00;00;00;29 - 00;00;22;24 Adam Hocking Welcome to The Rounds, a podcast of Marshfield Clinic Health System. I'm your host, Adam Hocking. The Rounds brings together medical experts to discuss fresh, fascinating and important topics from the world of health care. How do we deal with the loss of a loved one? How do we navigate the holidays in the wake of that loss? What purpose does grief serve and how can we do a better job of discussing death? 00;00;23;16 - 00;00;34;27 Adam Hocking Joining The Rounds to discuss those questions and much more is Kathy Doe. Kathy has a master's degree in social work and she is the bereavement coordinator at Marshfield Medical Center, Rice Lake. 00;00;37;16 - 00;00;39;18 Adam Hocking Kathy Doe, thanks for joining us today on The Rounds. 00;00;39;23 - 00;00;41;04 Kathy Doe Thank you for having me, Adam. 00;00;41;16 - 00;00;56;05 Adam Hocking So I'd like to start pretty generally in kind of defined terms for the audience. And we're going to be talking about grief today, which I think is particularly important maybe during the holiday season. But can we start by defining terms and just tell me how you define grief? What is the definition of grief? 00;00;56;23 - 00;01;36;00 Kathy Doe Sure. Well, grief is simply defined in the dictionary as a deep and significant feeling of loss as experienced through the death or disappearance of a loved one. I would define grief as the deep sadness someone might feel whenever someone experiences a sense in a reality of loss of someone that is loved. And although we experience grief throughout our lives, from the moment that we're born, the loss of a toy, a friendship, a favorite item that we treasure, we seem to reserve grief for the big one or that word that we dread hearing the most, and that's death. 00;01;36;26 - 00;02;10;25 Kathy Doe So even though we have had the opportunity to practice the grief experience as we grow older, we rarely use that word. It's not a word that is normalized in our culture. I'd also like to just touch on there's an equally important concept that goes along with this that we don't discuss, and that is anticipatory grief, which essentially is what caretakers of ill loved ones experience on a daily basis, which can be also very emotionally draining. 00;02;11;11 - 00;02;21;15 Kathy Doe Although these feelings can be somewhat addressed in support groups if offered in the area like dementia or Alzheimer's groups, it's still a form of grief. 00;02;22;03 - 00;02;31;20 Adam Hocking So would you say grief really is present in our lives, in situations outside of death, but we really only sort of embrace that term when it comes to death. 00;02;31;24 - 00;02;46;10 Kathy Doe Absolutely. Every day we practice grief. Little by little, but we don't acknowledge it. I don't think enough in the educational system or at home because it's just something we we don't see as as normal. 00;02;46;29 - 00;03;10;24 Adam Hocking Do you think that especially in central Wisconsin, in the service area that Marshall Clinic has in central northern Wisconsin, where communities tend to be rural and a little more isolated, we know that access to even primary care, things like that can can be a challenge. I would imagine that's even more so for something that can be maybe more of a niche service, like like hospice or grief type services. 00;03;12;01 - 00;03;16;12 Adam Hocking Is there a barrier in central Wisconsin, too, to access to these types of resources? 00;03;16;24 - 00;04;00;19 Kathy Doe Well, I see a number of challenges here. First of all, actual grief counseling and support services are few and literally far between in our rural areas. Most health care facilities require insurance and co-payments, and even if individuals are insured, it can take weeks to get in to see a provider just for an assessment. Thus, individuals depend on their primary physicians to oftentimes prescribe prescription medication to assist with symptoms that come with grief, like for insomnia, loss of appetite, medicine, loss of interest in life activities, unexplained physical pains, those types of things. 00;04;01;01 - 00;04;37;01 Kathy Doe So there's a stigma attached to people who profess grief and sorrow, and most people would rather isolate themselves and talk about this pain. And secondly, many individuals are frightened to drive in rural Wisconsin. People tend to stay at home. Once they get there because they don't want to be alone on the roads at night, problems with road conditions, older and less reliable vehicles little to no public transportation and not wanting to depend on others who they already feel they're burdening with their grief. 00;04;37;15 - 00;05;17;26 Kathy Doe A third thing that I see is that people experience different types of losses and also grieve differently from one person to the next. Although specialized grieving groups and services might be offered to larger cities or people in larger cities, people are often felt or left to attend grief support groups like the one that we offer here in Rice Lake with others who have not had similar experiences through some experience death, through terminal illness, others through traumatic accidents and loss, and finally trying to find additional funding for this service. 00;05;17;26 - 00;05;48;24 Kathy Doe If we don't acknowledge a need or see the significance for the service, we will continue to perpetuate this problem, which can and potentially will turn into a mental illness if not dealt with. We already know that statistically people who lose their loved ones generally die themselves if they do not receive support services. Caretakers are especially vulnerable as they generally pass up their own medical appointments and care for themselves because of all the time and energy that's spent in taking care of their loved ones. 00;05;50;09 - 00;06;21;02 Kathy Doe Grief is a necessary process for healing. If we do not allow ourselves the time to work through this, it will manifest its way into our lives in different forms, again, through physical illness, emotional instability, depression, anger, grief will wait for us as long as it needs to. Other consequences of dealt with grief might be the loss of jobs, relationship problems, inability to focus. 00;06;21;11 - 00;06;38;05 Kathy Doe So there are layers here that we're talking about when it comes to grief. It's it's not just sadness. It affects us differently, but can really make an incredibly negative impact on our lives. 00;06;38;21 - 00;06;47;13 Adam Hocking I know often something that's talked about are the stages of grief. Mm hmm. Is that something that is more relevant in popular culture, or is that something that that really does hold true? 00;06;48;12 - 00;07;21;09 Kathy Doe I think Elizabeth Kubler Ross did an incredible job in bringing grief out of the closet, but she primarily worked with individuals who were dying, not those who were left back to grief, although relevant. I think right now we're we're taking a look closer at the individual and acknowledging not everybody comes angry. They don't follow that prescribed stage of grief. 00;07;21;22 - 00;07;45;25 Kathy Doe So when I'm talking with people about going to groups, I generally speak with them individually and recommend that they meet with me first. Not everyone is is ready to attend groups and go through those particular stages. I have people who come into the groups who have lost a loved one two months ago and some people who come in who lost a loved 110 years ago. 00;07;46;08 - 00;08;09;06 Kathy Doe And so they're there dealing with things at different emotional levels. I tell people that everything that is said in the in groups that it's a safe place for them to go to express their emotions and where they won't be judged and not felt that they need to say anything at all. They may not be ready. 00;08;09;22 - 00;08;23;13 Adam Hocking And so if I came to a group session, I'm sure everyone is different and it depends on who's there and as you just said. But generally, kind of what would it look like? What happens in a session if I if I were to come and and sit in on the session with you? 00;08;23;29 - 00;08;53;03 Kathy Doe Well, I guess I would start so that people know, once they listen to this, that they would have the opportunity for us to come to a group where they're going to receive education. They're given information up front. I use the grief toolbox. It's a grief journey. So it's an actual program put together by specialists across our nation that addresses specific areas within group grief. 00;08;55;02 - 00;09;20;08 Kathy Doe So they they know that they're going to come and get information that will hopefully normalize their process in the group and not diagnose them with a problem. So I think that's the most important thing, is to know that they are given affirmation that what they're going through is normal. They are told that they don't have to say anything. 00;09;20;17 - 00;09;41;01 Kathy Doe Within a group they can pass, so to speak, so that they can sit and contemplate, digest what's going on, listen to other people and know that little by little they they actually start expressing to one another what's going on. Rather than me just being facilitating a learning group, it turns into their group. 00;09;41;13 - 00;09;52;01 Adam Hocking Hmm. That's so interesting. And so you think that group dynamic. Is there an alternative? Where do you know? Have you done individual sessions or is it always a group session. 00;09;52;26 - 00;10;22;19 Kathy Doe When people I receive a referral, when someone contacts me, I generally like to meet with them first. That way I can assess if they're ready for a group or appropriate for a group because I'm I don't want people coming in and it could actually hurt them more if they're not ready to be in that group process. So we work through some things and sometimes they make referrals to other places for them. 00;10;24;01 - 00;10;42;19 Kathy Doe There is a specific place. It's about 50 miles from here called the Healing Place in Eau Claire, Wisconsin, where they can go get grief counseling. I'm not aware of any one who specializes in grief counseling in the rice Lake in this area. 00;10;42;28 - 00;11;03;07 Adam Hocking You know, it's kind of been under the surface of of what we've been talking about is sort of that fear of of death. And I think that's, you know, universal to human beings. But it also might be sort of uniquely American in our level of fear. And I don't know if that's true, but, you know, in preparing for this interview, I read a number of articles, you know, headlines. 00;11;03;07 - 00;11;20;04 Adam Hocking Americans can't grapple with death. Americans struggle with death. And I don't know if it's a byproduct of our individualistic type of culture or what it is. But do you see, you know, in our country and the folks that you work with that that it's a really pronounced problem to be able to talk about death? 00;11;20;17 - 00;11;53;13 Kathy Doe Absolutely. I think we see that in how we've set up and live it within our system. People are given some aren't given any time to grieve. Most are given 3 to 5 days paid to grieve. That gives people just enough time to get out there, get a funeral or a memorial service set up to gather the pictures, contact the relatives and friends, and set up a service. 00;11;54;21 - 00;12;19;04 Kathy Doe And then they're expected to go back to their everyday lives. The following week. And in many cultures around the world, that's not how it's done. People spend quite often that many days celebrating a person's life and not having to focus on what we're going to do next week to get back to normal. 00;12;19;17 - 00;12;38;29 Adam Hocking And we're we're in the holiday season. And I know especially around Christmas, New Year's, when families are together and there's a lot of tradition and history and, you know, you you have these things that you do with your family every single year. For folks that have lost a loved one, those traditions can be very different over the holiday season. 00;12;39;20 - 00;12;45;20 Adam Hocking Do you see a spike in grief during the holidays and what do you kind of attribute that to, if so? 00;12;46;04 - 00;13;16;14 Kathy Doe Absolutely. Once again, holidays can be exceptionally painful for people, especially newly bereaved people who haven't gone through those anniversaries. I call them the birthdays, any celebration, any holiday get together because they're still looking at the past with and tradition with their loved one. And all of a sudden now that's no longer going to be the case. They're not going to be there. 00;13;16;15 - 00;13;43;04 Kathy Doe There's going to be a void, an absence and an increased pain. So we focus in our groups on how to get through that, how we need to go down a new path, a new normal, a new journey. And what I recommend to individuals and what they recommend to one another is to take care of yourself during that time. 00;13;43;23 - 00;14;05;27 Kathy Doe This is not a time where you need to be making decisions. I encourage people to go back to those people who said who tell them, you know, at the time of the death, what can I do? And the best thing that we can do for those people who've experienced a loss is to be with them. And sometimes there simply are no words. 00;14;06;15 - 00;14;38;15 Kathy Doe The worst thing we can do is, is to stay away, to not contact them. So we talk about plans, having a plan of action. If you don't want to go to a holiday celebration, kindly say to others, you know, thank you for the invitation, but I don't think I'm going to be able to make it this year. And if I'm feeling better, can I come at a later time or may I leave early? 00;14;38;15 - 00;15;00;16 Kathy Doe If something is going, I think it's best to have a friend that you can confide in. If you must go out shopping. If you need to go shopping, take someone with you so that if you need to exit, you've got a place to go. I recall finding a woman back in the by the fish tanks in Walmart here in Rice Lake. 00;15;00;16 - 00;15;39;03 Kathy Doe Just absolutely sobbing and and panicking. Before I even started this group. As a human being, I approached her and she said, I am I'm stuck. I can't get out of here. And she shared how she had just lost her husband and was hearing Christmas music. And she she panicked. So having someone close to talk with, being honest with people about how you're feeling and taking good care of yourself are the three things that we really focus on when it comes to these special or holiday times or celebrations. 00;15;39;21 - 00;15;42;06 Adam Hocking Why are you so passionate about this, this work that you do? 00;15;42;16 - 00;15;50;18 Kathy Doe Well, it I wouldn't if someone would have asked me a few years ago if I'd be sitting here today, I would have said, are you kidding me? 00;15;53;27 - 00;16;22;26 Kathy Doe You know what? It's the same question they ask people who go into taking care of funerals and that type of thing. They see this as a very negative, unhappy, sorrowful thing and I think my own personal experience my father had cancer. We went down that road with him for five years. I was with him when he passed. And one thing that he had said to me was, you're you're pretty good at this. 00;16;22;28 - 00;16;55;06 Kathy Doe I, I want you to continue to be with others to do this. And so I didn't I just I said I would do my best and took a little time off from that situation and applied for a position that came open because it kept blinking on indeed.com. And I thought, Well, there is a sign. Sure, I'll come down and talk to people here. 00;16;56;07 - 00;17;22;18 Kathy Doe Will I be the best person for it? I don't know. But based on experience, I'll give it a shot and I so I see this as more of a calling. I, I don't see this as a job. It's, it's something that I don't think that anybody should be alone or feel alone or feel abnormal because it is a normal process. 00;17;22;18 - 00;17;36;21 Kathy Doe And so when I see that people are having challenging times with situations like this, I feel I need to be there to comfort them because someone was there to comfort me. 00;17;37;20 - 00;17;47;04 Adam Hocking I hope I can ask this. How has doing this work informed your own view of what death is and how you would feel about it? 00;17;47;22 - 00;18;28;01 Kathy Doe I am no longer fearful of death. Over the past five years, I've been with many, many people who have died, and through this hospice program, I found it actually very comforting to know that we have medical personnel that are there to help and to make things comfortable for people, not only the the dying, but the embracing the family and comforting them and and allowing them to see that this is death, this is a natural part of life. 00;18;28;21 - 00;18;36;24 Kathy Doe And so it's actually made things less frightening and more comforting and assuring. 00;18;37;17 - 00;18;52;07 Adam Hocking So we talked a lot about the holidays. And in trying to get through that, as a person who is grieving. But if I have a friend who's grieving, how can I be sensitive to what they're going through? And how can I support that person, particularly at this time of year? 00;18;52;20 - 00;19;25;21 Kathy Doe There again, I think we need to be honest with ourselves and with others. It may not be a topic that it may be a topic we're awkward about, but again, I say saying nothing is worse than saying something that may be maybe that you might find a bit inappropriate. You know, I don't know what to say. So letting them know that you're there, calling them, letting them know they can cry and it's okay, you know, giving them a hug. 00;19;26;14 - 00;19;52;07 Kathy Doe Some people aren't huggers, but just being beside them is something that we can do. Helping with if they have children. Can I take your children to different events if you're not feeling like you can go? So just that acknowledgment and using I we practice using that person's name oftentimes in grief, we say I lost my husband, I lost my brother. 00;19;52;16 - 00;20;05;25 Kathy Doe Saying their name brings them back into life. That's another focus that we have. We often it's terrible thing to say, but we put people away when when we have a funeral. 00;20;05;26 - 00;20;06;05 Adam Hocking Sure. 00;20;07;01 - 00;20;22;03 Kathy Doe So bringing them back into life through the use of their names, through the use of their talking about memories, get people laughing. I get people crying and making them a part of their lives until they're gone. Is is very important. 00;20;22;24 - 00;20;44;13 Adam Hocking We all know that grief kind of comes in in waves. And it might be very acute in that immediate period after your loved one died. And then after that time, three months, six months, a year down, it might just come in waves and kind of grip you just momentarily. Yeah. Can you talk about sort of why that happens and talk about that evolution a little bit? 00;20;44;22 - 00;21;11;24 Kathy Doe Absolutely. Those are called grief triggers. We may go through an entire year of just taking care of business. We stay busy. We have the funeral, the memorial service. Then we have to get the cards out, the thank you cards. We have to take care of the business portion of grieving the bills, other things that come up, life situations. 00;21;11;24 - 00;21;36;28 Kathy Doe And we think if that we keep busy, it's going to get easier. Or we think, oh, I think I'm doing okay. And then we can be standing in the grocery store and go down an aisle and select an item that we don't need anymore. And it's like it hits you upside the head and you instantly freeze or cry or panic. 00;21;36;28 - 00;22;08;13 Kathy Doe Like the lady in in Walmart. And we have to leave and it totally takes us down. And then we wonder, where did that come from? Why did that happen? And that's just grief coming up to remind you that you still have some things to work through. So the good news is that's normal. The bad news is that your second year in grief can actually be harder than your first because you just were busy and ignoring it. 00;22;08;13 - 00;22;33;19 Kathy Doe And I say that you're still our program says that you were numb and frozen. And when we start to thaw, that's when we start grieving. And those triggers can come right back, could be a song, could be, you know, driving by the movie theater or a favorite supper club or a sports event, depending on the situation. 00;22;34;18 - 00;22;47;24 Adam Hocking You talked a little bit about kind of bringing people back to life by saying their name. Mm hmm. What are other traditions or practices or things people can do in the grieving process to kind of help keep that memory alive? 00;22;48;21 - 00;23;09;23 Kathy Doe I'll speak to what we do in our support group. The second time that people come back, I ask them to bring a picture of their loved one, to introduce their loved one to the group so that we know who we're talking about or a favorite item, a clothing item or something they did for a hobby. And it really seems to open the door. 00;23;09;23 - 00;23;28;22 Kathy Doe It's like, Oh, I don't have to put these things away. My goodness, they were a part of your life for 30, 40 years. Why wouldn't they continue to be a part of your life? They're still your husband. They're still your brother. They're still your father. They don't go away. We just because we physically can't see them doesn't mean we can't have them with us. 00;23;29;07 - 00;23;58;06 Kathy Doe And so that's one way that we can do that. We talk about celebrating, continuing to celebrate their birthdays. Why would we not put that back on the calendar next year? Why would we not have a party? And some people think that's bizarre and strange, but that's our culture. So those are the things that we we do. We talk about they stay alive in our memories depending on their loss. 00;23;58;18 - 00;24;15;02 Kathy Doe A lot of people have created groups like Mad, you know, Mothers Against Drunk Drivers or Alzheimer's dementia groups. So it makes them more passionate, but it also keeps the legacy of their loved one alive. 00;24;16;10 - 00;24;49;23 Adam Hocking I would assume that there there are times when when folks when they lose a loved one through no fault of their own, there's still guilt or shame about maybe the way the person passed or the relationship before the you know, before before the person passed. How do you help people kind of process those things and get past the the really sad part to where they can start to have happy memories about that person and laugh about when grandpa used to tell jokes or when Dad used to do this or that. 00;24;49;24 - 00;24;59;28 Adam Hocking How do they. It's probably too, too and I’m probably asking it too simply. But how do you get from that really dark period to where you can start to remember some of the good things? 00;25;01;04 - 00;25;24;18 Kathy Doe There's a term for that. It's called survivor's guilt. And again, very normal, especially with caretakers who think that sometimes their loved ones pass in the middle of the night. They weren't awake or they weren't there the last minute. They could have done something better if they would have went to a different hospital, a different doctor, blah, blah, blah. 00;25;26;11 - 00;25;51;19 Kathy Doe It's it's all the same. They just seem to they're guilty. They feel guilty because they're still alive and they could have done better. So we talk about how it's okay, you need to and not acknowledge those feelings at the same time. What do you think your loved one would say to you if they could come back and sit next to you here today? 00;25;53;06 - 00;26;27;03 Kathy Doe And they generally pause and that's a different way of thinking again. Well, he'd tell me to knock it off and to move on there, you know, and and then they might laugh. And so it's a step by step process. I, I generally have them come complete a journal where they actually talk through this. If they can't talk about it in group, they write it down so they can actually see what they're doing to themselves. 00;26;27;11 - 00;27;00;23 Kathy Doe As far as how that negativity will continue to fester itself, if you don't walk through that and start looking at again bringing that loved one back, what would they say? And some people, it may take months before they can get beyond that. But generally speaking, through talking with others, they start to laugh again. They they start to work through that. 00;27;01;19 - 00;27;10;23 Kathy Doe That's the best way I know how to answer that. It's hard to go from that dark side, but it's possible. And there is hope working through that. 00;27;12;26 - 00;27;42;02 Kathy Doe Generally, when I when I look back at our groups, the first thing we do is the use of the name using the journaling, bringing that journaling back into the group and sharing as they can. I have many people who write poetry bringing something insignificant. One woman brought in a beautiful woodcarving that her husband had done and that led her to talk more about their life experiences. 00;27;42;02 - 00;28;13;03 Kathy Doe And she's now sitting that back out, talking with others, and they generally we get one another's phone numbers and start talking in between groups as they become more comfortable. So attending community activities together, going into that movie theater for the first time or going out to dinner for that first time again. So hooking up with others and I always encourage people, you know, if they do belong to a church, that the groups that we do are nondenominational. 00;28;13;03 - 00;28;24;19 Kathy Doe So going back to churches is another place where they might find comfort. So wherever they might find sanctuary and comfort with other people is where I encourage them to go. 00;28;25;04 - 00;28;35;28 Adam Hocking When people are grieving, how do you separate someone who is going through a healthy grieving process versus someone who maybe is struggling on a deeper or even more severe or serious level? 00;28;36;22 - 00;29;10;22 Kathy Doe What is normal and and what is not normal in grief? Again, it looks different from one to another. And I think that's why medical professionals struggle with this so much, because sometimes grief can mask itself as as depression. And there is an element of depression to grief. But it's when people start pulling away, isolating themselves, not eating, not taking care of themselves is when I would have a concern and make a referral for more assistance. 00;29;11;16 - 00;29;34;06 Kathy Doe But things like taking clothing out of the home of the loved one, some people say, What should I do with the clothes? Should I sell the house? Should I wear my wedding ring? And I simply respond back? Is that something you want to do right now? Something you need to do, something you need help with? It's got to be their idea. 00;29;34;06 - 00;29;48;17 Kathy Doe They have to be comfortable with it. And I don't think that they should be making any significant changes until they're comfortable. And so it's a very again, it's a very individual thing. And that's what makes us so complicated. 00;29;48;17 - 00;30;06;07 Adam Hocking I think I'll ask one more question, if that's okay. Sure. How do you sort of balance allowing that individual journey, giving people space to grieve with? I want to make sure that they're okay. I want to make sure yes, I want to give them their space. But I want to make sure that they're taking care of themselves to an extent. 00;30;06;12 - 00;30;10;18 Adam Hocking I don't want to be intrusive, but I want to make sure that they're okay. How do you balance that? 00;30;11;00 - 00;30;44;06 Kathy Doe Most of the people that I see in in grief support, I've already had a private conversation with them. And again, if I see symptoms that would require more attention or I think it could be more damaging to them, they don't come into the group. I refer them on. But we talk about balance in group and we talk about there is that time to cry, there is that time to be alone and reflect on what's happening. 00;30;45;08 - 00;31;09;17 Kathy Doe But you also need to pay attention to, you know, taking care of yourself physically, getting back out into the community, testing the waters to see how you'll do and making sure that you have, again, someone who's very close to you, that you can trust, that you can call or someone who will you can trust will come and check on you. 00;31;09;17 - 00;31;17;18 Kathy Doe So it can really be a very delicate dance that you do in the beginning. 00;31;18;11 - 00;31;22;26 Adam Hocking Kathy Doe thank you so much for doing this incredibly important work and thanks for joining us on the rounds today. 00;31;23;01 - 00;31;31;27 Kathy Doe Well, thank you very much for having me. And I hope that people will get in touch with people when they're feeling this way and come see us. 00;31;37;09 - 00;32;03;04 Adam Hocking The Rounds is produced by Ryan Maderic and supported by the Marketing and Communications Department of Marshfield Clinic Health System. You can subscribe to the rounds and download episodes via iTunes or by visiting Shine365 dot Marshfield Clinic dot org. I'm Adam Hocking and I hope you'll join us next time on The Rounds.