Grief takes no holidays

23rd December, 2020

I originally wrote this column just before Thanksgiving one year, and then updated it in 2012 after the tragic massacre of the Newtown first-graders. Now COVID-19 — and all the losses and grief that 2020 has brought — makes it only too relevant once again. For families who have lost a child, each holiday brings fresh grief, hurdles to face, and mourning for celebrations that will never happen.

The glittering commercialism and noisy cheer of any American holiday can be stressful for most of us. But for the parent who’s lost a child during the past year, facing the first of many holidays with an empty place at the table can make already unbearable grief so much worse.

No one in modern America expects a child to die.  Children only die in nineteenth century novels and third-world countries, or so we’d like to think.

Yet accidents, violence, sudden infant death syndrome (SIDS), and cancer, among other causes, claim the lives of thousands of American infants and children each year. In 2020 we’ve also seen children die from a new illness — multi-system inflammatory syndrome in children, or MIS-C — following infection with the new coronavirus. Their bereaved parents become unwilling members of a club you never want to join—parents who know what it’s like to stand at your own child’s graveside.

If you’re a physician and it makes you horribly uncomfortable to consider that thought even for a moment, that’s good. Otherwise, you can’t relate to a patient or a friend whose child has died. No matter what your specialty is, eventually you will encounter bereaved parents. Medical education outside the field of psychiatry gives us little help in knowing what’s helpful to these families and what isn’t, especially during emotionally charged holiday seasons.

I can speak to this subject as a mother and a physician because my baby Alexandra died when she was five months and sixteen days old. It was a long time ago, but here is the first piece of advice I can give to anyone: understand that the pain of losing a child never disappears.   You’d be surprised how many people think that any parent—a patient, co-worker, or friend—should be “over it” in six months or so.  I wish that were true.

“How many children do you have?” That innocent question poses a painful dilemma for the grieving parent.  I’m fortunate enough to have three wonderful adult children, but it’s still tough to answer.  If I say I have four, then the natural follow-up questions about their ages and what they’re doing become increasingly awkward.  If I say three, then it feels as though I’m betraying Alex or forgetting her. To answer “Three living” is a serious conversation-stopper that seems unfair to toss like a grenade into a casual chat.

Perhaps a better conversational opener is to say, “Tell me about your family.” In a medical interview, this gives the patient leeway to disclose painful information in whatever way is most comfortable. In a social situation, it allows the respondent to divert the conversation gracefully to the latest misdeeds of the family’s golden retriever if that’s what she’d prefer to talk about. The emotions of recently bereaved parents are terribly raw, and it can be hard for them to cope in social situations where tears would be out of place.

It’s hard to advise any grieving parent about the best way to approach the first holidays after their loss. In the best-case scenario, other relatives are understanding and supportive, and can host a holiday gathering at another home; of course, this may not be an appropriate option for 2020 in terms of COVID precautions. If there are other children in the family, the presence of close relatives may be the best way to allow them to celebrate the holiday without guilt and give the parents some respite.

For other parents, it may be helpful to do something that is completely different from their traditional holiday routine, acknowledging that this first year is going to be painful and difficult no matter how they choose to manage it. Volunteering at a local food bank may be a meaningful option for families with older children.

Support groups can be extremely helpful, especially around major holidays.  If you refer a patient to a support group, make sure in advance that the composition of the group is appropriate. An infant loss support group that consists mostly of women who have suffered miscarriages will probably not be much comfort to a couple who has lost an infant to stillbirth or SIDS. Parents who have lost an adolescent child to suicide or drug overdose have different needs than a family whose child died of cancer.

Symptoms such as appetite disturbance, sleeplessness, lack of energy, or fearfulness can be well within the normal spectrum for many bereaved parents, especially during the first year or two. Patients may present with digestive dysfunction or secondary infertility. As an anesthesiologist, I’ve met patients coming for surgery who seemed at first hostile, difficult, or unusually anxious; the underlying reason turned out to be that they had suffered a recent death in the family. It’s been helpful for me to be able to say that I have been through the experience of loss, and describe how—almost imperceptibly at first—sorrow lightens over time.

If a parent is unable to return to a normal level of function, and especially if care of other children in the family is compromised, referral for psychiatric evaluation is mandatory. It can be tempting to try an antidepressant first, especially when there is a long-standing relationship between the patient and a primary care physician or obstetrician. But for young parents, the sexual side effects of serotonin reuptake inhibitors can be distressing, and can interfere with success in conceiving again. The wrong medication choice could delay a return to normal sleeping patterns, and in rare cases increase the likelihood of a suicide attempt.

I still remember well our first Christmas without Alex, who would have been fifteen months old. We decided to leave our home in North Carolina and visit relatives in Los Angeles. I was seven months pregnant. To say that I was in emotional turmoil most of the time would be an understatement, and the boxy hotel room with its small artificial Christmas tree didn’t help.

But the hotel had an outdoor pool that was heated year round, and on Christmas Eve, though the night was chilly, we went swimming. As I floated in the warm water, looking up at the stars in the night sky and feeling weightless for the first time in weeks, I remember a flash of hopefulness. That was the first moment I thought that happier holidays might actually come again, and in time it proved to be true.

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