“Grace in denial.”

It’s not infrequent working in palliative care, that I will see complicated grief in patient’s families in the form of anger and denial. Recently I heard a podcast with the guest was David Kessler, who co-wrote the book On Grief and Grieving with Elizabeth Küber-Ross. The podcast was an interview between Khloe Kardashian and David Kessler, where he shared the following insights on grief that fundamentally shifted the way I look at anger and denial in patients families.

The Kardashians are known for many things in pop culture and mainstream media, but perhaps many do not know that the family have grieved a loss where their dad Robert Kardashian died at age 59 to esophageal cancer. He was diagnosed in July 2003 and died two months later. He was 59 at time of death and Khloe Kardashian was 18 at the time.

This is a common scenario that sets up the family for complex grief that I see in practice: 1) when the patient is diagnosed at a young age (typically between age 30-60), 2) there are young children involved (either kids or teenagers), 3) the cancer is already advanced or metastatic at time of diagnosis, and 4) rapid deterioration from time of diagnosis.

When Khloe questioned the way she handled her father’s death at the time, David Kessler responded with radical compassion:

“You’re doing grief right, you’re doing it as a 18-year-old would”.

And it made me realize that in healthcare, sometimes we may have certain ideas of what the “right” way to show up for a patient in their last stage of life looks like. It’s not uncommon that there are implicit judgement if we see a family member did not come to visit their loves ones in hospital or hospice, or if they are travelling out of the country, or if they refuse to talk about death and dying… And while this is often from good intentions of trying to prevent family members of developing complex grief, this statement from David Kessler reminded me that everyone is on their own journey.

A teenager is going to approach grief and their parent dying the way they would approach other aspects of life, and it may not be text book perfect response but that’s the capacity they have at the time. And it reminds me again of the radical acceptance and compassion as healthcare providers we must have for our patients and their love ones.

In discussing anger and the denial that Khloe felt like she had during the two months from her father’s cancer diagnosis to his death and the grief that David Kessler experienced following the sudden loss of his son to overdose:

“Anger is grief. Anger is pain’s bodyguard. The anger shows up first to protect you.

If you had all the feelings of your father’s death and I had all the feelings of my son’s death in one day, we would be on the floor and we would never get up.

There’s a grace in denial. Denial paces things out so we can digest it slower”.

This created a fundamental shift in the way that I view anger and denial - perhaps two of the most common reactions that I see from patient’s families in complex grief.

Denial is necessary as a protective mechanism from people’s heart breaking in a way that prevents them from being able to function on a day to day. It may be surprising to some, but there are a lot of practical things people have to sort out while their love ones are dying – organizing the will, finances, arranging funeral homes, perhaps getting their kids to school/home and/or arranging child care while they are in the hospital.  

There is a grace in denial. 

And it is important working in healthcare to extend that grace, as much as we can.