End of life care: coping with bereavement

Bereavement affects people in different ways and there's no right or wrong way to feel. “You might feel a lot of emotions at once, or feel you’re having a good day then wake up and feel worse again,” says Sarah, who works at Trinity Hospice in London. She says powerful feelings can come unexpectedly.  “It’s like waves on a beach; you can be standing in water up to your knees and feel you can cope, and then suddenly a big wave comes and knocks you off your feet.”

Experts generally accept there are four stages of bereavement: 

• Accepting that your loss is real.
• Experiencing the pain of grief.
• Adjusting to life without that person.
• Withdrawing your emotional energy from grieving and putting it into something new. In other words, moving on.

You will probably go through all these stages, but won’t necessarily move smoothly from one to the next. Your grief might feel chaotic and out of control, but these feelings will eventually become less intense. Give yourself time, as they will pass. You might feel:

• Shock and numbness (this is usually an initial reaction to the death. People often speak of being in a daze.)
• Overwhelming sadness, with lots of crying.
• Tiredness or exhaustion.
• Anger (towards the person who died, or their illness, or God).
• Guilt (about feeling angry, about something you said or didn’t say, or even about not being able to stop your loved one dying).

“These feelings are all perfectly normal,” says Sarah. “The negative feelings don’t make you a bad person. Lots of people feel guilty about their anger, but it’s OK to be angry and to question why.”

Some people also find they become forgetful, less able to concentrate and they lose things, like their keys. This is because your mind is distracted by the feelings of bereavement and grief. It doesn’t mean you're losing your sanity.

Coping with grief
Talking and sharing your feelings with someone is important. Don’t go through this alone. For some people, relying on family and friends is the best way to cope. But if you don’t feel you can talk to them much (perhaps you aren't particularly close, or they are grieving too) you can contact local bereavement services through your GP, local hospice, the national Cruse helpline on 0844 477 9400 or a local Cruse centre (see Useful links).

A bereavement counsellor can offer time and space for you to talk about your feelings, the person who has died, your relationship, family, work, fears, the future or anything else you need to discuss. You can access a bereavement counsellor at any time, even if the person you lost died a long time ago.

Don't be afraid to talk about the person who has died. People in your life might not mention their name because they don't want to upset you, but if you feel you can't talk with them it can make you feel isolated.

Anniversaries and special occasions can be hard. Sarah suggests doing whatever you need to get through the day. This might be taking a day off work, or doing something that reminds you of that person, such as a favourite walk.

If you need help to move on
Each bereavement is unique and you can’t tell how long it will last. “In general, we would say that the death and the person might not be at the forefront of your mind constantly after around 18 months,” says Sarah. This may be shorter or longer for some people, and this is normal.

Your GP or a bereavement counsellor can help if you feel you aren't coping. Some people also get support from a religious minister. You might need help if:

• You can’t get out of bed.
• You neglect yourself or your family, for example, you don't eat properly.
• You feel you can’t go on without the person you’ve lost.
• The emotion is so intense it’s affecting the rest of your life, e.g. you can’t face going to work, or you’re taking your anger out on someone else.

These feelings are all normal as long as they don’t last for a long time. “The time to get help depends on the person,” says Sarah. “If these things last for a period that you feel is too long for you, or your family say they’re worried, that’s when you need to seek help. Your GP can refer you if you need it, and can also keep an eye on your general health.”

Some people turn to alcohol or drugs during difficult times. If you would like help cutting down see Drinkaware or Frank (see Useful links).

Pre-bereavement care
If someone has an incurable illness, they and their loved ones can prepare for bereavement. “Practical things can help, such as discussing together what the person wants for their funeral, and making a will,” says Sarah.

Bereavement counsellors also offer pre-bereavement care, helping patients and their family to cope with their feelings. This can be especially important for children, Sarah explains. “Children’s stress levels are at their highest before their family member dies, so support during this time is important.”