January 27, 2012
By Claire Edmonds, PhD
……….previously, we left our hero in the unlikely position of surrendering to the bereaved Mrs Smith, who is mourning the sudden loss of her husband. She has a painful tooth and in the process of opening up, she really opened up, something that happens to the bereaved in spite of their well meaning intention not to fall apart. Grief is like that, a tsunami with aftershocks, lots of them, and often ill timed and completely non-volitional on the part of the bereaved. Mrs Smith knows that she is in the dentist’s chair not the psychiatrist’s couch, but then, you did ask how she was… So, you have surrendered because you know there is no way out. You have to go through, not around. And in fact, by giving this situation its due time, you will in fact help yourself and Mrs Smith move through this moment with compassion and dignity. So what skills do you, our hero, have in your utility belt? First of all you are going to give her the gift of time which you will have indicated to her by putting down your instruments, taking off you mask and sitting calmly beside her. Well done, you are half way there. You will then indicate that you have heard what she has said. It doesn’t matter what you say specifically, but rather the tone and the intention that you bring to this moment. “Oh my, I had no idea, I am so sorry…” That’s all it takes- you are just acknowledging the momentous information she has just given you. Now here is the hard part. Stop talking. Do not tell her about your own bereavement experiences, do not change the topic, don’t tell her how she looks great, don’t ask her about her tooth. Just sit there. This is tougher than it looks because the voice inside of your head will be pushing you to do something, say something, anything that will circumvent the next moment. There is a part of you that doesn’t want to hear what she has to say, doesn’t want to acknowledge that nice people can lose someone they love, suddenly and savagely, doesn’t want to hear the details or witness her weep. But tough it out. If you can stick a needle into someone’s mouth and watch them flinch, you can certainly manage this moment by focusing on your breath and grounding yourself (like your patients do when that needle goes in).
If she feels safe and supported she will tell you more, she likely has a set story that she has been telling her lawyer, her mail delivery person, her hair dresser, her not so close neighbour. She may cry, you can hand her a tissue or two, but not masses of paper or she will feel like you are trying to glue her back together, like she is a broken. (She’s not, she’s just grieving) You can nod, make quiet affirmations like, “oh my”, “oh no”, “hmmm”, just to let her know you are there. When she stops, after she has given you the general lay of the land, it’s your turn. You want to speak to her from the heart, let her know that you heard her; “I am so sorry that you lost Gerry. What a shock it must have been. I can’t imagine”. Resist telling her that you know how she feels, because you don’t. You can’t, not in that moment. Let her have her feelings, let them be hers. Even if you lost a loved in the very same way, your feelings are not a part of this moment, of her moment. Don’t embellish, less is more. However, you might like to share a small memory, like the last time you saw him, or some small moment that lets her know that Gerry had an impact in the world, that he was liked. If it is appropriate, you might touch her forearm to help her ground in the chair a little. It may ground you too. Sometimes a touch can speak a thousand words. Finally, you may want to give Mrs Smith a few moments to compose herself. You might offer her some water. You might say something like, “I will back in a few minutes, I just need to check on another patient, and then we will look at that tooth that’s been bothering you”. This gives Mrs Smith a chance to regain herself and a chance for you to break the tension. Don’t leave her for long, just enough time to catch her breath. When you return, it will be time to give her the help that she came for- help with her tooth.
If other patients are annoyed that they had to wait a few minutes longer, you can tell them a patient needed your help and that if they ever needed extra time, you would be there for them too. Finally, after you have ascertained that Mrs Smith needs a root canal (poor lady, like she hasn’t had enough stress), you might want to comment on her courage to come today. She has take a big step in attending to her own needs, taking care of herself, something that the bereaved often have a hard time doing. You might say something like, “Mrs Smith, I am sorry about your loss. And I am so pleased that you came in for help today. Taking care of yourself is very important, I am glad you came. Now let’s make that next appointment.” A follow-up card of sympathy from you and your staff would be a nice touch. Well done, doctor, well done.
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