The Aftershocks of Trauma and Grief
It's likely that nothing can prepare us for the loss of a loved one and the grief that follows
Dr Saul Hillman shares his own experience in the wake of his mother's death
If you are bereaved and need support through your grief, find a therapist here
Whilst my previous blog focused on the immediate and adrenalin-fuelled traumatic shock of an event, this one is more about those traumatic after-shocks that we start to feel. We are often in a completely unprocessed terrain following shock or loss, and will confront many different reactions and feelings in ourselves.
At times, we will re-experience the trauma, whether this is through repetitive thoughts, flashbacks or nightmares. We might also become avoidant and even numb in how we avoid activities or people, feel distanced and lose interest. We might also have an increased arousal through increased anxiety, irritability, anger, or hypervigilance. I am not sure where I was on that day after I learned of my mother’s road accident and subsequent amputation. Perhaps, I was in several places at once which would also have included being in a place of denial about the whole catalogue of events.
I had woken with a crashing psychological hangover and slowly orientated myself to the seismic ruptures of what had happened the day before. The thought of navigating my way through the day felt near impossible. I skipped breakfast and dropped my son off at school and began my gargantuan assault course. As I walked to the bus stop, I started to call a few family members and close friends of my parents and relayed the tragic news to them.
As I presented a condensed version of the events of the day before, I was confronted with their uncontrollable grief, confusions and questions. It already felt too much. I bussed in to visit my Dad in hospital and be there for his own discharge. My brother was with my gravely ill mother several miles away at another hospital and somehow the plan was for our whole nuclear family to come together later that afternoon following his discharge. As I got off the bus at Warren Street, I saw the boardings with further reminders that yesterday's accident did actually happen just outside the hospital where my father was. It was too dramatic and surreal to take in. I felt numb surveying the area.
I was clearly still in shock but another flood of energy was driving me forwards throughout the monstrous day that lay before me. If the day before had been all about a reptilian shock to what I learned, today was maybe the after-shocks and slow attempts to piece everything together. It was far too early to make sense of something so far removed from what I had experienced. After all, I had to protect myself from the sheer overwhelming intensity of what I was having to process. I had too much that I needed to do so the numbness and detachment was to follow me for a while yet. Of course, if someone stopped me in the street, I would have articulated what had happened to my mother, yet when those endless phone calls littered my day, I was quite uncharacteristically robotic and unemotional whilst I let them relay their own outpourings.
I took the lift up to see my Dad and picked off from where we were the previous night. I saw a grief-stricken man whose own health somehow seemed immaterial and even somewhat of an inconvenience. He was slowly being prepared for discharge and doing his utmost best to defiantly show me and those professionals around him that he was fine. Whether this was to reassure me or delude himself, it didn't matter.
Eventually, my father was discharged and we took a cab and motored through the congested streets to St Mary's and then meandered our way up the lift to the trauma unit where my mother, his wife, was. We were both petrified at the prospect of seeing her and had little idea of what to expect. I somehow felt I had to be the stronger one and as we approached the side room. My brother popped out, we embraced just like we had done the night before when things were at their most raw, and then I peered apprehensively into the room to see a tenuously recognisable version of my mother deliriously lying on a bed, decorated with tubes and masks. I felt faint and nauseous, my mouth dehydrated and heart pounded, but I stumbled across to hold and greet her, suppressing any urge to burst out crying or screaming.
She was in such an altered state of consciousness, that it was hard to know what to say or do. We all hovered round her bed, uncertain of how this absolute nightmare could possibly have a satisfactory conclusion. Though it was largely an incoherent and hallucinatory fog, there were some isolated fleeting fragments of coherence to cling onto, but it was all too surreal to stomach. My father looked broken but then I am sure I looked the same. I kissed her goodbye and hid my devastation from her as best as I could. As we left the hospital and hailed a cab, we went back to his house, or should I say, their home. It felt like being in a slow burner of a horror movie. We got back to his home laden with his bags from the hospital. This should have been a celebratory hospital discharge with a reasonable prognosis, yet my father was entering their empty home of 40 plus years feeling that sense of absolute terror that this void would remain for a long while.
I settled him in, walked him to Waitrose to start the process of getting him to manage those facets of life that he had rarely had to engage with. As he wobbled down the street and throughout Waitrose, everything felt unsafe, I kept thinking my father was going to topple over. I stood at the pedestrian crossing looking on distrustingly at all vehicles and then would find myself compulsively scrutinising people's lower limbs. I was exhausted and had to leave my father to experience the painful reality of his first night of discharge. Somehow, I could not or did not wish to contemplate my father's own vulnerability. I left their home and decided to jog for a couple of miles to reach the end of my son’s football training just so I could have the buffer of something unbroken in my life. As I approached the training park, several parents who we were friends with looked on warmly, approached me, hugged me...only further solidifying this grief stricken reality.
I grabbed a beer on the way homes, forced some food down me and set to for a disturbing and fragmented sleep. One cataclysmic nightmare involved being trapped in a world of limbless people including my mother was particularly upsetting. I had to resign myself that I was so wired that I just could not be shut down.
Wednesday arrived. It had not even been two days since my mother’s accident. It all felt like the beginning of an epic and tragic journey through utter quagmire. I was waiting for news, uncertain of how to fill these anxious and heavy hours whilst my mother was meant to be having the second and most pivotal amputation from the knee down. It was a protracted grief-stricken-swamp of time, and one never experienced before. It felt like a death but then the uncertainty and impotence of what was happening with my mother was too much to bear.
Following a number of hours of waiting, I learned that the surgery had been delayed till the following day owing to an emergency! Once again, I felt confused, relieved that she remained stable, and that someone else was deemed to be more of an emergency than my beloved mother, but only too aware that I would have to do this all over again tomorrow or the day after. I later sat in my parents' garden whilst my Dad inhabited his space and routine upstairs. As I was desperately seeking some brief solace of my own, I then heard a terrifying scream followed by a succession of deafening thuds. Startled, I ran in and only too aware that something awful must have happened and that my father had fallen down their hazardous wooden stairs. As I raced inside, he was at the bottom of the stairs fully conscious, quite calm and seemingly pragmatic about what had happened. I had approached the scene convinced that this was going to be catastrophic and even fatal. He was intact, though bruised, and so was I. During those most terrifying moments, I could only selfishly think about how I would live with myself for having chosen to relax outside in their garden, blanking out the fact that my father had suffered a stroke only five days previously.
A new day arrived. The world felt even more dangerous than it had the day before when I was fixated on both violence stemming from road vehicles and the fragility of our own bodies. I was now further sensitised to any unexpected clamour following yesterday's stair fall. It was another interminable day of waiting for news on the delayed surgery on Mum's right leg. It was only now that I was appreciating how pretty much every morsel of my life up until now had been solidly predictable. I chose to distract myself through work emails, speaking to friends, exercising, comforting my father, meditation and music. I even had a patient in a catastrophic crisis of his own and chose to provide him with a telephone session that day.
The painfully anticipated phone call did eventually arrive. Fear filled my mind for what path this horrific journey would now take. I spoke with doctors who conveyed that the coming days and even weeks were potentially hazardous, critical, unpredictable and complicated, especially for a 79-year-old woman who had been through what she had. I had no appetite. I had no voice.
As I reached the end of the week, I was in that terrain between utter exhaustion and agitation. I was feeling overrun by the physical sensations of anxiety that were like an unwelcome stranger. I was in pain, heavily perspiring, feeling sick and hyperventilating. I was having repeated flashbacks whether these were events I had witnessed like my father’s crash down the stairs or events I could only imagine such as my mother’s collision.
I was too agitated to sit still and walked round my neighbourhood where I could not help bumping into various people. I started relaying the events of the week to people I would normally only greet and exchange the briefest of pleasantries with. I calculated that this form of candour would be good for me.
The weekend arrived and I was at a loss how to occupy myself, clutching and checking my mobile phone as if it was the only thing that really mattered. It was becoming like a nervous tic. But then of course, in many ways, it felt like a lifeline as I awaited further updates from either my brother or the hospital on my mother’s progress in intensive care. Every moment in time felt sizable.
In many ways, these early days following the trauma were not that dissimilar to our response to death of a loved one. They are both losses. There are some important steps to take which I was beginning to make sense of and these included acknowledging the reality of what had happened even though at times I found myself thinking and talking through a screen of denial. I was also having to acknowledge the flood of feelings and rather than fighting or avoiding them, interacting with the panic, devastating distress, or anger. There are some people who suggest we even need to befriend that pain. In the early days following the accident, I stood in the park watching my son playing football with friends and eddied into a panic attack. It felt awful but I found my way out of it through compassion. Perhaps, compassion and self-care were pivotal in those early days – in those dark and empty moments, I did listen to music, read, walk, absorb nature and much more. Without that, I would have been far worse.