As someone who loves food and cherishes family, I never quite understood the notion of dreading Christmas – until the year that grief came knocking on our door.
That year, my young sister-in-law died in her sleep. Her chronic illness wasn’t meant to be life-threatening, but she was gone before 40. The ensuing days were a blur. Amid the philosophical question of why, there was an enormous amount of actual work – at the house, bank and so many places in between. The grief weaved in and out of all our days, but it weighed most heavily on her broken parents.
We figured Christmas would be hard. The easy way out might be to skip the occasion. But that seemed, well, the easy way out, and to my devout Irish Catholic mother-in-law, pure anathema. The food was the easy part: the traditional roasts and puddings to honour Irish heritage and the indispensable naan, butter chicken and prawn masala in a nod to Indian culture. But it was the table setting that gave me heartburn. Should I pair an empty chair with an empty plate and glass? Could a ceremonial photo faithfully represent a life? How formally to acknowledge the glaring loss?
In the end, I placed a small statue of an angel surrounded by a tiny wreath in place of a plate. As we sat down to lunch, my father-in-law unfolded a speech. In it, he reminisced about his youngest child and the happiness she had spread. As he recalled her favourite habits and haunts, his voice faltered. My devastated mother-in-law continued – and the loss felt exponentially larger, the air pregnant with sorrow. Earlier one of my children had innocently postulated that if everyone kept crying, the food would grow cold – suppressing a smile, I ventured that that wouldn’t happen if we first made room for their grief.
As an oncologist, I am no stranger to grief. Every year I talk to the bereaved about the difficulty of the “first” birthday, anniversary, and holiday. While they scarcely believe it, I know that most people are resilient and will find ways of coping. But this year I feel less sure about recovery, because in another year spent in the shadow of the pandemic, complicated grief is overlaid by guilt.
Everywhere you look, there is guilt. During prolonged lockdowns and onerous restrictions, patients with suspicious symptoms declined to seek care because they were afraid. Initially they feared catching the virus, but even after being vaccinated they didn’t want to be trapped in hospital all alone, a special curse for the elderly, confused and non-English speaking.
Imagine the guilt of the wife who knew that her husband was bleeding months before she forced him to get a colonoscopy. Or the son who couldn’t have known that his “just tired” mother harboured a neglected breast cancer. While their death could be attributed to “bad biology”, it does nothing to assuage the guilt of those who must live with their regrets.
But the worst guilt of all is felt by people who knew that their loved one was terminally ill and who had envisioned a different kind of death when it came: surrounded by love and care, if not peace and quiet. This simply didn’t happen. For most of the year (and even now) visitors were banned from the hospital. With guards stationed everywhere, the entrance to hospitals became a troubling and foreign sight with desperate relatives queuing up to plead their case, mostly denied.
A wife was willing to pay any price to see her husband from whom she had never been separated. A frantic father chased the ambulance as his disabled adult son was shuffled across hospitals. Hapless relatives from interstate or abroad faced such an exhausting challenge to see the dying that many never even tried. Last week, the independent Victorian ombudsman criticised the “unjust outcomes” and anguish caused by the narrow exercise of discretion in allowing exemptions.
Notably, the public health order always permitted visits to dying patients, but the catch was recognising that the patient was dying. Most doctors are poor at recognising the end of life: a deficit severely exacerbated by the lack of continuity as staff were furloughed, rounds were truncated or worse made “virtual”, and the patient’s staunchest advocates, the family, were kept away from the bedside. On one hand, people suffered from lack of timely care. On the other, the propensity of medicine to keep treating at all costs exacted a toll on the dying.
Once, I was called to see one of my elderly patients who had spent days in hospital without my knowledge. I walked in to find ongoing infusions of antibiotics and fluid in a patient with agonal breathing. My first call was to his wife. Starved for news, she raced to the hospital but as she reached the front door her husband took his last breath.
Amid the awfulness of the moment, my team was told that since the patient was dead (instead of dying), the wife could no longer come inside and would have to go to the funeral home. Our spontaneous, sheer incredulity won the day, and she was ushered in. She was “lucky” but far too many relatives never got to see their loved one at the end of life for a last caress, a necessary reconciliation, a final goodbye.
Psychologists are starting to see a wave of severe bereavement, the kind that impairs daily life and close relationships. In the United States it’s estimated that each Covid death there will leave nine bereaved.
This Christmas will bring a different kind of grief to the dinner table: anticipated grief intertwined with unexpected guilt. As a society, we tolerate controlled displays of emotion while balking at anything prolonged. But experts warn that the inability to express or revisit grief can be just as traumatic as the original loss. This is perhaps why in Macbeth, Shakespeare warned to “give sorrow words; the grief that does not speak knits up the o’er wrought heart and bids it break”.
The pandemic has changed a lot of things, but more than 400 years later Shakespeare’s advice still rings true.
So when we see our friends and family this holiday, the greatest gift we might have for the grieving is to make room for them to reminisce and regret while being fully present in the moment.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar.
