If you are a nurse, there is no doubt you have heard of stages of grief as well as Elisabeth Kübler-Ross and her 1969 book “On Death and Dying”. Whether you were introduced to the stages of grief during your behavioral health clinical rotation or when covering end of life issues, it is evident that the emotions and grief when faced with terminal illness, death and dying are extreme. It is also true that individuals go through the stages of grief when faced with less severe life stressors as well including chronic illness, job loss, and the ending of relationships. Even the little stresses of life may elicit the stages of grief as well.
The commonly accepted five stages of grief are as follows:
1. Denial and/ or Isolation
2. Anger
3. Bargaining
4. Depression
5. Acceptance
These stages may or may not progress in that order. Also, even when progressing or completing a phase, it may be revisited again.
The story that I am about to share is not intended to belittle the extreme grief of those who are facing death or terminal illness. The grief associated with death or illness cannot easily be quantified.
Although true, the following account is written primarily to illustrate the similarities of emotion to the stages of grief that may be experienced when facing any unexpected stressor.
In my own life, I can recall a recent circumstance when my husband experienced these stages of grief when faced with a particular unexpected stressful experience. Over a year ago, during my second semester of nursing school, we had been in the midst of an unusually rough winter with a record number of snow storms. During one of these snow storms, when there was a state of emergency in place, we were relaxing at home in the living room, enjoying the day off. I was holding my toddler on my lap, running my fingers through her long, wavy hair, admiring her golden highlights. My heart skipped a beat when I spotted a teeny tiny particulate that appeared to jump from her scalp. As my heart feverishly was beating, my nimble fingers assessed her scalp and roots. The worst thought crossed my mind- it was every parents dreaded nightmare: lice! Not only was I upset about the idea of lice, I dreaded the fact that I had to break the bad news to my husband.
Using the techniques I learned about end of life care and oncology clinicals about breaking bad news, I wanted to make sure my husband was comfortable. I asked my husband who was sitting less than 5 feet away from me on the opposite couch, if he was seated comfortably. I proceeded to preface my conversation by telling him that I had to break some bad news and that he may need to prepare himself. In professional textbook-like fashion, that would have made my psych clinical instructors proud, I proceeded to tell my husband in a calm and matter of fact tone, that I believed our daughter had lice. The events and reactions that quickly unfolded, although incredible, were a classic case of the stages of grief.
1. Denial - my husband responded in disbelief and anger when he immediately demanded that I explain to him what I meant by "lice". "What is Lice?....I don't know what Lice is...." he simply stated with a blank look in his eye as if he had never heard of lice. Perhaps by denying the definition of lice, he was denying the possibility that our daughter had become infested with a case of head lice. I proceeded to slowly and calmly explain to him what lice was so as to clarify what I meant by the term lice. Immobilized, he stood in front of me with a glassy stare. He responded that she could not possibly have lice since we were in a middle of a snow storm.
2. Anger- Shortly after, my husband's voice became louder as he yelled that we were in the middle of a snow storm and that it was the worst possible time to have lice. He yelled at me for telling him she had lice. He ranted and raved, demanding why I chose this particular time to tell him she had lice.
3. Bargaining- Then he began to argue that it was not possible to have lice, telling me I had to be mistaken. He questioned ,y perceptions telling me it must be something else- dust or dandruff. When I insisted it was lice, he tried to convince me that I imagined it.
The events that followed were strange and unusual - almost unbelievable in fact. The following account can not be neatly classified under any specific stage. The next thing I knew was that my husband was sitting down with the toddler on his lap. In classical ape-like fashion, he was started combing through the strands of hair with his fingers, and with his fingers he appeared to be picking something from her head. He proceeded to inspect what he found, squinting his eye for a better look. With a look of satisfaction and accomplishment, he proceeded to put his fingers in his mouth. What he was eating, I could not tell. It was imperceptible to the naked eye. Strand by strand he meticulously picked through the hairs of her scalp, grooming her like a Sliver Backed gorilla from the zoo, inspecting what he found before carefully placing it in his mouth. I had no words as he was exclaiming triumphantly and confidently, "see....see! ....If this was lice, would I be eating it?!?" I watched without judgment. I could only imagined the stress of the idea of lice had caused a mental breakdown.
4. Depression- At some point my husband grew silent and was also at a loss for words. Several minuets of uncomfortable silence elapsed.
5. Acceptance- Finally at lightening speed, with renewed purpose, my husband ran up to the bathroom. Without delay I heard the shower. Less than 5 minutes later he ran down, wet. and red as a beet, proudly stating he took a hot scalding shower. At this point I felt he had accepted the conclusion that our daughter had lice, and in his own way, he was attempting to self medicate himself in the even he too had lice, not realizing that lice and nits are not killed by hot water alone.
These events lasted the course of about 30 minutes at most as he cycled through the phases of grief in response to a stressful situation. I am happy to say that my daughter did not in fact lice as my eyes had probably been playing tricks on me. Perhaps in my concern and fears about lice, I had gone overboard in jumping to conclusions. Another careful look through her hair I could not find any evidence of lice or nits.
