26: Adolescent Grief: "It Never Really Hit Me … Until It Actually Happened"

The Patient's Story

Robert is a bright, engaging, forthright 14-year-old. His brother is 8 years younger. His parents had been married a long time and had a close circle of friends and family in their community. Robert is healthy, a good student, and athletic, competing in a variety of sports at school. When Robert was 7 years old, his mother was diagnosed as having breast cancer metastatic to the liver. Mrs S initially underwent a bilateral mastectomy followed by a regimen of chemotherapy. She was disease free for 2 years. At recurrence, she had an oophorectomy and received 2 chemoembolizations to the liver for new hepatic lesions, followed with cycles of chemotherapy. Three years after initial diagnosis, skull metastases were discovered. A few months later Mrs S was treated for congestive heart failure but continued chemotherapy.

A year later, Mrs S was both exhausted from the treatments and frustrated by their limited effectiveness. She explained her goal to her physician: "All I want you to do is keep me alive to see my son's bar mitzvah. Nothing else matters." The event was a month off. During that period, she declined quickly. Yet, she reached her goal.

Mrs S made numerous preparations for her death, including writing her life's story for her sons, creating a "roadmap" of advice, and collecting mementos to be given to them as they reach life's important milestones. Robert had been confronted with death even before the loss of his mother. Several years before his mother's diagnosis, when Robert was 5 years old, a newborn sister died just after birth. In addition, during Mrs S's illness, Robert's paternal grandmother died of colon cancer.

Mrs S's illness was so protracted that Robert said he had become "immune" to her remissions and relapses. Almost immediately after the bar mitzvah further brain metastases were discovered. Radiation was ineffective and hospice care was initiated. She died peacefully at home, several weeks later. Although he was kept unusually well informed about his mother's condition throughout her illness, he was nonetheless surprised when she actually died.

Following the death, after a couple of weeks of numbness, Robert reported feeling depressed. He felt that a piece of himself was missing. Talking with a guidance counselor at school was helpful. The depressed feelings disappeared quickly, but they were replaced by loneliness, which has persisted. Robert has coped with this by writing poetry and was able to eloquently express his feelings about the loss of his mother at the time of the interview, which took place a year after her death.

Perspectives

A Perspectives editor interviewed Robert a year after the death of his mother.