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Bereaving the Heart that Suddenly Stops


DeNean Hardman

Saybrook University

MBM5517: Mindful Approaches to Grief and Loss

Dr. Gina Belton

February 2, 2024

 

 

Abstract


The death of a loved one is one of the greatest catalysts of change in many individuals' lives, especially when the death is sudden, and there is no time to prepare. Death due to sudden cardiac arrest (SCA) adds challenge to the bereavement process and factoring in the age of the bereaved family member and the closeness of the relationship creates an increased risk and likelihood of prolonged grief. This application essay highlights this form of grief through the writer’s personal experience with the inclusion of contemplative approaches to bereavement during such life-and-death experiences.

            Keywords: bereavement, grief, sudden cardiac arrest, healing

 


 

Bereaving the Heart that Suddenly Stops

It was January 14, 2000, approximately 6 pm, when I received the phone call. I recall being informed that my father was at Westchester Medical Center, and it was reported that he had fallen. My brother told me that he would meet me at the hospital. I was 19 years old, it was dark and rainy, and there was no GPS on the cell phones at that time, or at least I did not have that luxury. I don’t remember how I made it to the hospital, but my life was forever changed when I left there that evening. I arrived at the emergency room, my child’s father, David, was standing beside me, and we made our way to the reception desk. I did not see my family or anyone else who looked familiar, everyone appeared as a blur, anyway.  They were all moving with urgency while simultaneously appearing to move in slow motion.


I gave the nurse at the desk my father’s name and told her that I had been informed that he had fallen. I recall her not saying anything other than “Follow me.” David and I followed her down what seemed like the longest hallway, and I peered into every open door and peeked behind every curtain that we passed. When we finally arrived at the end of the hallway, the nurse opened the door, and it was then that she told me that he had passed away. I don’t remember the words that she used, and they honestly did not matter at that point. “Deceased” was not how I expected to find him, especially since I believed that it was just his knee that had been the issue.


There I stood, at the foot of my father’s hospital bed. The room was almost bare, as he lay there covered only in a white hospital sheet with a small plastic piece from an intubation tube left in his mouth. After being carried out of the room by my brother, I had no idea who alerted him that I was screaming and crying, all balled up on that cold linoleum floor. It was then I was verbally informed that my father had passed away from cardiac arrest a few hours earlier. I didn’t even know that he was sick, much less, that his heart was in a constant state of strain and distress.


Sudden cardiac death (SCD) is the broad term that is often used to describe unexpected natural deaths from cardiac-related issues (Mayer et al., 2013). While cardiovascular disease is known to be a leading cause of death, the impact that SCD has on the bereavement of loved ones may be even more challenging since their death is not expected. Mayer et al. (2013) expressed the belief that certain types of deaths may be more challenging for loved ones to come to terms with than others. When there is an event such as the sudden death of a loved one, the bereaved are catapulted to now live in a new world, one that they had not had the opportunity to plan for.


The Goodbye Before the Goodbye


Before the day of his passing, I used to call my father every day at work, just before 5 pm. The naggings of a teenage daughter, “Daddy, what time will you be home?”, “Daddy, what are we having for dinner?”, “Daddy, can you stop at the store for me?” or “Daddy, can I have some money?”.  On that Friday, January 14th, I called him late, but he answered. “Daddy, what are you still doing at work? You were supposed to have left already.” He chuckled and told me that he had been waiting for me to call. Maybe he knew that would be our last earthly conversation and he didn’t want us to miss it. While he did not pass away from a diagnosed chronic illness, who can say that he did not have awareness of his death, nonetheless. Cohen-Mansfield et al. (2022) concluded from their study that patients do have a level of awareness of their death before the time that they pass.


While I was only a teenager when my father passed, he was 64 years old and did not prioritize his health care. A very quiet man, whose life centered on working and coming home, providing for his family was his priority. Ironic that he died on a Friday while leaving his job, at the end of his shift. I, on the other hand, was the self-proclaimed caretaker, who monitored many of his moves, to his annoyance. I recall often standing over him in the middle of the night, watching him sleep, for fear that he would stop breathing. The startle on his face every time he opened his eyes, and he would find me “just hovering”. I feared his death and the thought of discovering him deceased. The other irony, he died without me even being there. This makes me think of the excerpt from Being with Dying, and Halifax (2008) sharing the story of how Matsúwa was disappointed when his plan of death was interrupted by his family.  I do not believe that my father felt that I would “interrupt his plan”, but I have wondered if he knew my fear, and saved me from finding him. My not being present at the time of his death may have very much been a part of his plan.


Life After Their Heart Stops


Carlsson et al. (2022) stated that circumstances associated with the sudden loss of a loved one often create obstacles for an individual’s forward movement in the process of grief and all too often have a great impact on their overall well-being. At 19, what would I know about grief or what would I know about living life without one of the major contributors to my life? I was 19, with a 2-year-old, and had no idea of what to do next. Carlsson et al. (2022) surmised that individuals suffer from an extreme amount of stress when their loved one passes from cardiac arrest. This stress is in part due to reminders of the reality that life is not promised, the individual may now be challenged with responsibilities that they are not accustomed to or prepared for, and that feelings may need to be pushed away just to be able to engage in everyday functioning.


I recognize now that my way of grieving was putting my feelings in my pocket, with the determination that I would survive life, in a way that made my father proud. I had to “grow up” without those “almost 5 pm” phone calls about what would be for dinner or the responsibilities of the house that needed to be addressed. I had to “adult” without my only real adult resource and my future felt so uncertain because I was truly now left unsupervised. Not only did I have to take care of myself, but I had a young child to take care of as well. Having a young child meant that I also did not have the opportunity to be alone with my feelings or allow myself to process them.


Blue’s Clues and bathtimes did serve as a great distraction, which was also appreciated, though when a loved one passes, some solitude is necessary. Time alone is beneficial as it aids in the opportunity to be present with your thoughts and feelings associated with the loss and the new life (Carlsson et al., 2022). Carlsson et al. (2023) reported that there is an increased likelihood of both prolonged grief and psychological distress when the bereaved family member is of female sex, younger in age, and if the death is unnatural, though also goes on to state that additional research adds that there is an even greater level of this distress when a family member passes from SCD. While my father’s death was not unnatural, it was due to SCD, and I was young, with very few supportive resources.


Fisher et al. (2020) spoke to the concept of “preparedness” when it came to the coping strategies of the bereaved and explored the 14 Brief COPE strategies. The 14 Brief COPE strategies referenced were 1) Active Coping, 2) Planning, 3) Positive Reframing, 4) Acceptance, 5) Humor, 6) Religion, 7) Utilization of Emotional Support, 8) Use of Instrumental Support, 9) Self-Distraction, 10) Denial, 11) Venting, 12) Substance Use, 13) Behavioral Disengagement, and 14) Self – Blame (Fisher et al., 2020). While I was not aware of these coping strategies during my initiation into a grieving lifestyle, I actively engaged in at least 4, which were acceptance, self-distraction, substance use, and behavioral disengagement.


The action of acceptance falls into the area of active emotional coping, while my remaining 3 fall within the area of avoidant emotional coping (Fisher et al., 2020).  The findings from Fisher et al.’s 2020 study reported that there was an increased likelihood of the severity within the areas of grief and depression of the bereaved individuals who utilized avoidant emotional coping.  The utilization of avoidant emotional coping strategies may not be intentional or purposeful, there may be times when the level of emotional insight or intelligence may only afford this opportunity. For myself, I believe that I did the best that I could.


Leaning into honesty and transparency of this grief experience, I did not move from an avoidant emotional coping style for at least 16 years from his death. My lifestyle was filled with distractions, such as my son and providing for him, establishing a career, and accumulating degrees. I filled my life with meeting his physical needs while avoiding my own emotional needs. I continued to engage in self-distraction, substance use, and behavioral disengagement, though, from the outside, I appeared relatively “stable”. By 2016, I was married, owned my own home, had 2 master’s degrees, and had somewhat of a career, though, from the inside, I remained a 19-year-old, who had yet to come to terms with her most major life loss. Then, my son left for college, and the floodgates of true grief were opened.


I came to wonder why the gates were opened, then recognized that they were never securely closed, but more comparable to a beaver’s dam being tasked to withstand tidal waves. Boss & Carnes (2012) explored The Myth of Closure highlighting ambiguous loss and reminding us that ambiguous loss fails to offer closure. Ambiguous loss was defined as the loss of a loved one, not to death but the disappearance of their mind or body (Boss & Carnes, 2012). While my father physically died, there came I point when I realized that I did not lose him to death, he was just no longer here in physical form.


About a year after his death, I began to be visited by his presence in my dreams. His visits increased throughout the years, I was unable to make sense of them, and I awoke each following morning, mourning his death all over again. Because these were dreams, I had not been comfortable sharing my “death experience” every time I had these dreams. To me, my father died multiple times, until I realized that physical death was not the finality. Now, I no longer mourn him as I have learned to call him just like those 5 pm phone calls, and I have resumed my place as that nagging daughter, just with more grown-up problems and prepared for adult conversation and confrontation.  Carlsson et al. (2022) stated that the practice of bereavement has moved from “getting over” or “letting go” of the loss of a loved one and has morphed into the development of having a healthy relationship with a transitioned loved one. I am grateful for this healthy relationship with my transitioned loved one and I recognize that it required my periods of solitude to develop this stage of our relationship.


Conclusion


There is limited research on almost every point that I touched upon in this application. Limited research regarding loss related to SCD, limited research related to the loss of a primary caretaker during early adulthood, and limited research about awareness of death before death, yet there is an abundance of research related to bereavement. There is also ample support available to those who feel that they are alone in their loss. May no daughter (or child) feel the loss of their father as I felt but may every daughter (or child) feel the connection after death that I feel. Even for those who view physical death as the finality of life, may individuals be provided with the tools, resources, or supports, to develop active emotional coping strategies so that the death of their loved one does not hinder their ability to live their life.

           

References


Boss, P., & Carnes, D. (2012). The myth of closure. Family Process, 51(4), 456–469. https://doiorg.tcsedsystem.idm.oclc.org/10.1111/famp.12005 


Carlsson, N., Årestedt, K., Alvariza, A., Axelsson, L., Bremer, A. (2023). Factors associated with symptoms of prolonged grief and psychological distress among bereaved family members of persons who died from sudden cardiac arrest. The Journal of Cardiovascular Nursing 38(5):p 454-461, 9/10 2023. | DOI: 10.1097/JCN.0000000000000937


Carlsson, N., Bremer, A., Alvariza, A., Årestedt, K., & Axelsson, L. (2022). Losing a close person following death by sudden cardiac arrest: Bereaved family members’ lived experiences. Death Studies, 46(5), 1139–1148. https://doi.org/10.1080/07481187.2020.1799453


Cohen-Mansfield, J., Cohen, R., & Brill, S. (2022). Awareness of imminent death: Results from a mixed methods study of Israeli family caregivers’ perceptions of their awareness and that of the patients for whom they cared. Omega: Journal of Death and Dying, 302228221107236–302228221107236. https://doi.org/10.1177/00302228221107236


Fisher, J. E., Zhou, J., Zuleta, R. F., Fullerton, C. S., Ursano, R. J., & Cozza, S. J. (2020). Coping strategies and considering the possibility of death in those bereaved by sudden and violent deaths: Grief severity, depression, and posttraumatic Growth. Frontiers in Psychiatry, 11, 749–749. https://doi.org/10.3389/fpsyt.2020.00749


Halifax, J. (2008). Being with dying: Cultivating compassion and fearlessness in the presence of death. Shambhala. 


Mayer, D., M., Rosenfeld, A. G., & Gilbert, K. (2013). Lives forever changed: Family bereavement experiences after sudden cardiac death. Applied Nursing Research, 26(4), 168-173. 10.1016/j.apnr.2013.06.007

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