Anticipatory Grief: The Living-Dying Interval

Grief following the loss of a loved one is a socially-accepted response to a common life experience. However, there is another kind of grief that is less well recognized and discussed, and that is anticipatory grief; grief that occurs before death.

Hospice providers are familiar with anticipatory grief. We provide care for terminally ill patients and their families during the period between initial awareness of impending loss and the actual loss itself. Anticipatory grief is a normal response that occurs during this time.

Holding on. Letting go. These are the conflicting demands of anticipatory grief. Of course, we all know that death is inevitable, but realizing that a loved one is on a path to pass away sooner rather than later can elicit a variety of reactions including shock, confusion, denial, crying, anxiety, helplessness, anger, guilt, and fear, among others.

Awareness of an impending loss may allow loved ones to finalize connections with the dying person via reconciliation, forgiveness, reminiscing, shared activities, and making new memories. For this reason, anticipatory grief may be called the "living-dying" interval. It is a bittersweet period when you can still physically interact with a dying loved one.

Hope remains an important component in the face of impending loss. Family and patient may maintain hope for recovery. Sometimes, families display ambivalence regarding their healthcare decisions and even about the use of medications to relieve pain.

Loved ones hope that they have been good caregivers. Spiritual connectedness may increase feelings of hope at end of life. Even when there is no available cure, there can be hope for time well spent, having had a purposeful life, and a peaceful death.

There is no perfect way to navigate anticipatory grief. It can be overwhelming, exquisitely sad and beautiful at the same time. It can also be an opportunity for healing.

At some point, we reach the realization that we will eventually lose our loved ones as well as our own health and lives. This realization could cause us to experience perpetual anticipatory grief. Perhaps the experience of losing a loved one has something to teach us about how to live, which is to make the most of each moment, to communicate honestly and lovingly with those in our lives, and to seek joy. Joy is the opposite of grief, but the two may coexist, and they do, as we enjoy that precious "living-dying" interval.

Jennifer Gruenloh, RN, CHPN, provides care to patients and families at Allied Services Scranton Hospice Center.