Lump (18)

We’re sitting on the couch at D & S’s house, enjoying good company with old friends and getting ready to watch an episode of “Orphan Black” when she makes a quip about dying within the year and suddenly I am all in pieces.  I have to look away while I compose myself and for a moment I can’t even trust myself to speak.  I’m shaken for almost an hour.

According to Kubler-Ross model explained in the book On Death and Dying there are five stages to loss of an intimate relationship.  Originally written in 1969, the model has been refined over the decades since, and is not without problems and criticism, but as a working model it isn’t bad.  The five stages are:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

Originally these stages were thought to be a) distinct and b) linear, but subsequent research indicates that they are more like a spectrum, people can feel more than one of them at a given time, and that people often bounce back and forth between the various reactions over time.  It is a much more fluid process than originally thought.  Nevertheless the reactions themselves are straightforward and easy to understand, and make a good basis for a discussion of reactions to death, with the understanding that it isn’t a checklist – people don’t go down the list one by one until they hit acceptance and all is well.

The Kubler-Ross model was also developed primarily to understand the process that individuals go through during the loss of an intimate relationship that they are going to survive.  Children of divorcing parents, lovers splitting up, and those who survive the death of a loved one.  But those who are dying of a protracted illness such as cancer go through the same general types of feelings.  So in this case I go through it, she goes through it, and everyone we love and who loves us goes through it too.

As I sit  on the couch with my face turned away, tears welling up in my eyes, I am in one place along that spectrum of reactions. Is it Denial?  Depression?  Anger?  It doesn’t really matter here.  The point is that when she quips about her impending death, she is somewhere else.  Denial?  Anger?  Acceptance?  She and I are going to go through this together, but we won’t always be in the same place in dealing with it.  It’s likely, in fact that we will be in different stages of dealing with Lump for the majority of her treatment.  Even in the times we are having the same reaction, we will very likely be responding differently.  The motivation may be the same, but the expression likely not.

The same holds true for everyone we love and who loves us.  They all go through the different reactions as well. Whenever we meet them they will be somewhere on the spectrum, maybe in a different place than we are, or maybe in the same place but expressing it in their own way.  Something we all of us need to keep in mind – this is a shattering event.  It changes us.  It affects us every day.  And it is possible that every day we will be reacting to it a little bit differently.

Given the complexity of the problem, the several stages of reaction, and the variety of individual expression at each stage, it is no wonder that traumatic loss is not something we talk about much.  The emotions that it brings up often push the bounds of socially acceptable behavior – one is not supposed to cry on the couch of one’s friends, for example.  In social situations it is so much simpler to not bring the matter up and risk a faux pas than it is to risk an emotional reaction that we cannot control.



Subsequent research on the Kubler-Ross model has given strong indications that positive outcomes are linked to positive environment.  In other words, as with illness itself, dealing with the trauma of illness and loss is made easier and is more likely to result in eventual recovery without lasting effects if it is done under good conditions.

Being with friends, interacting with them, enjoying their company.  These things make for good conditions.  Doing enjoyable things with enjoyable people is one of the best ways to influence the outcome of an illness.  And it is also one of the best ways to improve the outcome of a traumatic event.

Our society has it rather backwards in this regard.  We are taught that illness is weakness, that sadness is weakness, that stress is weakness, and weakness is to be hidden.  There is a certain sense, I suppose, in isolating those with communicable diseases, but cancer is not communicable.  There is a certain sense, I suppose, in isolating those with mental illnesses that might make them dangerous to themselves or others, but grief is not a mental illness.  There is a certain sense, I suppose, in giving people some time to themselves to process traumatic events and issues, but isolation is not a matter of privacy.

It is easy to be social during the good times.  It is easy to hang out with friends and talk about hobbies or vacations or books.  Hanging out with friends and talking about illness or death or loss is not so easy.  And make no mistake it is HARDER because when dealing with traumatic events we are all of us bouncing around up and down the spectrum of reactions all the time, and even within a given area of that spectrum our expression of a given reaction are going to vary from person to person.  Its as if we are all playing ping-pong, soccer, volleyball, basketball, and lacrosse all at the same time, trying to figure out which sort of ball others are tossing at us and what rules pertain to how we engage that ball and send it back appropriately.



This is where friendship is crucial.  This is where understanding is crucial.  This is where love is crucial.  This is where forgiveness is crucial.

Friendship is crucial.  Friendship provides the support that we all need in times of crisis and trauma.  It isn’t just about the one person undergoing the trauma – it’s about all of us because we are all reacting to that trauma.  Friendship flows in all directions – from her and to her, from me and to me, from those who love us and to those who love us.  Often we worry too much about doing the right thing, or not doing the wrong thing.  We think too much about how to avoid making the situation worse, and too little about how we can make the situation better.  Everyone wants to be a good friend to those they care about, but nobody wants to make the situation worse or become burdensome to those going through trauma.  Too often we forget that the person going through trauma is going through trauma – but the people who love that person are going through trauma too.

Understanding is crucial.  At times of trauma, people are going to react. Everyone who cares about the person who is undergoing the trauma is going to react to it, is to a certain extent going to be going through the trauma as well.  Understanding by everyone concerned that this isn’t just an event she is experiencing, or an event that she and I are experiencing, but an event that we are all experiencing, and event that we are all traumatized by, that we are all reacting to, is necessary in order to provide good care and maximize the chances of good outcomes.  For all of us.  We all need to recognize that we are needed, and at the same time we are at our most vulnerable.  It is true that there is always something going on with everyone, but particularly traumatic events like cancer are unusual and we react to them differently, more strongly, than we do to the everyday little dings and dents that life puts in us.  That said, no friend is going to set out to be hurtful at times like this.  Its important to understand that, and to react to what friends say and do with that in mind.

Love is crucial.  We tend to use the word “like” for friendships, but particularly for strong friendship the word “love” is, I think, more appropriate.  Again because our society is sometimes less than totally forthright about emotions, our language tends to downplay them, using words for our feelings for friends that are the same as our feelings for ice cream.  But we love our friends.  And they love us too.  It’s important to remember this during times of trauma, because emotions are all over the place right now.  And far from being some sort of problem, or thing to be avoided or glossed over or ignored, this is a good thing.  Really,.  Remember – we’re all going through this together, and the reason that we are all going through it together is because we all care about each other.  And the fact (fact!) that we all care about one another is the key to positive outcomes for all of us (all of us!).  Our culture tells us to shy away from this, but it is important that we do not.  Because if we love someone, and we love (love!) our friends, we want good outcomes for them.  And good outcomes in the case of traumatic events spring from the sort of support you only give to those we love, not to our favorite flavor of ice cream.

Forgiveness is crucial.  All of the above leads to this – during a traumatic event we are all of us experiencing a whirlwind of emotions.  These will change from day to day and even from hour to hour.  Even acceptance isn’t the end of turmoil because acceptance will come and go over time just like the other reactions.  Because we are individuals, our reaction to and expression of those emotions is going to vary considerably.  Jokes about death for example the could be an expression of any stage of the Kubler-Ross model depending on the individual and depending on the type of humor.  Because we all of us will be reacting differently to trauma at any given time, and because our expression of that reaction differ even if we are going through the same “stage”, it is extremely easy for us to hurt one another.  If she is floating around in “Bargaining” today and I am in “Anger” we are going to express ourselves about the same trauma very differently.  Even if we are both floating around in “Acceptance” our expressions of that acceptance may be very different.  What feels like “Acceptance” to her may feel like “Denial” to me.  So emotional collisions – potentially painful emotional collisions, are inevitable.  We all of us are going to hurt.  We all of us are going to be hurt.  Maybe a little.  Maybe a lot.  But the pain is, if not inevitable, at least hard to avoid.  This is why we need to forgive. Consciously.  We tend to forgive friends readily, but at times like this the idea of forgiveness needs to come to the forefront for us.  There is a wound in our hearts and minds and souls.  That wound is the trauma.  And in order to bring about good outcomes (which we all want), we need to recognize that wound, and that we are ALL wounded, and that good outcomes means good outcomes for all of us.  Sometimes because of how we are dealing with our own wounds, we may accidentally poke the wound of another.  And we all react badly to pain, whether it is physical or emotional.  But at this time when we are at our most vulnerable,  we also need to be the most willing to forgive hurt, and not simply out of kindness (though kindness is nice) but because the people who have the highest chance to hurt us are the people that we all need the most to support us and help us through.

We’re in the car on the way home, when she speaks up.  She says she knows that her quips upset me and she apologizes.  I tell her that it’s OK and it is – because I understand after giving it some thought that quips about death were the way she needed to express where she was in the process at the time.  And yes, they hurt me, because I was somewhere else in the process when she said them.  But that is almost always going to be the case.  It can’t be helped, its just the way our brains deal with traumatic events and we can no more change it than we can stop breathing.  Now she understands, because she is my friend and she loves me, that because I am her friend and love her too that I will forgive what I understand to be an honest and necessary expression of her trauma processing.  And because I am her friend and love her, I trust that she will forgive me for making this processing harder by my reaction to it.

And so we drive across the bridge, heading for the future.

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