Reflections on retirement 6: Bereavement and Transition

The other day I walked through the corridors of Warwick Hospital for what may be my last time as an NHS employee. I thought back on all those days and nights – many years ago now – walking (and at times running) through similar long, pre-fab corridors as a junior house officer. Those days (and nights) are long gone now, and I can’t say that I miss them – certainly not the horrendous long hours and the relentless intrusions of the dreaded bleep – but I do look back with a bit of a sense of nostalgia.

Bereavement and transition

It is often said that retirement is a kind of bereavement. Looking ahead to my retirement, though, it doesn’t feel so much a bereavement as a transition. I guess I am privileged: privileged to have had a career that has been worthwhile and fulfilling; privileged to have also had meaning and worth in my life outside my work; and privileged to be retiring at a stage when I am able to look forward to all the new things I will be able to do.

But any transition also involves loss, and I recognise that for many that can be acutely painful. Particularly where retirement is accompanied by a sudden or gradual loss of significance.

So as I go through this change in my life, how do I make it a positive transition rather than a painful loss? There are three questions which I have found helpful in facing any kind of transition, which can be summarised in the three concepts of mourning, meaning and moving.

Mourning: How do I let go of all that has gone before?

For me, this has been a gradual process: stepping back from hospital work and nights and weekends on call; dropping my clinics to focus more on my academic and specialist work; and now leaving paid employment with the NHS entirely. As I look back there is so much I am grateful for: my colleagues; the families I have worked with; the things I have achieved in my career. I can recognise and celebrate the contributions I have made to protecting children, supporting families, and encouraging and empowering other professionals – both locally and nationally. At the same time, I can accept the things I haven’t achieved; the mistakes made; the unfulfilled dreams: the closure of our child health MSc; the doors closed on a return to Cambodia; my lack of promotion to an academic chair; my failure to establish a sustainable local team for responding to unexpected child deaths. And I can acknowledge that there will be aspects of my work that I may miss: the interaction with my colleagues, children and families; inspiring teaching sessions with motivated students; chairing our local serious cases sub-committee…

Meaning: how do I make sense of this transition?

In a way this, for me, is quite an easy question. And in this I recognise, again, just how privileged I am. I can look back on the journey my career has taken, and see lots of meaning and purpose in it. While at the time there were aspects which were perhaps harder to make sense of – my repeated failure to pass my MRCP exams; the traumas we faced in Cambodia; the gradual disintegration of our academic child health team; the frustrations of unsuccessful grant applications – overall, there has been a sense of purpose, of doing something worthwhile, and now, being able to move on to new opportunities. Looking back I can see how my life and work have had meaning, and how it has unfolded in a path that has brought me to where I am now, with all the skills and experience I have gained along the way. And I am blessed in now being able to take that expertise and apply it in new areas – both nationally and internationally, as well as, perhaps, developing new areas of interest and engagement.

Moving: how can I make the most of this new phase of my life?

For me retirement is a wholesome and positive moving forward. I am looking forward to the new opportunities it brings. To be able to take the skills and experience I have gained over these years and use them in new and inspiring ways. And to enter into a more gentle pace of life, one where there is no longer the pressure to achieve or be productive. There is so much I am looking forward to: being more involved in the rhythm of life at Breathing Space; working from home, looking out at the beauty of our garden; morning toast and coffee with Lois; helping create the house and garden as a place of peace and serenity; pursuing other projects here in the UK and abroad; starting a PhD; spending time with family and friends…
And, for now at least, no longer walking down long, pre-fabricated hospital corridors.

May 31, 2016

“What’s natural about a healthy person dying?” Making sense of the inexplicable.

“I know they are saying natural causes but what’s natural about a healthy person dying?” – bereaved mother

In spite of huge advances in research and policy, our understanding of the many genetic, biological and environmental factors contributing to sudden infant death syndrome (SIDS) remains partial. Over 200 babies in this country die suddenly and unexpectedly each year. This is far fewer than the thousands who died in such ways during the 1980s, and largely attributable to recognising and tackling environmental risk factors such as unsafe sleep. Nevertheless, each one of these deaths is devastating and we owe it to parents and families to do everything we can to prevent them.

One of my PhD students, Jo Garstang, has just published some of her research based on interviews with bereaved parents, listening to their experiences and how they understood their infants’ deaths.

Parental understanding and self-blame following sudden infant death: a mixed-methods study of bereaved parents’ and professionals’ experiences

Working with Jo over the past few years has given me the opportunity to reflect on my own experiences with bereaved families.

It seems to me that there are three basic drivers underlying how we grieve, which I like to think about in terms of saying goodbye, moving forward, and making sense.

Saying goodbye captures the expressive aspects of grieving, encompassing the various ways in which we express the pain and hurt we feel; moving forward, the restorative aspects – those actions that allow us to move on with life, recognising that our lives have changed, but need to carry on. This is not letting go or moving on as though the loss we have been through has not happened, but rather holding the pain that we feel as a part of our lives as they now are, yet not being crippled by it.

The third aspect, making sense, overlaps with both of these and it seems to me, is a central part of all grieving. Whenever we lose someone through death, we need somehow to make sense of that, to find a narrative that helps us to understand and live with the pain. And this is never more so than in the untimely death of a child.

“No parent should have to bury their child.” – King Theoden, Lord of the Rings

One of the greatest needs of the bereaved parents I have met is a need to explain and make sense of their grief. Different families approach this need in different ways, but one of the key findings from Jo’s research was that many parents construct a narrative of blame. Several families expressed their frustration at not knowing why their baby died, and the powerlessness that imposes.

“An unexplained death by its nature is an unpredictable event rendering the parents powerless to prevent future tragedies, thus increasing the anxiety and grief.”

In response to this, some parents blame themselves for their child’s death, and end up carrying a huge burden of guilt on top of the grief with which they are already living. Others seek to blame others – health professionals, police officers, other family members – for their baby’s death or for what happened afterwards. All of this provides a frame of reference within which the family can make some sense of their grief, and both say goodbye to their child and start to move forward.

“Self-blame can be a normal part of grieving after infant death: by blaming oneself for the death, it stops being a random, unexplained event, and can be controlled, giving a sense of order; this situation may be easier to live with.”

However, while blame, whether self-blame or blaming others, may help ease some of the pain and helplessness of unexplained grief, it seems to me that in the long run this is counterproductive and ultimately works against fully saying goodbye and moving forward.

In contrast to those families who seemed stuck with narratives of blame, some families in Jo’s research neither blamed themselves, nor anyone else, for their child’s death. It seems to me that this provides a resolution: an understanding that makes sense, and enables a healthy saying goodbye and a way to move forward. Some of these parents were able to accept the way in which different environmental factors may have contributed to their child’s death without having to live with perpetual guilt over it. Such an acceptance provides hope: for any future children, it means there are things the parents can do to reduce the risk of death.

And so, one of the key findings from this research is that we owe it to parents to be honest, even when that might be painful. It isn’t easy to discuss with parents how their actions, such as smoking or falling asleep on a sofa with their baby, might have contributed to their child’s death. But if we do so frankly yet with compassion, it seems to me that we can move beyond an unhelpful and patronising attitude, to one which truly supports parents at a difficult time and enables them to grieve, positively.

“We should acknowledge that risk factors may not be easily modifiable, but this should not stop us sharing the information with parents, to help them understand more about why their child died and to assist them in making informed choices with subsequent infants.”

You can read Jo’s research paper online at:

Parental understanding and self blame

June 13, 2015June 13, 2015

Grey

This morning, in our reflections, Lois and I were using a practice called Terra Divina which we came across in Ian Adams’ helpful book, Running over rocks. Adams encourages us to pause and contemplate the natural world around us, to ‘read the text of the landscape. [This is] like reading a book, except now it’s another language that you are reading – of clouds and birds and trees and sunlight.’ We seek whatever catches our attention and accept that as a gift.

As I looked out of our window on the damp summer morning, I was drawn to the flat, grey sky beyond the trees. All was dull, shallow, grey. There were none of the usual dawn colours of the sky; none of the depth of blues and golds and pinks. The trees were lacking their usual green vibrancy. Even the birds were muted in their morning symphony of praise.

As I lingered with the greyness, I thought of the young couple I visited yesterday evening. For them this morning will bring no leaping green trees, no blue dream of sky[1]. Just the dull reality of life without their little baby; the steady trickle of rain and tears; grey.

I trust that, one day, hints of colour might start to creep back into their lives. But for now, all I can do is hold them in my thoughts in the grey of this day.

Kyrie Eleison

[1] From ‘I thank you God for this most amazing day’, Chapel of Tarore Songbook, Ngatiawa River Monsatery