…Our sorrow lives in us as an indestructible force, only changing its form…and passing from pain into sympathy—the one poor word which includes all our best insight and our best love.
—George Eliot, Adam Bede1
Mrs A, a longtime patient of Dr M, is 77 years old and has been widowed for 2 years. Her husband, a well-respected public figure, died after a protracted course of diabetes, hypertension, coronary artery disease, congestive heart failure, end-stage renal disease, and, ultimately, renal failure. The husband, who was not Dr M's patient, had been cared for at home by Mrs A until his final 10-week hospitalization, which involved repeated admissions to the intensive care unit. One of their sons moved into their home temporarily to help care for his father and another son and a daughter live nearby.
During the first year of widowhood, Mrs A visited Dr M more than usual—roughly every other month. Her visits were nominally to address symptoms (eg, insomnia, perpetual weeping). It was clear to both Mrs A and Dr M that bereavement was the major source of these problems, so much of the time was spent addressing that explicitly. Dr M offered a sleeping pill, which she declined. Mrs A began seeing a psychiatrist and attending a bereavement support group. She was interested in obtaining additional information about grief and bereavement, including written material and Web resources.
Mrs A and Dr M were each interviewed by a Perspectives editor.
MRS A: Immediately following my husband's death there was constant pain. I did things, but it was very difficult; he was in my mind all the time. I was running videos of his last days in my head—everything that had happened in his care, and how he reacted, and what the doctors were doing with him—it was not a very good way to die. I also felt numb…It's hard to recall what happened and why I made certain decisions. I was depressed and couldn't sleep well. And I cried. I've never cried as much as I cried for the first few months after he died. I still cry when I think about it…I'll never get rid of that pain. I know there is anecdotal evidence that if people had cancer, it can recur after a spouse or a partner or a child's death. I've had cancer 3 times, and I didn't want that to happen again. That's one reason I really worked at trying to get myself steady.
DR M: I saw Mrs A about 3 weeks after her husband died. When I saw her, she wanted to talk about him and her grief, not about her usual problems. So we did. She told me she was still crying daily, multiple times each day. I found out that, despite her age (77), this was the first ...