Grief is an integral part of our human condition. All of us have lost or will lose someone we love beyond all telling. Our social nature makes us want to bond and become attached to others. “‘Tis better to have loved and lost, than never to have loved at all.” For how many centuries has this saying been a guiding insight into our human relationships? Grief is the price of those attachments of love that we make in our lives. How we deal with it has a lot to do with how we can put the loss into a broader perspective that allows us to continue to live despite the engulfing void in our lives.

Hearts heal faster from surgery than from loss.

-Ellen Goodman, Boston Globe, January 4, 1998

She died, and the person I was died, too.

-A widower of seventy, following his wife’s death

Life must go on; I forget just why.

-From “Lament” by Edna St. Vincent Millay

Remember me, when you can’t go on;
Think of me, when all hope is gone.
When you’re all alone and no one seems to care,
I will always be there.
For I am everywhere, and I have always been here;
Since time began, I am.
And I will never leave you, for I am your friend.
Just look inside your heart, take my hand.

-“Remember Me,” lyrics and music by JoAnna Burns-Miller, 1999

Grief demands expression of powerful emotions. We need an opportunity to tell and retell events, stories, and memories, all of these but reflections of our deep love for the person who has died. This is why it is so much harder when you have no one to talk with about how you are feeling. It’s also true that some people are more vulnerable than others in the throes of bereavement and have more trouble overcoming their grief.

This book, devoted to the human side of cancer, is at its heart about loss, the threatened or actual loss of health and life. But it also about surviving the loss of a beloved person who has died of cancer: spouse, parent, child, sibling, friend. “How do I go on after losing someone whom I loved so deeply and who mean so much in my life?” I hear this asked, sadly, all too many times. One in four families is touched by cancer each year. Indeed, cancer has become the leading cause of death in this country as heart disease mortality has diminished. This chapter describes the pain of grief and of the bereavement that follows the death of someone close.

Those who have experienced a significant loss and struggled to go on will recognize all too easily the feelings and emotions brought on by grief; I hope the discussion and suggestions for coping will be helpful. For those who have not yet been touched by loss, the chapter may not seem so relevant. But for readers who have a loved one who is ill and whose life is threatened by cancer, this chapter describes the feelings of grief, what is known about the human process of grieving, and offers some approaches that may help.

Grief before loss

Death from cancer is often preceded by a lengthy period in which both the person who is ill and the healthy caregiver recognize the likely fatal outcome, while at the same time trying to deny it. This period is sometimes called a time of anticipatory grieving. However, no matter how clear the outcome is, and how prepared one believes one is, the actual death somehow comes as a surprise: “I didn’t expect it so soon.” “I was still hoping for the best.” “I can’t believe it’s really happened.”

Grief after loss

The first hours and even days after death are often recalled later as: “I was in a daze; I can’t even remember it.” “I was so numb I had no feeling at all.” “I went through the funeral without even realizing what was happening.” “I felt so unreal, as if I was watching a movie.” “For days, my heart felt like a piece of stone.” This is a kind of benign temporary denial of the painful information as the psyche tries to absorb the catastrophic information.

But the numbness is interspersed, in this acute stage, with waves of intense grief, of crying and sobbing, that come on several times a day, occasioned by a sympathetic word, a hug of affection from a friend who understands, or seeing some object that suddenly brings back the gravity of the loss. Caught up in a wave of grief, you become distraught, crying without easy control, and overwhelmed for a period of minutes with trouble regaining emotional control. Sudden vivid memories come back, coupled with a sense of unreality, disbelief, and panic, swelling to an overwhelming feeling that “I just can’t go on.” These waves are so difficult to bear that you try hard to prevent them by avoiding contact with people. However, the act of sharing the loss with another, as painful as it is, is actually helpful because it encourages talking about the loved one and sharing memories, which makes the loss real and reduces the feeling of “maybe it isn’t so.” It also celebrated the life of your loved one.

A panicky, anxious feeling accompanies the sadness and helplessness and makes it hard, if not impossible, to carry out daily tasks. You may find yourself wandering aimlessly around a room picking up objects without thinking or pacing in agitation with the thought, “I can’t live like this.” You may avoid activities that brought you pleasure before, particularly those that remind you of your loved one. For example, you may not want to listen to music that was previously a shared source of enjoyment because it makes you feel sadder. These feelings are all intensified during the waves of overwhelming grief described above.

Along with psychological distress, grief disrupts normal physical function. The abrupt change in your pattern of living-caused by the absence of a key person in your life-disrupts the brain and biological rhythms (the body’s normal twenty-four-hour rhythm of function), especially of the nervous, hormonal, immune, and cardiovascular systems. These physiological changes lead to the common physical symptoms of grief. For example, it may be impossible for you to concentrate, to keep your attention on any topic. Sighing respirations are common, and choking sensations occur often with crying. You may feel weak and profoundly fatigued. Sleep may be difficult, ranging from fitful to impossible. Food has little taste;it “sticks” in your throat. Weight loss is common, and you may look pale and ill, in addition to looking profoundly sad. Strikingly, many of these physical consequences seen in human beings are similar to reactions observed in animals. For example, Dr. Myron Hofer, a psychiatrist and researcher, has witnessed similar effects in infant mice when their mother is taken away from them.

During this stage of acute disorganization, you may feel distant from others and want to be alone. Yet you must go through the cultural rituals that follow a death: the wake, sitting shivah, the funeral, and the burial or cremation. These rituals around death developed over the centuries for a good reason: They encounter the tendency to isolate oneself. They ensure that you are surrounded by others who care and who share the loss. For several days, you may rarely be left alone by family and friends, who wish to give you comfort with sympathetic words and gestures.

This complex picture usually persists for about six weeks. Dr. Erich Lindemann, chairman of Psychiatric at Massachusett