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Q. I am a 20-year-old college student and I recently lost two grandparents to cancer. I was close to both and am having trouble dealing with guilt and regret for not being there when they died or spending more time with them. What can I do?

A.

Losing grandparents, no matter what age they were when they died, will always make us feel that we just wanted more time to spend with them. The sense that there was more to say to them, more special times to share, and more memories for us to “collect” and treasure for the future may move us to be filled with guilt or regret about not having done enough.

Although guilt can be a common characteristic of normal grief, it should be balanced with the awareness that we really tried to do the best that we could for our loved one given our human limitations.

It is very difficult to lose two grandparents to cancer in such a short amount of time. How does someone grieving two important loved ones cope when the losses are one right after the other? Allow me, if you will, to step into the role of your grandparents and speak to you directly in each of their “voices”:

“As you know, I have always wanted the very best for you. I remember you when you were born, and was so proud of you as I watched you grow up. You were the dream come true for your parents, and the joy of my life in my later years. We spent a lot of wonderful times together, didn’t we?

“The last thing I would want is for you to focus too much on the fact that you may not have been able to be there with me during my last moments. My greatest hope is that, as you live your life, you will hold onto the memories of me, which are deep inside of you.”

This simple role-play exercise may help you to replace the negative thoughts with positive “feedback.” You can also think about your grandparents' most significant qualities, those that you will never forget. Consider that these positive qualities are part of the legacy left to you and everyone else your grandparents cared about.

We offer an online bereavement support group and our social workers can help you find local bereavement services. An additional resource is griefnet.org, which also offers support groups and resources.

Q. My 42-year-old brother passed away this year and I was his caregiver. I am devastated and do not know how to cope this holiday season.

A.

The holidays are a time for giving, so please give yourself the gift of acceptance — your grief is part of your healing process. It’s natural that remembering your brother at this time brings sadness and pain. Express your feelings and try not to isolate yourself from those who care about you.

Remembering your brother on special days is way to honor him. He can be there in spirit through a symbolic ritual such as lighting a candle at a family dinner or planting a tree on New Year’s Day. Do things that have a personal meaning to you and will foster positive memories of him.

Your feelings are a normal response to loss and you need to give yourself time to adjust to living in this world without him. Do what you feel up to doing during the holidays, but take care of yourself and let others know that you have limited energy, both emotionally and physically.

To learn more about grief, what to expect, and how to cope, please read:

Finally, How To Go On Living When Some One you Love Dies, is an excellent book that is written by one of the foremost experts on grief, Therese A. Rando (Bantam Publishers).

Q. I am a 4 year survivor of prostate cancer, my sister just lost her 11-month ordeal with pancreatic cancer. She was told she had cancer almost 20 years after losing our mother, so holidays are rough for me and the rest of the family. Any thoughts as to how to handle this?

A.

I am very sorry for the recent loss of your sister and the trying times that you and your family now face, especially as the holidays approach. Likely, there is a “legacy of loss” that has become part of your family’s experience during this time of year, which may add to the grief you are now experiencing. The struggle to try to maintain some degree of normalcy during a very confusing and difficult time is profound, and I’m glad you are reaching out for guidance.

I want to assure you that it is possible to get through this time in a way that feels “right” for you individually and also as a family. There are no rules here; listening to yourselves and acknowledging your limits will be very important as you approach the weeks ahead. Consider each commitment you make and ask yourself honestly, “Is this something I can realistically take on right now?” You are carrying a heavy load and taking time to pay attention to your feelings will help you to make choices that will honor your grief and spend time together as a family.

This time can also be an opportunity for you to come together as a family in very meaningful ways. Perhaps you will decide to avoid the holiday pressures, and instead simply spend your time in each other’s company. It will be important to open up a dialogue with your family about their feelings, thoughts, and ideas as to how they would like to spend the holidays while remembering your mother and sister. Be honest and gentle with yourselves and with each other—this will help to facilitate communication and understanding and find the right balance.

For more information that might be helpful, please view Memorial Sloan Kettering Cancer Center’s video, Coping With Grief During the Holidays.

Please know that you are not alone and if you or any of your family members would like some additional support, please call our Hopeline at 800-813-4673. Our Hopeline is answered by CancerCare professional oncology social workers who are here to help and guide you. I hope you and your family will find some comfort during this difficult time.

Q. I lost my only daughter this past Jan. 2011—she was only 38 years old and left 3 young children. They do not live close to me. Christmas is coming up and I don't know how to get through all the joy of others. I do not want to be a downer to my other family members. I am married, but my husband is going through his own grief. Suggestions?

A.

I am so very sorry for the loss of your only daughter, and at such a young age. Your grief, especially as you face the one year anniversary of your daughter’s death, is understandably intense right now and needs proper attention and care.

You are not a “downer”—you are experiencing grief and that is real. This is a time for you to do whatever you can to take care of yourself. If you feel like crying, pardon yourself, and go have a good cry. Take the time and space you need to feel whatever comes your way and as much you are able, protect yourself from those who might place unrealistic expectations on you or judge you. Trying to force yourself to be happy might cause you additional stress, so try not to do anything you are not comfortable with; remember to pay attention to your feelings and internal reactions, and be gentle with yourself right now.

In order to take good care of yourself, consider identifying trusted friends and family to share your concerns with. If there is anyone you can confide in, call upon them to become your “shepherd” in helping to guide and support you during this difficult time. You might also come up with a “script” or something that you can say that feels authentic when people ask how you are doing, such as “this is a difficult time, but thank you for asking.” Making room for your grief during the holiday season may help you to feel less pressure, and hopefully allow for moments of peace, solace, or even joy that may come your way as you remember your daughter and spend time with your loved ones.

For additional guidance, please read our fact sheets, “Grief and Healing With the Loss of a Loved One” and “Helping Children Who Have Lost a Loved One.”

If you would like some additional support, please do not hesitate to call our Hopeline at 800-813-4673. You can speak with a CancerCare oncology social worker who can provide support, guidance, and resources.

Q. My daughter passed away from cancer about 6 months ago and I'm concerned about my 2 grandchildren, ages 7 and 4. Could you give me advice about how I might be able to help them?

A.

As a parent who recently lost a child, it can be very difficult to deal with your own grief while also trying to support other family members, including children. How you support your grandchildren may vary depending on their age and how they are grieving.

Your grandchildren are most likely grieving differently than the adults in your family. You may find that they can be crying or sad one moment and then asking to play a few moments later. This is a normal reaction for children and can be helpful in their grieving. Especially with younger children, play is a way for them to express difficult thoughts or feelings that might not otherwise be shared.

You may also find the children continue to ask questions about their mother’s death or if she will be coming back. For children under the age of 7 it is difficult to understand that death is permanent, so they may continue to ask about it. While these questions can feel uncomfortable to answer, it is important to continue to address these questions in a concrete way. Saying that she is “asleep” or “passed away” may sound comforting to adults, but can easily confuse children.

Continue to love and support your grandchildren as you have been doing and take the time to listen to their questions and concerns. It is important for them to know that there are adults they can turn to.

Some families find it helpful to attend bereavement groups for children that have lost a loved one. These groups usually use play and creating art as a way to help children cope with their grief, while meeting other children who have also experienced the death of a loved one.

Here are a few additional resources that may be helpful:

If you would like some additional support, please do not hesitate to call our Hopeline at 800-813-4673 and speak with an oncology social worker who can provide support, resources, and guidance.

Q. I'm a third-grade teacher and one of my student's mothers recently died of cancer. I'd like to know how to help her, and how to help the rest of my class support her.

A.

When a child loses a parent, it is natural for those around them to want to take away the pain or say something that will fix it. It is important to remember that you do not need to have all the answers. What your student needs most is to know there is someone there to listen and support her. For the most part, you will want to continue to provide structure and guidance in the same way you did before her mother’s death. Children, even those who are grieving, do best when adhering to their routine and what is familiar to them.

If you have the chance to speak with her privately, you can let her know that you are available if she ever wants to talk. This does not mean you need to take on the responsibilities of a counselor; rather you can be the starting point for her to get additional support. If your school has a counselor, you can help by introducing your student to him/her. Let your student know that if there is ever a time where she feels it is too difficult to be in class she can signal to you and leave to go to the counselor’s office.

As a class, many of the students may have some experience with death, maybe the death of a pet or a grandparent. Most will not have experienced the loss of a parent. The children in your class can be supportive of your student in very concrete ways by making a sympathy card, putting a care package together, and doing other kind gestures.

The following are resources to help the school staff as well as the child’s father:

Q. A kindergartner’s twin brother died from cancer. What are some things to best help the family and the surviving child?

A.

This family is adjusting to a major loss, and now more than ever, they need patience, love and understanding. The first rule in helping is: “Listen.” What are the parents telling you? Most often, the best way to be of service will come out in their words, although probably subtly.

Grief is an ongoing and lifelong journey, and there is no right or wrong way to grieve. In terms of the parents, very often, those who are grieving will forget to take care of themselves. This can take a toll on their health and can impact the household even more. You may need to remind the parents of the importance of self-care. Let them know that you are there for them, in whatever way they need. If they are not in a place to ask for help, be proactive. Some suggestions that might be helpful include cooking meals, cleaning, organizing, helping with thank you notes or grocery shopping. Just as friends rallied around them when they were taking care of a sick child, they now need a different kind of support, as they work on adjusting to their loss. Your helping out with everyday tasks may allow them more time for self-care, as well as more time with their child who is now adjusting to life as an only child.

At a kindergarten age, generally, children think in more concrete terms and do not understand the concept of “forever,” so it would be likely for this grieving child to think that his twin will come back. The family may need to remind the child that his sibling will not be coming back. Using euphemisms for the word “death” can be confusing to children, as in, “My brother is lost, and I am going to find him!” If the family has a belief system that includes heaven, the child may need to know that they cannot visit the twin in heaven. Younger children are less able to use words, but will express themselves in games, play or drawings. Through play, the parents might be able to pick up on thoughts or concerns that the child finds too complicated to express directly.

Children also use “magical thinking.” This child may think that what happened to his twin may also happen to him. Lots of reassurances need to be given, and questions need to be answered honestly with the child. More than ever, this child will need hugs and kisses and “I love you’s.” Many studies indicate that twins have a deep level of connectedness, and this may make this new separation more difficult. The child may also experience survivor’s guilt, and an open discussion to address this is important.

When life can be so challenging, it can be hard to express that life can also have joy and beauty. In fact, it may be impossible to see it at times, especially when there is such profound loss. But it important that children learn over time that even though life may be difficult or unfair, wonder and joy can still exist. We need to keep the sense of joy, wonder and happiness alive in children.

I think it is both very helpful and important to keep the memory of the twin alive in the home. But how is that memory kept alive? Every family is different. The family may want to plant a tree, or create a memory garden. Perhaps they create a spot where photos of the twin are kept, or maybe the pictures remain throughout the house. If the family is spiritual, maybe they want to create a special prayer that will become part of an evening ritual.

Additional resources for families coping with loss include:

Q. My co-worker and friend recently lost her husband of 23 years to prostate cancer. I want to be there for her, but I'm not sure how best support her. Could you give advice on what I might say or can do?

A.

It can sometimes be difficult to know what to say and/or what to do for someone who has experienced a loss. Feeling uncertain in terms of what to do and/or say is however common and normal. Death is not an event or human experience that can be “fixed” or “made better”. And, the struggle of loss and grief can certainly bring up feelings and experiences that we may have encountered as well.

Although we may find ourselves not knowing what to say to someone who has experienced a loss, there are ways in which we can offer support. An important way in which we can provide support to someone who is grieving is to offer what I suggest is the “gift of presence”. Simply letting your friend know that you are there to listen to her story and embrace her can be extremely supportive and healing. Remember that the grief experience is a process and everyone will grieve and heal in their own way and in their own time. This means that the support you offer your friend may change with the flow and movement of her grief and healing process. Grief and healing are interconnected and can often be experienced simultaneously. You may have to let your friend know therefore that the vicissitudes and range of emotions that may be experienced at times, although disconcerting, are normal. Allowing the process to be what it is, listening to your friend’s story, giving her a safe space, and offering validation of her grief will convey the message to your friend that you are “present” to her and care. Helping your friend find a support group can also be very helpful in connecting her to other people who are experiencing similar feelings and struggles.

You may want to read CancerCare’s fact sheet, How to Help Someone Who Is Grieving which may offer further suggestions and tips on how you may be of support to your friend.

Q. My older sister recently died and my friends have urged me to join a support group to help me deal with her death. I'm not quite sure how to go about doing this - could you help direct me?

A.

Often, when we are grieving the loss of a loved one, we may find ourselves questioning whether or not our feelings are normal. We may discover ourselves asking, “are there other people out there who are like me and experiencing similar feelings as I am”? Bereavement support groups can be exceedingly helpful in lessening feelings of isolation and aloneness. Not only do these support groups help us cope with the loss we are experiencing, but they offer fertile ground for camaraderie and support. Support groups provide us a safe space where we can share our story with others, grieve, and begin the road to healing.

Grief is a journey. Although everyone in a bereavement support group is brought together by the commonality of a loss, it simultaneously is important to remember that everyone copes with loss differently. In a support group not only will you be able to listen to the ways in which other people cope with a loss but you may also learn and develop new strategies for coping with your loss as well.

Many times people who engage in bereavement support groups frequently feel like “family”. This is a common experience as group members in sharing stories and feelings create lasting and powerful bonds with each other. Participants in support groups validate our experience and emotions. They reinforce our strengths when we may experience intense feelings such as sadness, anger or confusion. Group members support us as we remember our loved one and go through holidays, anniversaries, birthdays and other significant milestones.

In closing let me mention that although bereavement support groups can certainly strengthen and foster our capacity to cope with loss, it is important to keep in mind that support groups may not be for everyone. If this should be your experience, there is nothing wrong with you. Perhaps individual bereavement counseling would be more helpful to you during this period.

View CancerCare’s support groups.

Q. My husband died about five months ago and I think I should be feeling better by now, but honestly, I feel worse. Is there something wrong with me?

A.

Let me first begin by mentioning that there is nothing is “wrong” with you and what you are experiencing at the moment. This experience is normal and actually quite common. Many people with whom I have worked have indicated discovering themselves on an emotional roller coaster at times. People often believe that grief and the healing process manifests itself in a linear fashion. We assume that we simply move from one “stage” to another. The grief experience however is quite contrary to this perception. Remember that grief and healing is instead an evolving and dynamic process. Changes in how we feel physically, emotionally and spiritually are to be expected. There will be days in which you may feel good about yourself and life and conversely there will be days when you may feel everything around you has fallen apart. Our feelings and experiences are similar to the tides of the ocean; the tide flows in and the tide flows out. Keep in mind that everyone is different. People cope with loss and heal in their own way and in their own time.

Healing is not simply about picking up from where we left off as if nothing ever happened. Rather, it consists of an attempt to create legacy and keep the memory of our loved one alive. It is important to allow the process to be what it is and to allow yourself to be where you need to be. Try not to judge yourself nor be critical of your feelings and experience. Nurture your soul during this period and always reach out to those around you who are supportive and caring.

Engaging in individual bereavement counseling, participating in bereavement support groups and reading literature pertaining to loss, grief and healing can be exceedingly helpful in normalizing your experience and validating your feelings. It can also afford you a safe space to share your story so you may not feel so alone.

I would recommend reading these CancerCare fact sheets as they may be of benefit to you; Living with Grief: How Can You Help Yourself and Coping with the Loss of Your Partner or Spouse.

Q. My mom has been living with metastatic breast cancer for about 8 years and she's at the end of her life now. She has started hospice care and her prognosis is that she has about 4-6 months left. I don't feel particularly sad because I've kind of prepared myself for this along the way and my family has always been good about informing me at each step in my mother's care. Also, I'm worried about how I will feel about her loss after she's passed and worried that the grief might come all at once. What do you think?

A.

I appreciate your honesty in raising this important issue. The concern you are experiencing over whether or not your grief might come all at once is commonly voiced by people who are expecting the death of a loved one and/or are bereaved.

Although we may discover ourselves anticipating a loved ones death and therefore beginning to grieve, the actual death of our loved nonetheless is traumatic and can lend itself to our feeling overwhelmed. Feeling “prepared” that is, cognitively for a loved ones death, does not necessarily mean that at the same time we are fully “prepared”, emotionally. This is normal; though I have to admit it can be disconcerting at the same time and feel quite unpleasant. Many people who have shared their stories with me have often described themselves as being on an emotional roller coaster. You may experience many feelings such as disbelief, anger, sadness, and confusion either individually, or perhaps all at once. It is important to remember however that everyone grieves a loss in their own way and in their own time. There is no set way in which to grieve. Although the literature and others around us may paint a landscape for us of what grief may look like, there can be no blueprint or roadmap for the grief experience. Remind yourself that the emotions you may be experiencing in the moment, no matter how palpable they may feel, will not last forever. As with the changes and movement of the tide, there will be days when you may feel good about yourself and life and days when you may not feel this way. Once again this is normal. As time progresses the moments when you feel good about yourself and life will begin to take precedence over those moments of grief and uncertainty. And, last, it can be helpful to view the grief experience as an important part of the healing process as well. Although the grief may be intense at times and the range of emotions you may be experiencing may feel consuming, simply allow the experience to be what it is. Try not to judge the process nor be critical of yourself. This is the body’s way of re-grouping and attempting to heal itself after a traumatic event. Learn to trust and honor the body’s wisdom.

In addition to validating your emotions and grief, I would encourage you to reach out to people who are supportive of you. Surrounding yourself by people who are nurturing and life affirming can help strengthen your capacity to cope with your loss and ensure the healing process.