How to Grieve

The bereavement fair is coming to a location near you

Grieving is a process. The psycho-babblers describe five stages of grief, which they label Denial, Anger, Famine, War, and Conquest. Or something like that. It really doesn’t matter, because after this generalization, they go on to say that the stages are totally different for everyone, which is a pretty effective disclaimer. When my wife died I was vaguely aware of all this, and I knew that I would go through a series of changing emotions lasting indeterminate amounts of time. What I failed to appreciate was the extent to which this process has been dissected, defined, addressed, and monetized by the medical establishment and its metastatic associates.

My foot got hurt a couple of weeks ago, so I made an appointment to go see Dr Oops1. It was the first time I had seen her since my wife’s passing, and she hugged me while collecting her co-pay. In the examining room she poked at the sole of my foot for a while and said “That’s weird”. Then she told me it should get better by itself and to see a podiatrist if it didn’t. On my way out, the nurse gave me a smile and two sheets of paper. One was a referral to a podiatrist in Pacifica. The other, in standard operating procedure format, was entitled “Grief (Actual/Anticipated): Home Care Instructions”.

The document began by undermining its own existence with a paragraph explaining that grief is natural and does not require medical treatment. I surmised that there must exist aberrant grief conditions that do, in fact, require some medical intervention because the document went on for a full page after that. Indeed, some of these situations were listed:

Contact your doctor if you have any of the following problems that last for 2 or more weeks:

  • You feel sad a lot or cry all the time.    I have to say I found the prescribed interval for chagrin to be a bit meager. I have been sad for far more than two weeks. I haven’t told the doctor, though, because it seems ridiculous to dwell on it. And I really don’t want any Prozac.
  • You have trouble sleeping.     Sleeping has not been a problem. Waking up is where it gets hard.
  • You find it hard to concentrate, make decisions, or remember things.     This, too, has been going on for more than 2 weeks. More like 20 or 30 years, actually. But Dr Oops knows about this already: she insisted on putting me through some kind of cognitive ability test one morning last summer, before I’d had coffee. She gets a remittance from Medicare.
  • You change how you normally eat.     My refrigerator’s content is now comprised of a half dozen eggs, a sixpack, four peaches and a supermarket roasted chicken. Also 12 bottles of mango protein shake.
  • You feel guilty about the death or loss you have suffered.    I’ve discussed this previously.
  • You are using alcohol or drugs to help you cope with your loss.     I use alcohol or drugs to cope with everything. That’s what they’re for. If I told my doctor, I’d just get hassled and given a prescription for some other drug, something made by Lilly and stepped on by CVS. Who needs it.
  • Be sure to contact your doctor if you think about killing yourself    It’s good to know she’ll be there for me. Suicidal urges must be managed on an appropriate schedule, however. If I call Dr Oops’s office between the hours of 12 and 2 on weekdays, I will be informed that the staff are at lunch. If I call on a weekend, I will hear recorded laughter.

Curious about where my small town doctor was sourcing her prose, I looked more closely at the paper I’d been handed. In the margin there was the web address of a company called athenahealth (“At athenahealth, we put people first”). Apparently, they are Oops’s chosen provider of electronic health records and home care instructions, including grieving protocols for those having recently lost a spouse, job, or pet.

It is in the nature of businesses to differentiate themselves by offering their customers more services, especially ones that can be culled from government databases and cost nothing. It is in the nature of entrepreneurs to fill niches, offering to those who grieve — and to those who know them — every conceivable solace. And so we have grief counselors, support groups, grief camps, sleeping pills, and home care instructions to go along with the cards and tissues.  And these are offered by companies and charitable institutions, and it is in their nature to hire management and staff and to protect their economic turf and thereby their salaries. And so, out of death, an industry is born.

At this point I received a phone call from Dr Mimi, wife’s failed oncologist. My nosey eldest son had contacted her and voiced concern about my mental state, my ability to cope with engrievement. What an asshole. Dr Mimi wanted to reach out to me, all according to best practices, and to offer me the resources of her formidable university. Normally I would have blown her off, but the word “resources”, unexpected in this context, somehow made me think of Australia, which is being exploited by the Chinese according to an article I had been reading while practicing grief unassisted. In private. This left me slightly confused, and I agreed to have her send these resources, whatever they might be.

They turned out to be links to some websites, online grief clearing houses. I felt compelled to explore.

The first was an outfit called Kara (“Our guiding value is empathy”), with the succinctly delineative web address Kara sends out volunteers to support dying patients and survivors in the Palo Alto area. I’m not sure what the volunteers do, actually, but it seems all to be based on something called the Shanti Project, so I think mantras must be involved.

I moved on to Pathways, a provider of home health and hospice care. Pathways publishes a quarterly newsletter, “Seasons Through Your Grief”, for those who want to be kept up to date (on grievous matters?). I learned that Pathways partners with, “the premier resource for condolence, sympathy, and loss-related content and gifts”.

These outfits offer counseling, workshops, support groups, memorial events, and more. There was also a link for Hospice by the Bay, a UCSF affiliate which is currently advertising for graduate students to apply for bereavement internships. Send an email to Human Resources.

For myself, I have no use for most of these professional outlets. I’ll keep my distance from the ghouls, thank you. I’m not a social person, nor do I choose to grieve in the presence of others, to elicit rote responses, however sincere or adept. The thought of support groups is revolting. Why would I want to rub elbows with a bunch of other people who have just suffered a loss? Why would I listen to their stories? Fuck them.

The dynamics of the market affect everything in society, of course, and it’s interesting, if depressing, to see them play out here. Functions once considered religious have been deconsecrated and market segments are being contested by lay, medical interests. But why go to a doctor for something that is natural and does not require medical treatment? Why not apply the AirBNB model? Locally sourced solace. Through a central booking service, empathetic individuals could set up shop, offering a kind ear, platitudes from a list provided by the franchisor, and perhaps access to a room with yoga mats. All for $75 an hour billed to your insurer. Everyone makes out. Some would specialize in clients grieving for pets — a lucrative market segment, as the shorter lifespans offer potential for repeat business. Others might choose to concentrate on those in the less violent stages of grief, avoiding clients who might kick walls in anger and risk hurting their own feet.

1 The naming of Dr Oops is described here.


Lips Stuck Together

Adjusting to solitude

At first I had no idea how much it would affect me. I hadn’t thought ahead or even considered this possibility at all, although I should have. We could all see how sick she was. But at the time I simply couldn’t make my mind confront that scenario. And then I was numb. For a long time, I only thought I felt the pain, but I was in shock. So it wasn’t until weeks after she died that I began to realize what it meant to lose not just my wife, but the only person I’d ever really wanted to spend time with.

My life changed completely in those few weeks, as events faded into routine. It’s not just her death, there is this, too: I’m almost always alone, now. There is no one else. There’s no one to bring news to, to make laugh, to ask for an opinion. It’s  as though I was transported to another planet, and I must learn to live the life of an expat. This daily solitude was easier for me long ago, when it was voluntary, a circumstance somehow leading toward the life that lay before me. I actually enjoyed being alone back then. But now, all that lays before me is a few more years of the same. It has become more difficult.

There are many things that I can’t do on this new planet. Restaurants are impossible, there is nothing to do there except think. I see old couples sitting at other tables and jealousy wells up inside of me. How come she gets to live? Why are they allowed to be happy? I try to go early when places are empty, sit at the counter, have a quick burger, and leave. Fine restaurants, long meals, those things are out of my life. I can’t do them any more. Concerts, ballgames, any entertainment you would normally go to with a spouse or significant other — where I would have taken her — are off limits, as well. I can’t do them alone, and I don’t want to go with another couple, to be a third wheel. Charity is embarrassing, however well meant.

Even travel, once one of our great joys, would be a constant reminder of her absence. We were thrown together all the time overseas. But that kind of adventure — that once brought us so close — would now make this solitude even starker.

So I sit in the house alone, eating takeout and trying to work on my projects. Some art, a photograph, a piece of writing. It’s all completely pointless. No one is going to look at them, appreciate them, or even care that I’ve done them. Why do I bother? Just to pass the time? Waiting around to die.

Every once in a while the phone rings. One of the boys checking up on me, or some friend who has promised to “be there” for me. I have to lick my lips before I speak. They are stuck together from disuse. I’m glad to hear from people, of course, to break up the long day. But I can’t help feeling that I’m a burden. The guy who’s alone, with whom we should spend some time. Practically all of the friends I have were made through her. I was part of the bargain: you had a put up with the husband. Now that she’s gone and I’m the whole ball of wax, it has to be far less appealing. And the smell of death is on me. I am more than ever a pariah.

My life has become a sort of minimum security prison. I can come and go, but some places, some activities are off limits. And I’m definitely trapped, no way to get out. Life sentence with no parole. There are times when the realization that I can never speak with her again fills me with panic. Like claustrophobia, it makes me jump out of my chair. Pacing empty halls in the house where we once lived, I wish there were some way I could join her. But, how? I’m far too much of a coward for suicide. So for now I’m stuck here, like a refugee longing for distant shores that can only be imagined. Will I find her there?

There are times when anger overflows and I break down, swearing out loud in these empty rooms at the god that did this to us. This senseless thing. I call it a coward as it crouches in hiding, wanting to anger it, to make it strike me down, too. But it is too cruel to do that to me now. It’s going to make me wait.


Good bye to my best friend

Thanks to all of you for coming. Raye would’ve been so happy to see you all here, she so loved this community, and of course her family and friends who have come here to be with us today.

Raye loved the coast with its foggy weather, and she loved the people we met here. The friends that we made, some of whom have become like family. She felt that she belonged here, and that gave her happiness.

She gave back as much as she could, as a teacher, a volunteer, as a mother. To me she gave the most of all, as a wife of 45 years. I’ve lived with her all of my adult life. And I loved her, as many of you did, but in our own special way.

I took her for granted in a lot of ways, the qualities she brought to our relationship that made it so comfortable, so easy to live together. So lately, I’ve been trying to articulate what it was that made her so special. Maybe some of you saw the same things in her, and that’s why you have come here this morning.

We all knew her as a lively, funny, cheerful person who was fun to be with, of course. I loved those things about her, but they weren’t the real reason I felt the way I did. There was a lot more to her than that.

For one thing, she was creative. And tasteful. And enterprising. We remodeled our home once, knocking out a wall, and she designed our new space. Hired contractors. Painted walls and doors herself. Now I live in that environment, and she’s still there with me, wherever I look. But her creativity wasn’t the main reason I loved her.

And she was smart, too. Not with words or technology, but with people: she could understand and communicate like I never could, in ways that didn’t require words. On a trip to Japan once, we were in some store buying lacquerware. I’d been studying Japanese for a few years and I was trying to deal with the shopkeeper, who spoke no English. When I pulled out my credit card to pay he started asking me something very complicated. I had no idea what he was trying to say, but Raye figured it out right away: did I want to pay in installments. She didn’t need words. She understood gestures and attitudes, looked in people’s eyes to know what they were saying. I didn’t realize how smart she was, at first, because I’m not like that at all. But although I really came to appreciate that perceptiveness, it wasn’t really the main reason that I loved her, either.

You may not know this, but she was an adventurer. You have to have adventures in life, that was our credo, and Raye was game for anything. Right after we got married we wanted to travel, but we didn’t have much money. Still, we saved up what we could, quit our jobs, packed up our apartment, took backpacks and hitched around Europe for a year. Throughout our lives we managed to create opportunities to travel, Malaysia, Europe. month-long trips to Japan.  Everywhere she would meet people, interact and learn things even though she often didn’t speak the language. I often spoke the language but would just stand around and stare.

And she had the courage for adventure. She was brave enough to follow me into a post-doc’s uncertain career in the Midwest, and ultimately to our landing place out here, with two kids in tow. Raye was always positive, she faced any challenge or catastrophe with optimism and resilience. When we hitchhiked, she always knew a ride would come. And she believed she could beat the cancer that finally killed her. Even in the worst, painful moments of that fight, she carried herself with dignity and grace.

She was intrepid and I loved her for it. It made so many things possible, but even that was not the main reason I loved her.

Raye was above all a very loving person. She could look a you in the eye — not just me but many people — and say I love you and mean it. XOXOX. I could never do that. Her love kept looking for ways to express itself. Mine was usually hiding. And she loved so many people, her family, her friends, the children at Farallone View, the school itself. I could only manage a few. She looked for the good in people, in me, in you, in the bad boys in her 5th grade class, and she always seemed to find something to love.

In love she was generous. Give the waiter a nice tip he was one of my students. This cousin needs help with tuition. And she was always willing to give something up. She took pleasure in giving. If you needed something, she would just look to see if she had enough. I’d look to see what we’d have left afterwards, but she never worried about stuff like that: socking it away for her old age.  It just made her happy to give to the people she loved.

In love she was supportive, she wanted to help people achieve their goals. After all, she was a teacher, and a great one. An enabler. She supported me while I went through grad school, pushed me to go there in the first place. It made her happy to see me succeed and to have been part of it.

In love she was responsible, late night homework grading, meetings. Getting to class well before the kids to set up. You weren’t just going to school, you were going to Mrs Furst’s room, she was always there to let you in. Kids felt safe there. They trusted her. That gave her joy.

So, while I loved my wife for all the reasons I’ve mentioned: her creativity and adventurousness, her perceptiveness and humor, perhaps my greatest reason for loving her was that she was so full of love herself, of laughing, selfless love, that I just couldn’t help myself. She knew how to love, and I didn’t. But when she looked at me, she saw something good there, too. And she trusted me, completely, with no holding back. There was never any doubt in our relationship.

We were opposites in many ways. She was always cheerful, I was a grump. She was gregarious, I am a hermit. Her glass was half full, I had an empty paper cup. She held everything precious, I took it all for granted. She thought I was the greatest thing on earth, and I didn’t even realize what I had in her. But she knew how I felt about her, even before I knew it myself. That made her happy, too.

She understood me, and we fit together perfectly and resonated. Together we were more than the sum of our two parts. Often we would sit in separate rooms at home, each doing our own thing. We were alone but we were together. We were always together.

Now she’s gone and the parts can’t match up anymore. But she gave me something in our 45 years together.  She changed me. Where the pieces used to fit, my edges aren’t as rough as they used to be. So in a way I still carry her with me, and I always will. Maybe it’s the same for some of you. Maybe she changed you, too, in some way, and you’ll always have that.

Raye was very happy in this community, that’s where we can find consolation in her passing. She lived a good life here, really felt that this was home, the place where she belonged. That was important to her. Many of you have come this morning because she touched your lives in some way: as teacher, colleague, family or friend. You’re the reason she was happy here. You should feel good about that. She loved interacting with you and she felt your warmth and regard for her. You gave her joy, and I thank you.

And now, let’s raise these Mimosas in a toast and send her on her way with one last blast of love.

Raye Furst
Raye L. Furst   August 2nd, 1947 — April 2nd, 2016


Advance Directive

Do Not Resuscitate

160331_1533 As you walk past the nursing station you see them. The patient binders. They contain medical records, test results, insurance papers, the documents describing these failing bodies. And in each one a sheet of red paper, the advance directive. Instructions to follow in case of a critical event. The name of the party responsible for making these decisions if the patient is unable. Last week, that was you.

There are three questions on the page. Should the heart be forced to beat if it stops? Electric shock. Massive pressure. Should a breathing tube be inserted if the patient cannot breathe? Should a feeding tube be used?

You had discussed this in the past of course, the two of you, as you filled out these papers. An abstract exercise. There was agreement: no heroic measures. But a grey area, as well: if there is a chance of recovery, a normal life, maybe then…

Last week it became terribly real. She lay there babbling, unable to respond. 911. You followed the ambulance to the ER. They told you to send for your kids.

You already knew she had metastatic cancer. At first the chemotherapy had seemed to work, granting a brief reprieve. Then the tumors came roaring back, causing blood clots and a previous trip to the ER. She had just started treatment with a new class of drugs, only a few days before. No time to evaluate its efficacy. Now a tumor was blocking one kidney, causing infection and sepsis. A blood clot in her lung. Should a breathing tube be used?

The staff in the ER clearly didn’t think so. She has metastatic cancer, they repeated. But what did they know of these new drugs? They were not oncologists. In this era of medical specialization, they read the newspapers just like you to learn that immunotherapy had provided miraculous results, for certain cancers. No one knew if it would work for this one. But it was up to you to decide.

And you decided that she deserved a chance, one last opportunity to fight this thing after so many years of pain. To claim a few years of the retirement you both had planned on. So the breathing tube went in, and later the feeding line as well. And you watched as she suffered some more.

From the ER to the ICU. From the ICU to a regular hospital bed. From there to a skilled nursing facility, where the folders sit at the ready. Had it been days or weeks? There was no tracking the time. People came and went, friends, relatives, the kids. Confined to her bed, she tried to hide the pain from them. But you could always see it there, as you asked yourself if you’d done the right thing or if you’d simply been selfish, unwilling to lose her, unprepared for the enterprise of death.

She would never tell you if she thought you’d been wrong. Ever generous, even now she is careful not to burden you with guilt. She thanks you for being there, calls you her rock. But you wonder if, late at night when she is alone and hurting, she curses you for what you have done.