HJAR May/Jun 2022

be disturbed. Although a grown woman, she may feel the need to be held and com- forted as she was when she was a young girl. Not feeling herself, the mother knows this is related to the terrible loss of the boy’s father in her life and how her life has changed in ways that she is just beginning to understand. None of what is described for the mother and her son would be unexpected. We would not expect the 3-year-old boy to express the insight and awareness of the connec- tion between his feelings and his situation. We would be shocked and amazed for him to come home frompreschool and tell his mother, “Mom, I had a bad day. I spilled my milk, bit a kid and ended up in time-out. I think it’s because Dad died. I’m just not myself these days.” The higher our developmental level, the more we can understand and express the sources of our dis- tress and our grief. Children need adult support and guidance when grieving due to their limited experience, aware- ness, and comprehension. They need positive outlets for their feelings, ques- tions and thoughts, good role-model- ing, age-appropriate explanations, and new ways to remember and be con- nected to who or what was lost. Chil- dren, like adults, can make healthy adjustments, but they need adult sup- port and assistance. Adults often need support and assistance, too, as few of us navigate grief well alone. Grief and the Provider Grief can have a powerful presence in our roles as healthcare providers. Our healthcare lives and the lives of those we serve are full of losses. Some of these losses are challenging because of their sig- nificance or frequency. Some losses are easy to identify, such as when we come to care deeply for a patient who dies. Other losses are about howwe see ourselves, people, and the world. Faced with intractable problems and pain, we grieve the loss of the image of ourselves as effective helpers and healers. We grieve the loss of the dream of a world where the innocent are protected from suffering. We grieve the loss of certainty and predictability in life. We grieve the idea that we can always make a significant difference — that we can avoid feeling and being helpless. How we handle loss and grief makes a difference to the people we serve, our fami- lies, and ourselves. A story to illustrate: I once worked with a mom and her ele- mentary-age son who had a serious, life- threatening illness. Over months, many aggressive and creative efforts were made to prevent his death and provide him with a good life. Sadly, the boy died. On the day of his death, a healthcare team member who tried so hard to save his life came to his room, approached his mother, hugged her and stood with her. Few words were needed or spoken, but the message of care and support was clearly communicated. After this teammember left, another came. This teammember also pushed the bounds of conventional treatment to give this child a better chance to live, but when the team member looked in and saw the lifeless body in bed and the grieving mother with no family present for support, they turned and walked away. Both teammembers had losses. Both were grieving. Motivated by care and pain, one was able to offer com- fort to the mother. For the other compas- sionate team member, the burden of grief blocked the path to offering comfort. Regardless of the outward reaction, each experienced heartbreak. Too often, the grief experienced by healthcare professionals is “disen- franchised grief,” a term also coined by researcher Ken Doka. Disenfran- chised grief exists when grief is not acknowledged or is viewed as invalid. Disenfranchised grief is grief in need of a home where it can be recognized, welcomed and treated with the care it deserves. As healthcare professionals, we need to find ways to validate and support the significant grief experi- enced in our work. We need to give our disenfranchised grief a caring home, and we can all do better with this. Part of doing better by grieving people is recognizing and attending to grief when it exists. Because loss is part of our patients’and their families’ lives — and our own lives — grief natu- rally occurs. The presence of grief is an experience that deserves recognition, understanding, and support. Grief is there because care, love, and compas- sion are present, and that is good news. What can we do with the presence of grief in our lives? Here is a suggestion for a place to start: take a moment and a few deep breaths, breathing in compassion for yourself and breathing out compassion for others. Grief is still mostly miserable, but it doesn’t have to be as lonely. n “As healthcare professionals, we need to find ways to validate and support the significant grief experienced in our work. We need to give our disenfranchised grief a caring home, and we can all do better with this.” GRIEF 20 MAY / JUN 2022 I  HEALTHCARE JOURNAL OF ARKANSAS