How the dead visit us

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I want to tell you a ghost story. 

As loyal readers will remember, my mom died when I was pregnant with my oldest daughter. Since my mom was no longer physically present, my husband and I made a point to talk about Nanny as much as possible. This way, our baby (and then her sister) would know she had another grandparent, even if she only knew her in pictures and stories (of which, thank God, there are many). 

But, because kids are spooky, it turns out she could see my mom. At least once. This is the ghost story: I was holding my toddler in my arms when she looked right over my shoulder at a fixed point and said, “Nanny?” I turned around faster than I ever had in my life and said, “Mom?”

No answer. Very annoying.

But I am positive she was in the room with us. I know some people don’t believe me when I tell this story. I can’t provide any evidence that it happened. I don’t need to. In that moment, I know my daughter saw my mom; I felt it in my bones. Whether it happened “in real life” or I invented it in my grief, it doesn’t matter. What matters is that it helped me.

My clients sometimes hesitantly share their own ghost stories. There are a variety of ways they offer these anecdotes, ranging from uncertainty to joy and relief. Sometimes they’re recounting a vivid dream or lights flickering or butterflies at unexpected times. Whatever it is, when they ask me, “do you think it’s really them?” I answer, yes. And also, does it matter? 

What matters is that the dead are with us, whether in our imagination or memory or in the actual house or air. They show up in ways profound or small, inexplicable or clear. You can believe in ghosts or not; what’s important is how those experiences make you feel. And if you haven’t had a spooky visit, ask for one. Maybe the dead don’t answer in words but I do think they’re listening.

When grief is bittersweet

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I took my daughters on a walk in the woods the other day and happened upon some birds taking a bath in a stream. My very first thought was, “I have to call Mom.” Almost simultaneously, I remembered that I can’t call her; she’s been dead for more than seven years.

But she popped into my head in that moment because she used to tell this story about me waiting next to my grandparents’ birdbath to see the birds. There’s even a picture to commemorate the story: three year old me in a pink winter coat, staring determinedly at the (very empty) birdbath. My mom told me how they tried to convince me that I was too close and the birds wouldn’t come but I waited and waited anyway. She loved telling that story. So when I came upon those robins bathing in the stream while I walked with my own children, I was seized with the desire to call my mother to tell her, I finally managed to catch the birds in the act.

It was sad, obviously, to realize I couldn’t actually call her. But what a lovely moment, to forget for just a split second—to have her be so alive to me still.

This is what I mean when I describe grief as bittersweet. The long, winding road of bereavement is filled with these moments: listening to a song that reminds you of your person; finding their handwriting in an old card; hearing a story you’d forgotten or never known about them. It’s sad, of course, but it’s lovely too, that the person you lost is still with you.

Grief isn’t all sharp edges and painful black holes—though those are part of it. It can also be a gift. Let it be. Let your heart feel full, even if it hurts. Find the sweetness in your grief.

The Grief Wishlist

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When my mother was dying, I was pregnant with my first baby. As you can imagine, there were a lot of complicated feelings swirling around: joy and relief (it was a process for me to get pregnant; this was a very wanted kid) mixed with grief and anxiety and also hope that my mom would be alive when the baby came. As close as we were, it was almost impossible for us to talk about the idea of her dying before I became a mother. Mostly we didn’t talk about it at all. Then one day she suggested that I write down a list of questions for her about babies and she would write down the answers. Just in case.

I never did it.

Not because I didn’t want her answers; I wish I could go back in time and write down a hundred questions for her. But at the time I didn’t know what to ask and honestly, I didn’t want to admit to her or to myself that she wouldn’t be with me when I had the baby.

I wish I had written down something.

I’m sharing this story because it is typical of grief. “I wish” can be followed by any number of should have’s or could have’s, if we had only known that the person in question was going to die. I hear it from my clients: “I wish we had spent more time together” or “I wish I was more patient.” The grief wishlist can be unending if we let it be. There is always some regret when we lose someone we love.

The question is, what to do with those feelings? When I hear my clients say they wish they hadn’t spoken sharply to their loved one, or they wish they had been more present, I don’t wave it away and say it doesn’t matter. Instead, we sit together with the sadness and the regret and the guilt. We acknowledge all the things that can’t be fixed or changed once someone is dead. We talk about what the wish really means, which is usually, “I miss this person. I want them back. I wish they hadn’t died.”

Feeling our grief is the only way through it. When you find yourself saying, “I wish” or “I should have,” don’t run from that feeling. Tell someone you trust (ahem, like a therapist!). Write it down. Acknowledge that your grief is complicated and nuanced. Consider your grief wishlist as a tender, loving tribute to the person you miss. Personally, when my grief wishlist feels heavy, I talk out loud to my mom. It’s a private conversation so I won’t share it with you but I will tell you that doing that helps me. There’s something that will help you too; you just have to find it.

Can I swear in therapy?

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If you’ve ever wondered if you can swear/curse/cuss in your therapy session, I have great news for you: the answer is (mostly) yes!

I’m not suggesting you walk into your therapy session ready to use every foul or vulgar word you’ve ever heard. But there is evidence—actual scientific research!—that cursing can be helpful when we are in pain. Sometimes other adjectives fail us and the only way to explain how we’re feeling—the depths of pain we find ourselves in—is to switch to the four letter words.

Additionally, therapy is not the place to censor yourself. Therapy is meant to be a safe space to say whatever you are thinking, however it gets best expressed. For some people (myself included), cursing is a key component of that expression. Sometimes the only words that can accurately describe our pain are the “bad” ones. As a therapist, it’s a relief to me when my clients drop a swear word here and there because it shows me that they’re comfortable with me. The relationship between my client and me is the most important part of our work together; being able to express yourself naturally, without apology, is key to the foundation of that relationship.

Not everyone needs to express themselves this way, of course. Personally, I grew up with an Irish Catholic mother who could make a sailor blush if she was really on a streak; cursing was normal in my house. As with all therapy-related topics, your mileage may vary. But if you’re in a room with me and you want to explore your feelings by swearing, go nuts. I’ve heard (and said) all the words before. I may even join you.

"I don't know what to say in therapy."

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Let me begin with a small personal confession: this is the longest I’ve ever attended therapy as a client.

Maybe that doesn’t seem like such a big deal. But as someone who has made a living explaining why everyone should attend therapy actually, it feels mildly embarrassing, like forgetting the name of an acquaintance at a cocktail party. “Therapy is wonderful!” I’ve told people over and over for more than a decade while also not actually going myself for longer than 3-5 sessions. I’m a hypocrite, is what I’m saying.

I’m confessing my hypocrisy because I suspect a lot of people are like me: an acute crisis or some other event occurs that leads them to a therapist. They attend anywhere from one to maybe even ten sessions. The crisis passes; things get a little better. And they think, “well, I guess there’s nothing else to talk about.” So they stop seeing their therapist.

I hear this from clients sometimes: “I don’t know what else to say.” Or, “I don’t know what to talk about today.” Or, my least favorite, “what do you want me to talk about?” At that last one, I usually smile and reply, “that’s up to you.” I imagine my clients are not fond of this response but it’s the truth! I can’t see inside your brain. You have to tell me what’s in there that you want to explore.

All that being said, I get it: sometimes I struggle with what to say to my own therapist. She asks me how I am and I say, “I’m good!” and then immediately wonder if that means I should stop going to therapy. The crisis that brought me back to the proverbial couch almost a year ago has passed; I am good. But that doesn’t mean there’s no more work to be done.

The other week, when I really did feel ok, I felt myself about to say those dreaded words “I don’t know what to talk about today.” Instead, I told my therapist that sometimes I’m afraid that I won’t have anything to say and she’ll tell me I don’t have to come back. She laughed (kindly but still, she did laugh because it was ridiculous). She assured me that she wouldn’t say such a thing. And that was all I needed to find a new place to begin. The storm that brought me in has passed but now is the perfect time to do some deeper mining: when I feel well enough to really explore the deeper stuff.

So if you find yourself in therapy at a loss for words, that’s ok. In fact, it’s good! It may be the beginning of a new phase of your work in that space. Hang in through the lull and you may find you can feel even better.

The pain and comfort of shared grief

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This is not what I wanted to write about today. In fact, I had started a totally different post yesterday. But this morning, whatever I had written before seemed pointless in the face of yet another senseless tragedy.

When a tragedy occurs—a mass shooting, for instance, or a racist murder—we experience grief, even if we haven’t been directly impacted. I don’t personally know anyone who was killed yesterday in Texas, or in any of the other violent tragedies that have taken place over the last several years, but last night I found myself crying in my husband’s arms, thinking about the devastation of those families and communities.

I’m not a big fan of the five stages of grief (the most commonly cited and probably most poorly understood theory of grief but that’s a discussion for another day). Despite my rejection of the five stage model, those first three stages describe my feelings at the moment: stage one, denial (this cannot have happened again); stage two, anger (why does this keep happening, what is everyone doing, someone should DO SOMETHING); and stage three, fear (we are not safe. My children are not safe).

I am rattling around between these three stages, both drawn to the news and social media and also wanting to hide from it. I want to talk about it at length with others but also can’t bring myself to discuss it out loud. I am alternately disbelieving, furious, and terrified. I want to do something useful but also feel paralyzed and useless. I am, in short, experiencing grief.

I know I’m not alone. So many of us who are parents talk about holding our babies close after this kind of event and that’s certainly something I did last night: I watched my children sleeping peacefully and thanked God they were safe. In my sadness and fear, I imagined parents all over the country doing the same thing. And I imagined all of us reaching out to hold each other up, clasping our hands together and sitting with the enormity of this tragedy and all the others that preceded it.

When something does not directly impact us, it can be easy to turn away from it (denial again, right? “That will never happen to me, ignore ignore ignore”). And there can be some turning away: we cannot sit only with pain all day, every day. But there can also be some turning toward each other. We can grieve together. We can hold space for each other in moments like this, acknowledging that witnessing suffering and tragedy is nearly as bad as experiencing it for ourselves. We can call what we are experiencing grief, even if it is not our personal loss to bear. We can be still in this moment and feel the wave of anguish, of anger, of fear. It won’t swallow us if we hold on to each other. It brings me a measure of peace to believe this; I hope it does for you as well.

How to Mark the Anniversary of a Death

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I have never found the right word or phrase to describe the date of someone’s death. Anniversary sounds like something to celebrate; death day sounds flippant for some reason. Still, I can’t think of another way to say it so we’re going to stick with anniversary, which is technically what it is: an annual marker of an important date. And anyway, whatever you call it, the date of a loss is important and needs to be acknowledged.

A lot of people hang on to the idea that after that first anniversary passes, they will somehow be on the other side of grief. And although it’s true that time heals, there is no “other side” to grief. Which is not to say it never gets better; of course it does. But it doesn’t end. You don’t get to the other side so much as enter a new phase of grief. During holidays or birthdays or death anniversaries, our grief can grow again. As I've written before you haven’t had a setback when you feel your grief. Rather, you are continuing to experience normal, typical, regular grief. It ebbs and flows, like the tides.

Paths, tides, other sides: forgive my tortured metaphors. Let’s get more concrete: how should you mark the anniversary of a death?

The short answer is: however you like.

The longer answer is: it depends.

It depends on what will make you feel… not better, but comforted. What will make you feel that the day can pass without you white-knuckling through it? For some, the routine of every other day is paramount. I’m not recommending you ignore the day, but if it brings comfort and solace to get up and do your normal stuff, then that’s what you should do. For others, the day needs to be honored and ritualized and marked somehow. In my family, one of us texts the group chat with the number of years that have passed. It’s a small thing, but it helps to remember that we have suffered our losses together; that we are not alone in our grief. It’s a ritual, albeit a small one.

That’s the thing about rituals: they don’t have to be epic. You can choose to mark the day in a small, quiet, safe way. In fact, that may be the only way you can mark it. You can also choose something big and loud and intense. Your mileage may vary, as they say on the internet.

What’s important is that you figure out what works for you. There are no rules to grief and there are no rules about how to mark a death day. But I encourage you to mark it in some way: to write a note, share a photo, text or call someone you love who remembers. Tell a favorite story, take a walk in the woods, speak out loud to your person. Perform an act of service, sing a song, cry in public or in private. Find the thing that makes the day go by. Because it will go by. More days will come, some better and some worse. And on the worse days, I encourage you to lean in; let yourself feel. The only way out is through.

The grief "to don't" list

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After a death, people seem to think that there’s a grief checklist, a list of tasks to accomplish that lead to your grief being over. The person dies, you have a funeral, you’re sad for awhile, then you have to “move on,” whatever that means. Sometimes well-meaning family and friends decide that it’s time to help move things along. They start asking, “when are you going to donate all those clothes?” or, “don’t you think it’s time to get rid of the reading glasses?” They want you to rid yourself of the physical reminders of what you have lost as if that will help you “move on.”

Great news, though: you don’t have to get rid of anything. The people who are telling you this don’t understand that the clothes and the pictures and the glasses aren’t preventing you from getting over your loss. For some of us, keeping those things around is like having an anchor. There’s a reason we have cemeteries and shrines and altars to the dead: we want something physical to go to, to be near, to hold, so we can grieve.

After my mom died, a pair of her slippers stayed by the door for like, four years. I could not bear to move them. She had left them there, thinking she would be back to slip them on when it was cold in the house. She had touched them; that made them sacred. After awhile, the spell was broken and they were put to use by other feet. I can’t tell you why it changed; it just did.

This is all to say, there’s no rush to get rid of the stuff. You are not stuck in your grief if you aren’t ready to clean out the closet or put away the pictures or take off your wedding ring. On the contrary, you are moving through your grief by experiencing it. Some well-meaning (but very wrong) person may soon ask, “when are you going to get rid of all this stuff?” When they do, you can answer, “when it’s time.”

What if I want to know about my therapist?

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Once, during a job interview, the interviewer asked to describe my boundaries with clients. A pretty vague question, right? Like, it depends! But seeing as how I was in an interview for a job I wanted (and eventually got, thank you very much), I played along and responded: I answer the questions my clients ask me (within reason).

Because here is the thing: when you are sitting across from me in that first session, I want to know some pretty deep stuff right off the bat. For instance, do you drink alcohol? Use drugs? Are you religious? Have you ever tried to hurt yourself or someone else? Not exactly cocktail party conversation. So if a client has a question for me (like how old am I or how many kids do I have, etc.), I’m more than willing to answer.

Some things about me are already clear: I wear a wedding ring, for instance. I’m fairly young. I’m a woman. I’m white. For some therapists, this is about as much information as clients are allowed to know. There are different schools of thought and none of them are wrong; in some ways, it’s a personal preference. There are good reasons for a therapist to not spend a lot of time talking about herself. For one thing, that’s not why you’re paying me; we’re here to talk about you, my friend. For another, some clients use this tactic to deflect and avoid the stuff they need to talk about. But I think, especially in the rapport building phase of therapy, it’s normal for a client to wonder, who is this person I’m telling all my secrets to?

So ask away! If I don’t want to answer, I won’t. Part of this process is developing a relationship and setting boundaries within it. I’m happy to tell you that I have two kids and a little dog and a husband. I’m happy to tell you that I’m in therapy myself, and that it helps me be a better therapist for you. I’m happy too, to talk about why you want to know about me instead of telling me about you. Like I said last time, almost nothing is off limits. This is a road we walk together. So tell me, what do you want to know?

May her memory be a blessing

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There have been a lot of deaths recently. Maybe that sounds strange. Of course I’ve had a lot of patients die; I work in hospice, after all. But, as any medical type person can tell you, sometimes deaths come in clumps. When there are so many so close together it feels like whiplash. Because in the meantime, as patients are dying, I’m getting new referrals every day. I feel like some kind of hospice robot: “Hi, I’m Elizabeth, I’m a social worker from hospice, I’m just calling to introduce myself…” The weight of all this loss does pull me down sometimes but more so, I’m afraid I will lose some sense of importance in my work. That I will become numb to the endless death as a way of protecting myself but as a result, I will also lose some empathy.

But yesterday I lost one of my favorite patients. At the beginning of my practice, I would have been too afraid to name her that way; I thought you couldn’t have favorites. But my very wise hospice preceptor told me at the beginning of my hospice career that “one out of every hundred can really get to you; more than that, you’ve got a problem. But you’re allowed one in a hundred.” I keep those words close to my heart for days like this. The patient I lost over the weekend was one of those hundred, the first one in a long time, in fact. Her death really hit me.

That’s hard to say, honestly. It’s hard to explicitly acknowledge my grief when I lose a particularly dear patient. I suppose it’s because I’m afraid that I’m too close or burnt out or not doing it right. It doesn’t happen with every patient, of course; that would lead to burnout. But when it does happen, when I lose a patient I particularly liked or even loved, what should I do? How can I memorialize a loss that isn’t really mine? The waves of death have numbed me a little of the years but then this lovely lady died and it knocked me over a little. It reminded that I’m not actually a robot. I am, it turns out, just a person—a person who sometimes misses patients who have died. I know they are remembered by the people who loved them but I want to remember them too. I want to acknowledge the loss of someone special to me, even if it isn’t really my loss to bear. It is allowed. It is part of what makes this work so sacred and beautiful.

So here’s to her—and to the few before her, those other “ones in hundreds” that float up in my memory today; may their memory be a blessing.

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Too much and also not enough

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Today’s theme is: nothing would be enough.

Something I’ve learned about the physical process of dying is that it can take a long time. And during that in between time, when someone is slowly slipping away, there isn’t a whole lot to do. Family members ask me all the time what they should be doing, besides medicating and sitting and doing the personal care that a living/dying body still requires. And all I can tell them is, what you are doing is enough. There is no secret other task to complete; you’re already doing everything you can. Lately I’ve learned to add, it doesn’t feel like enough, but nothing would. Nothing would be enough.

Extrapolate that thought to the situation we all find ourselves in: the seemingly endless marathon of work and childcare and eldercare and anxiety and boredom and news and sickness and and and. Nothing we are doing feels like it is Enough: there are not enough hours in the day, not enough mental space to hold all the events of the world, not enough self care, not enough socialization, not enough of anything. And yet, what could be enough at this moment? What would be enough, except to return to our normal lives?

So much of my work is giving permission to others to let go. I have leaned over the bed of a dying body and whispered that it’s time to go. I have sat in intimate silence with near strangers and assured them that it is not cruel, but loving, to want their loved one to die instead of live in suffering. I have encouraged both the dying and then the bereaved that what they are doing is enough, even though it doesn’t feel that way. I have said it in supervision, to social workers who feel they should be smarter, more skilled, better advocates. I have meant these words every single time. But I find myself forgetting to apply them to myself.

I could make you a list of all the times over the past ten months—the past ten years, really, of my career!—that I have felt I did not do enough. I think any social worker could list for you the mistakes they’ve made over a long career: resources they did not know about, clients they could not reach, tasks they forgot to complete. But I would also argue that what has gone undone is far, far less than what has been done: referrals made, clients heard and supported, minds changed. Even when we feel that there is not enough—not enough resources, not enough time, not enough of us—we continue to do the work.

And so I give you permission—who am I kidding, I give myself permission—to let go of doing more. There is no more; there is what we are doing and it is enough.

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Burning out, taking care

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I don’t want to write about burnout.

I don’t want to write about self care.

I don’t want to reiterate and review what we all understand, not only as social workers but as parents trying to maintain some normalcy for our children; as professionals attempting to be effective and innovative with new work challenges; as adults navigating how to safely socialize with our loved ones. I don’t want to acknowledge that I have hit a wall because we are six months into a global pandemic and in the midst a political horror show and I have two little kids and three jobs and it’s honestly just too much.

The thing is, it’s not hard to write about burnout and self care: they have become meme-ified and pop cultured to death. There are articles and BuzzFeed lists and Tik Toks (I would imagine; I’m too old for Tik Tok) that explore these topics. But because the internet eventually blunts the edges of nuance from anything, these concepts feel more like buzz words than complicated and fraught issues. But there is nuance to be found. There are levels of burnout; there are different forms it takes, different ways it manifests, not just in our professional lives but in our personal lives. There are ways to talk about self care, too, that are complicated, that force us to consider the complicated nature of society and privilege, that go beyond “make sure you’re getting your 8 hours of sleep a night!” There may be nothing new, exactly, for me to say about burnout and self care, but here I am. Again.

I am tired. I am tired of a pandemic that has robbed me of the most basic joys of my life: overscheduling our weekends with out of town visits and parties and tertiary friends. I am tired of a political discourse that is disappointing at best and disgusting at worst. I am tired of a scary and unknown future that awaits us with climate change and racial violence and injustice. I am tired of the news, every day, of people in power doing the objectively wrong thing. I am tired of checking off the box on my psychosocial assessment that says I provided education about self care to the patient and their family. Did I do that? Did the words ring hollow? They ring hollow in my own mind so I imagine they aren’t coming across full of vitality and assuredness.

I am sleeping; I am eating; I am exercising (kind of; running up the stairs twenty times a day counts, right?). I am doing the self care things but I am still in the burnout place. That’s why I keep returning to these concepts. It is not as easy as saying “treat yourself” and getting a pumpkin coffee. Self care is complicated and difficult because the majority of us cannot just turn off. In fact, I know I’m luckier than most. I can’t write about self care and burnout without also acknowledging my great privilege. When I am exhausted, I have a partner who can pick up the home and kid slack. Although I am enraged by the lack of justice for my Black brothers and sisters who have been murdered by police, my whiteness allows me to be only angry, not traumatized. When I have reached my limit at work, I can schedule an easy day or call out sick. But I am still struggling.True self care does not feel possible in this environment. I keep thinking to myself, there is a way to be restored. But what is it? How do I find it?

This is the part where I should review the signs of burnout and tell you some of my favorite self care tips. But I don’t think that’s what we’ll do today. Instead, I want to thank you for reading; I feel better after the words are out of my head and released into the world. And I want to say, too, that I think it’s ok to hit the wall once in awhile. Sometimes doing the best you can is to let go of the best and just, you know, do.

Be well this week; I’m certainly trying to be and I hope you are as well.

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Finding hope

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There is a lot of hope in my work.

I know that sounds strange because I work with people who are dying and grieving, but my experience mirrors that old adage that hope is like oxygen: we need it to survive. The concept of hope changes for my patients over time; they go from hoping to get better to hoping to die, comfortably and with dignity. But still, the overwhelming feeling I meet is hope. And while I am inspired and awed by it, witnessing hope in these circumstances can be tricky.

A few years ago I went to see a young patient who was actively dying. I can’t remember her name but if I close my eyes, I can see her face: I am in her apartment, with her husband and her sister; I can see their faces as well. I can see the patient beginning to leave her body; that is, she was physically still with us but her soul (or whatever you want to call it) was not totally there. And I will never forget, while she was breathing in that shallow, erratic way that means death is close, her sister said to me, “Other people get miracles; maybe she’ll get one. Do you think that could happen?”

I’ve met this experience so many times during the six years I’ve worked in hospice: hope crashing into reality. And what is my role then? How do you validate someone’s hope and fears and raw grief while also educating them about what is actually happening? How do you say nope, no miracles today, she’s already leaving us? It would be cruel, in that moment, to say those things but it would also be cruel to lie and say, yes, it’s possible she will sit up and the cancer will be gone and she will be your sister again.

Despite the scene being so vivid in my mind, I can’t remember exactly what I managed to reply. My hope is that it was something like: “I hope that’s what happens; but what we’re seeing makes me think we’re at the end. And I’m so sorry.”

My words are lost to me now, because they aren’t that important. Instead, the lesson of being very still is what has stayed with me. In those moments, when the family is in a kind of chaos, I am always tempted to rush: to meet the family’s anxiety with my own out of some weird empathetic sensibility. Instead, I have trained myself to become as still and quiet as possible, to try to spread calmness through the room, even as I feel afraid to say out loud that there will probably not be a miracle.

I’m writing this today because I have been thinking a lot about hope in the past several months. I often feel a dearth of it when I read too much Twitter or see someone in the Wawa not wearing their mask correctly. I wonder when this will end, when we will get to the other side, when I will be able to hug my friends again. At moments (just moments) I feel hopeless. But my work brings me back, somehow. There is hope to be found even in dying. If that can be true—and I promise, it is, I have seen it—then there must be hope to be found anywhere.

Image by John Towner

Image by John Towner