracle.

With my warmest regards,

Alex Lickerman, MD