Grief and Trauma After a Sudden Bereavement
Dr Saul Hillman shares his own experience of sudden bereavement, the loss of his mother, to illustrate the impact of trauma and grief
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Here I would like to talk about the immediate shock and reaction that comes with trauma and grief. As with my previous article around imagined grief, in this article, I will be illustrating these themes with my own personal experiences.
Trauma and grief of course has its own roadmap; there are many ways of traversing the journey, from the immediate shock, past the complicated and confusing barrage of emotions, alongside the learning of new ways of coping and adjusting, and onto seeking support. It is rarely linear and so much of our journey will be down to our own idiosyncratic ways.
My own experience of shock began whilst my father was in hospital recovering from a minor stroke. The day felt like any other typical weekday; there was no serious sense of anything that atypical and foreboding.
As I left a launch lunch for a new research unit that I had just joined and walked back to my office, I realised that my phone had been on silent and had missed calls and a voicemail from my brother alerting me to call him. I had barely reached the top step to my workplace when I anxiously called him knowing that the urgency and tone in his message suggested something significant. Of course, at that moment in time, my only thoughts were consumed with my father's health and mortality, so I was only stunned when he told me that my mother had been run over by a bus on Gower Street. I had to get him to repeat this and froze in absolute terror at the thought of the gravity, the violence and cruelty of this moment.
I had stepped into the terrain of trauma, which is essentially any incident that causes significant physical, emotional, or psychological harm. When we experience overwhelming emotions, as I was just then, our older ‘reptilian’ brain takes over. I’d already had sufficient exposure in my life to the flight, fight or freeze modes that accompany acute stresses, so what I was starting to feel was simply an amplification of that. I felt threatened, anxious and frightened. This surge of adrenalin was energising me to simply cope with these terrifying hours that lay ahead. I was being inoculated with the adrenalin to be physically strong enough to make the journey and to have the mental strength to grapple with what I was going to have to face.
As I set off – well, I tried to, but I had to stop and sit on a bench and compose myself. All I knew was that at 13.15 on 3rd October, a pivotal moment like no other had struck me. I was to grow up and shed any vulnerability that had tripped me up in the past. I was terrified and for a few minutes I failed to move. I put my shades on, an old habit from the past that I adopted when I felt vulnerable, and set off to the tube station to begin a relatively short journey, which in my mind felt unbelievably arduous. Though I wanted to hide, I immediately ran into a former student, and rather than avoiding any potential interaction, I went to the other extreme and embraced her and decided to relay this exceedingly raw and painful news to someone. I lucidly wondered whether this might help me process what I just heard.
I took the tube and arrived at Paddington Station and again had a pang of avoidance when I fantasised about not following the directions to the hospital and instead heading towards the canal. That fleeting moment didn’t however last long. I then picked up my phone and noticed that the battery was an alarmingly low 10 per cent as I had failed to charge it the night before. This only accentuated the panic that I could be potentially non-contactable and even more detached from this frightening reality.
I soon arrived at an overcrowded A&E department and stood in a sweltering queue for my turn. When it was finally my turn, I communicated that I was here to find out about my mother and as I said her name and date of birth, I shed a few tears. A rather robotic clerk at the desk looked at me and asked why I hadn’t arrived earlier. He then disappeared before I even had a chance to respond. I was mortified and leant against the desk, only fearing the worst outcome. I had come over here as quickly as possible, but not only was I being blamed for my slowness to respond, I was being drip fed something potentially terminal and shocking.
The clerk returned a few minutes later only to tell me that my mother's details were not on their records, which only heightened my confusion, providing some relief that she was at least not confirmed dead, yet also adding to a sense of complete bemusement as to where she was. He then directed me to wait in the resuscitation/trauma unit waiting room, perhaps one of the most disquieting places that I had ever been to. As I entered this chaotic space, there were screaming, distressed relatives alongside hordes of doctors, nurses and police officers. I had never watched TV hospital dramas but this felt like one.
I paced up and down the room until a friendly looking police officer came out of the trauma room and approached me, placing a sympathetic arm on my shoulder and leading me away. I remember him earnestly telling me it was too noisy to speak and that we needed go somewhere quieter. I was in absolute shock and convinced that the slow walk towards a cubicle was the preparation for the morbid verdict that I’d been waiting for. In the end, he could not find a room so we stood in the corner and he relayed what I already knew about the accident and then said the deafening words that my mum had suffered 'life changing injuries'. I had never previously had to analyse those words but I was full of relief that for now, my mother lived on. She was in resuscitation and had lost copious amounts of blood after the accident and was being prepared for surgery. Then he said the word 'amputation', another word that had never had to be part of my everyday lexicon but one which I had enough of an idea to know what it signified. He suggested that I left the hospital and returned in a few hours when doctors would update me on how the surgery was going.
I left the hospital and sat by the canal, ordering some food that I could barely touch, a coffee that only wired me to pace along the towpath. I then went into a local shop and bought a pack of 10 cigarettes, a mindless outlet for times like this that somehow felt necessary. I called my brother, rung a couple of family members and then tried in vain to get through to my wife. I knew she was teaching but my neediness was off the scale so I redialled – without exaggeration – probably about 50 times, fantasising that somehow my desperation would eventually penetrate through. When I did get through, I probably barely made sense – it was the most raw communication I had ever had to make.
I returned to the hospital as instructed and lodged myself in a waiting room where at least I could rescue my dying mobile with a portable charger which had been with me all along. I got out my diary to be hit with the reality of my working life which at that moment felt so remote. I then noted that I had a patient that evening so quickly sent a cancellation text to the girl and the clinic. I had lost all sense of time. As I sat there in such an undefined state of limbo, I had no idea what to say. 'I am sorry that I have to cancel today at such short notice owing to an unprecedented family tragedy’. It felt quite chilling to put those words in writing. I was unconcerned about the boundary fractures of therapy.
Following that, I got out my laptop and thought I'd write a blog for my website series – it was going to be on crisis management. How bizarre was that! I wrote a couple of paragraphs but was then interrupted by footsteps and three doctors quietly entering the room. They were neither intimidating nor reassuring, but sat down encircling me and updated me on how the amputation surgery had gone. I was aghast for about the fourth time that day that this would finally be a painful announcement but instead, they reported that “it had gone as well as could be expected”. I never really fathomed why people used that expression as it felt it lacked any real meaning. I sat there and heard how my mother had lost 12 litres of blood and that it was “touch and go” when she first arrived. I knew one foot had gone and when I tentatively asked about whether the left foot would be rescued, they replied cautiously and said that they were not sure at this stage. I naively enquired as to how long my mother may be in hospital for if she was to pull through. The pretty junior doctor looked at me, shrugged her shoulders and said “we’ll probably be talking many months”. I had absolutely no notion of the convoluted paths that lay ahead for my gravely ill mother but somehow had imagined we’d be talking about weeks rather than months. They left the room and I soon followed with my world spinning around me.
As I completed the circle, I returned to the UCLH hospital where my brother was with my father and we essentially swapped roles. There was my poor, almost forgotten father who had been informed by my brother of the awful shocking events of the day. As I arrived at UCLH, the three of us hugged, cried, and had relatively little to say. I sat with my Dad and saw a broken man who was only just recovering from a minor assault on his own body. I sat on the edge of his bed, comforting and trying to reassure him, with more physical tactility between us in that period of time than at any time of my life. Soon, we were both tired and there felt like nothing more to say.
I left and wandered over to Gower Street to see the police incident board up where the accident had taken place. I felt sick but strangely numb. When I got home I had no appetite, but my children were up and I just cried and hugged them both, and of course my wife. My poor children will have been scarred from this experience and as I sat there, I poured out more than I probably should have done. I later regretted being so graphic about both what had happened and also what would happen. I went to bed and resigned myself to a night of insomnia – the magnitude of today's events was just such that any hope for respite was insurmountable. I was right.
We can help ourselves if we are in the immediate and often overwhelming aftermath of loss or trauma. First, we need to face and experience those difficult feelings in order to process what has happened even if our natural instinct might be to push them to one side. Second, we benefit from sharing our feelings by talking with others as a first step in making sense and healing ourselves. Third, we can continue to be active in order to benefit from both the physical exertion and the structure. Fourth, we can avoid negative coping strategies such as drinking too much, overeating, or isolating ourselves as these will only numb the pain. Fifth, we might wish to express our feelings in a different way. I wrote a journal as my coping outlet but there are many other such ways.
Finally, though the pain and shock will be overwhelming, it will be important to orientate towards the good things that still remain in our life that are worth working through the grief and shock. These positives might include our loved ones but also might relate to fleeting pleasures whether it’s a TV programme, a piece of music, watching the football or savouring some food. As with so many psychological battles, counselling or psychotherapy can offer a separate space to manage this period.