Coping with anticipatory grief
June 20, 2024 8:11 AM   Subscribe

What advice and resources helped (or didn't help) you deal with the emotional and mental aspects of approaching end-of-life of a parent or other close loved one?

My mother, 73, has metastatic bladder cancer. Recently her doctor has suggested a newer medicine that has shown some promise, and also researching clinical trials. Her doctor estimates her prognosis as 6 months without further treatment.

She has gone back and forth on if she wants to try further treatment or not so we're in limbo there.

My dad, my mom's sister, and I are the closest family navigating this. My aunt lives out of town but I am about 15 minutes away from my parents' house. I don't go there every day but I do when they need me.

I know I'm not alone in experiencing the sadness, unfairness and stress of a situation like this (it's especially hard to see her so frail), and I'm overwhelmed with the resources so I'm looking for more specific and recommended ideas/resources from people who have gone through this, and what helped...books, podcasts, movies, shows, counseling, I'm open to anything if it helps.

That's my general question but I have a few specific scenarios I'm trying to figure out how to navigate:

1. My older brother stopped talking to us four years ago so dealing with the anger I feel that he doesn't and won't have to deal with this.

2. Feeling guilty for when I do want to socialize/have sex.

3. Feeling resentful/envious of friends who haven't gone through this.

4. Handling the day-to-day changes in my mom's wishes.

5. Being unemployed and feeling guilty about not looking for a job because I do need one, eventually, and I know it's taking people a lot of time to find one.

I have friends, and two romantic partners (one of whom I live with), so I'm not alone there, and they've been supportive, but I don't always know how to ask for what I need. I have insurance through the ACA so I'm also going to see what, if any, resources they have as well. But any personal anecdotes and insights are much appreciated.
posted by girlmightlive to Human Relations (16 answers total) 10 users marked this as a favorite
 
I went through this process with both of my parents recently although in both cases, despite their prognosis of imminent death, they continue on. But it doesn’t matter, they’ll be gone soon regardless.

The best advice I can give you is to let her go now, and treat all of the time after this as bonus. That doesn’t mean that you don’t continue to be involved with her and helping however you can, just that it won’t tear your heart out every time you see her.
posted by Tell Me No Lies at 8:22 AM on June 20 [1 favorite]


Have you heard about the "ball in the box" theory? I first heard it directly connected to grief, but as a person who nursed my best friend through 5.5 years of cancer, including the final 6 months that led to her death, I can say that this might be a helpful way to frame your entire experience.

The analogy is that grief/suffering is like a box with a ball inside it and also a pain button off to one side. In the early stages, the ball is so huge that basically every time you move the box, it hits the pain button. It feels uncontrollable, how many times that pain button is being hit by the ball, so you're constantly suffering. But as time passes, the ball gets smaller, all on its own. It never goes away, and when it hits the pain button the pain is still very intense, but the new size means that you don't hit that button every time so it makes it easier to get through every day. And it's not a linear process, so some days the ball feels very big, pushing the button over and over. But if you wait, the ball will shrink down again.

What you're going through is hard and there's no real way to make it easier. I'm sorry you're experiencing this.
posted by BlahLaLa at 8:40 AM on June 20 [11 favorites]


My religious training and faith certainly helped me. Although it's rather unfashionable and passe, I never abandoned it. I'm an amateur gardener and I see it when I plant new flowers vs. end of season flowers. I find solace and beauty in that.
posted by Czjewel at 9:37 AM on June 20 [5 favorites]


I'm sorry that you're going through this. I have some other ideas percolating on other points, but wanted to address this one first:

2. Feeling guilty for when I do want to socialize/have sex.

I remember that shortly after my mom died (after dealing with cancer for several years), I was out with two close friends and we found ourselves cracking up over some shared adventure years ago. I remarked how it felt strange to laugh so much in the midst of grief, and one of my friends said, "You're allowed to have more than one emotion at a time." And that has really stuck with me, and still serves to remind me that our human need for community, intimacy, laughter, sex, etc doesn't fall neatly into the appropriate categories we've been taught they should. Grief is not a monolith; it shows up when/how it shows up for each person, and in the process it's ok to need and want other things.
posted by Molasses808 at 9:47 AM on June 20 [23 favorites]


The best advice I can give you is to let her go now, and treat all of the time after this as bonus. That doesn’t mean that you don’t continue to be involved with her and helping however you can, just that it won’t tear your heart out every time you see her.

this speaks to my experience with both my parents. I was able to be around a fair bit when they were first aging, then dying. You might say, I did the bulk of my grieving (certainly the ugly parts) well before they died, which I now view as way more feature than bug. It was damned hard at times, brutal even, but that's grief, that's life, that's what being human is.

One decision I made very early on was not to judge any of my siblings for their decisions, however much I disagreed. Which doesn't mean there wasn't anger, rage etc. But always hanging around in the background was a determination to NOT sever ties with them, to not self-righteously give in to that sometimes very tempting current. And now, three years since we've all been "orphans", we all still more or less like each other, we get along, we can all gather for a meal at a restaurant and make what amounts to a joyful noise.
posted by philip-random at 9:56 AM on June 20 [5 favorites]


I lost my mother three years ago, and knew she was going to die about five months before it happened. I went through the same thing you did with anticipatory grief. In my case, looking back, I was trying to reduce the pain of the blow that was going to come. When she died, I was numb and things were surreal. I realized then the things that I tried in anticipation were more or less unhelpful. The grief is unavoidable, the pain is inevitable. We try to protect ourselves but the raw truth is that when you love someone, this is the obligation that we have taken on. An obligation that we would not turn down for anything.

Some things which don't ease the pain but which will help with other things is to spend quality time with her, take note of her stories, and to bring joy to her in the way that only you can.
posted by storybored at 10:17 AM on June 20 [4 favorites]


Hey, I'm sorry you're going through this. I lost my Mom last September, she had been my only living parent since my dad died when I was 7. Her breast cancer had come back a few years ago but her death still felt very unexpected. And we were close, so it's just all kinds of shitty.

All of the emotions you say you are feeling sound very normal. Along with feeling lots of things simultaneously, or whiplash between feeling good briefly, then feeling guilty about it. For me it was helpful to be social so long as I didn't have to pretend that anything was fine or that life was fair, and I could just acknowledge the shitty time I was/am going through.

If I had more time with my Mom, I would try to help her maintain whatever agency she had, so for you this might mean accepting your Mom's wishes even as they change, and if she's still ambulatory, go to the restaurants she wants to go to even if you hate them (and then you're entitled complain about all that to partners/friends, and cry in the shower all you want). If she doesn't want to talk about stuff related to memorials/burial, don't push it. Whatever you decide later on will be perfect.

I think a lot of my anger just came from feeling powerless to change the things I wanted to change (ie. magic my Mom back to life), but I wonder if that's what's going on when you feel angry at your brother and guilty for other things you can't just remedy, especially when you're going through a horrible time like this. That's all okay too, go ahead and acknowledge that anger and guilt as opposed to trying to not feel those ways. This is absolutely a situation that warrants awful feelings, I don't think it's avoidable.

Re: feeling resentful about other friends, I saw a grief group called The Dinner Party recommended on the green, and have met some really awesome people through that. Many folks in my group have lost a parent and dealt with the lead up and aftermath, and it's good just to hear from people who have some inkling of what you're going through.

Oblique podcast recommendation, but I discovered an ancient Downton Abbey re-cap podcast that was/is still an excellent distraction. I also recommend doing nice things for yourself, like my sisters and I would buy fresh flowers just to have something nice to look at while we felt mad/sad/hopeless/etc.

Hugs to you. You don't have to navigate this time by being at your best or by being a saint -- you're already doing great by being there for your mom and your family. I don't think there's a wrong way to grieve as long as you don't try avoid it.
posted by Drosera at 10:23 AM on June 20


I think what helped me is realizing it isn't anticipatory grief; it's real in the now grief. For me, by the time my mom died, she hadn't been herself in quite a long time. Even though she hadn't yet passed, she wasn't able to give me the same kind of support that she always had. I was grieving what I knew of my mom. By the time she actually died, it was a relief to see her suffering end; and it was a relief to stop watching her decline; and it was a relief to get my own life back.

Then I felt guilty for feeling that way. But when I say her wake was a joyous event for me and my siblings, it really was, because we all had grieved already, and the reembrace and love at the wake were about joy.

I wish I had advice on how to make it work that way. For me it wasn't intentional, it's just how it worked out. The guilt was harder than the grieving in a lot of ways, and the answer to that was therapy.

I'm sorry you have to go through this. Parenting a parent is hard.
posted by dpx.mfx at 10:24 AM on June 20 [7 favorites]


I recommend some resources such as a stress assessment in this blog post.
posted by brainwane at 10:56 AM on June 20


I am so sorry you are going through this. You've gotten some great answers here but I just want to add that sometimes even if you think you have already done your grieving, it still may hit you hard and that's okay. I tried to anticipate all my grief when my aunt was passing and I was still absolutely overcome when it happened. I knew it was coming. I had several years where I knew it was inevitable, several months when it was more inevitable and several weeks when she was just waiting for a hospice bed, then several days in hospice. I was there for the whole time and I thought when she passed I would be able to see it as a blessed release. Turns out that you can mourn hard for a blessed release. I was completely distraught.

If that happens to you, it's okay. You didn't do anything wrong. Give yourself all the tolerance and kindness. There is no right or wrong way to grieve. This is the hardest thing and there is no way for it to be easy but eventually, eventually, memories do turn into blessings and the edges of grief smooth down.
posted by mygothlaundry at 12:33 PM on June 20 [1 favorite]


Bottom line, as far as the grief: you just feel it. The feelings come, you acknowledge them, they go, you let them go. It's all normal as long as you aren't hurting yourself or others. Grief is non-linear, unpredictable, super weird, uncheatable, lasts way longer than our culture wants to recognize.

One of the symptoms of grief is the fear you are Doing Grief Wrong and therefore You Will One Day Pay For It*, and certainly there are more serious forms of avoidance that will absolutely kick your ass so be extra mindful of substance use and related activities like workaholism, bad decision-making to create distraction trauma, exceptionally disordered eating, etc. But doing the shit you gotta do in life is not a grief-sin, nor is having good moments, nor is tending to all your relationships - you should no more expect yourself to not have sex (if you want to) than you should expect to not feed the dog, just because your mother is ill. It's not really related. Life goes on, you have to continue taking care of your stuff.

Now, on the other hand, grief and trauma, individually and combined, are the worst stress most of us will experience in our lifetimes. I'm not talking about an abstract concept, I'm talking about the organ damage and neurological effects of prolonged stress on your actual body. Traumatic stress does have a lot of evidence-based management techniques, that are meant to both keep you more functional and stable in the day-to-day but also ideally prevent some of that long-term damage like blowing out your thyroid or gallbladder or gut microbiome or really badly destabilizing emotionally when you can least afford to do so.

I have a crapload of books listed in a gdoc in my profile, cultivated from my own barely-pre-pandemic bereavement and doing volunteer grief counseling since, along with recognizing that there aren't any therapists left and nobody can afford them if they could find one. Various options there will likely be useful at various points in your journey. But for right now, today, the one from that list I would suggest trying to onboard before things get worse is The Modern Trauma Toolkit: Nurture Your Post-Traumatic Growth with Personalized Solutions. It's got actionable stuff for your nervous system in there.

I also don't believe in anticipatory grief. There's just grief, and maybe also complicated grief and ambiguous grief for unusual situations.

To some extent, you're going to have a bunch of difficult feelings - the brother, other people, probably moments of anger and frustration in the direction of your mother but not really AT her - that there's nothing you can do and "nothing you can do" is actually a totally legitimate decision and you just decide how much energy you think should be budgeted toward them. If you need 5 minutes a day to be angry at your brother, that's fine, just be mindful of your limited resources and don't spend them all on him. Try not to get too invested in your mother's difficult decision-making process, remind yourself she really needs to think out loud for a bit, and make your focus on supporting her in whatever calls for your support.

I'm sorry you're going through this, and I wish you all the best feasible journey together.

*There is also, for the overly ambitious, I'm Gonna Win At Grief (So Much Win I Won't Even Feel It) and yeah no, that's not a thing and if you catch yourself doing this make yourself stop.
posted by Lyn Never at 3:26 PM on June 20 [4 favorites]


I lost my mother physically in 2007, but sadly her mind was in decline for a few years prior. For instance, I was her power of attorney and I would explain her income and expenses to show her that her income was greater than the cost of assisted living and so she was on solid footing for the indefinite future.

However, as her mental condition declined she would become unresponsive in a trance most of the day. As a result she was no longer eligible for assisted living and had to go to a nursing home. Her finances then flipped such that she could only stay there for about a year before applying for a "Medicaid Bed" which are not easy to get.

As it turned out she passed away in her sleep after about 9 months in the nursing home, and I happened to visit her that day which was a blessing.

At the time all this was going on my wife worked at a Hospice (non-clinical position) and got much advice from her co-workers. By the way, the OP doctor's prognosis of 6 months might not be a guess, because it happens to be the maximum life expectancy for hospice. There is also a middle ground called "palliative care".

So, to summarize, I think my mother's case was difficult because of the loss of her mental abilities and her inability to discuss her situation. Of course that is not to say that the OP's situation is not very stressful and difficult. I remember one time a cousin stopped in to see my mother in the nursing home and button-holing me later as to how I could let her be in "this kind of place". I imagine he was just shocked and emotional that his "Aunt Betty" could not be somewhere better. And of course he was not there for all the steps leading up to that point.
posted by forthright at 3:44 PM on June 20 [1 favorite]


My therapist recommended this link when I was going through a similar situation.
posted by MadMadam at 7:05 PM on June 20


Have recently been recommended Bristol University’s Good Grief resources as someone who has been dealing with this stuff.
posted by johngoren at 10:40 PM on June 20


Ach, this is such a hard time of life, sending you care.

If you can afford not to work for a while, this is a great time to not have a job. Just pause on the job search, it's ok.

Hang out with your mom, take video and audio recordings of her, talk about the past if she's up for it.

Tell her you love her a lot, mend fences about past problems if she's up for it.

If it's safe, consider letting your brother know what her medical situation is, and offering him the chance to come visit her without any other family members there, if that's safe. Maybe don't tell your mom until just before he arrives, in case he declines or flakes. Even if he doesn't come, you will have at least given him the option, which in some situations would be the right thing for YOU to do, regardless of what HE chooses to do. (Please disregard this idea if he's unsafe, of course these situations are complex so I'm just speaking very generally and it may absolutely not work for you, and that's ok if so).

Make sure she's on palliative support asap. Palliative doesn't mean "near death", it means "symptoms really well managed for optimal comfort and quality of life", and it actually can prolong life.

Decide what you think "a good daughter" looks like in this scenario. Maybe visiting her 5 times a week? Then do that, and allow yourself other outlets as well. Seeing friends and having sex will help refresh you so you can give more love to your mom and also not crash as hard after this part of your life. Kettles need a steam valve!
posted by nouvelle-personne at 7:20 AM on June 21 [1 favorite]


If you can afford not to work for a while, this is a great time to not have a job. Just pause on the job search, it's ok.

this was a call I made with regard to my mom, and am thankful I did (and could). At first, it was just scaling back on stuff, alerting people that I had other "issues" in my life. But finally, there was a project that I was very much excited about, but I knew I couldn't do it justice ... and be there for my mom, whose needs just kept growing, and certainly couldn't organize themselves around my availability.

It really hurt to make this change because it felt at the time that I was giving up on a major part of my life/career. And I was. But now, I have to say it's probably the best decision I've made in my adult life. Ever. As for the career stuff, that's all back on track more or less, working a much different trajectory than previously, but I'm not complaining at all, I love where it's going ...
posted by philip-random at 9:15 AM on June 21 [1 favorite]


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