Stool softeners, Zofran, and other remembrances of loves past

This week was weird, even for me. On Monday I had knee surgery. It is the kind of knee surgery that’s so routine that the surgeon feels pretty blasé about telling you he does 15-20 of them a day. But there is no routine surgery when you’re the patient, and in my case, there is nothing so simple and straightforward that I cannot make a convoluted harangue out of it. 

It actually started before the surgery, when my psyche visited a cancer spider surgery dream upon me. This set the stage nicely, as it signaled to me that surgery – even a type utterly removed from cancer or Nina’s treatment – was going to be a trigger. 

Well, it turned out to be not so much a trigger as a bizarre trip down bad memory lane. The day of the surgery I took the prescribed opioids, but wound up with sudden onsets of nausea. I tried not taking the opioids. This resulted in me getting behind the pain curve and not sleeping for two nights. I went back on the opioids, this time with Zofran – the anti-nausea medication which handily enough I still have in my medicine cabinet from Nina’s last prescription. The Zofran did the trick – no more nausea – but then I remembered the downside to opioids and Zofran, which I’d also learned through Nina’s experience – massive constipation.

So back to the medicine cabinet I went for the bottle of stool softeners that have been there since Nina died. Her pain and bowel management legacy, it seems, is replete. It was an odd way to confront or revisit these issues. First, it’s just intrinsically odd to be filled with the desire to tweet “I pooped!” after your longest bout of constipation ever (because I am discreet and value privacy, rather than tweeting I texted my sister – who says decorum is dead?). But also, I ought to have remembered the lessons of pain meds and this was my first real encounter with an invasive medical procedure since Nina died. 

Fittingly, my experience was sort of the diminutive version of the kinds of things Nina went through – a friend who messaged to check in on me after surgery hit the nail precisely on the head when she asked if I were really in serious pain or just suffering from Male Pattern Wimpiness. 

But the connection to Nina’s course of disease was striking and direct. I have never been a good patient. My threshold for discomfort is startlingly low, let alone actual pain. It embarrasses me now, but I remembered when I went to have my knee examined recently that I had knee issues in 2016, too, while Nina was metastatic but not yet end-stage. I remember having great trouble getting up and down the stairs of our house. What must she have thought as she heard me groaning my way through the morning, with her metal vertebrae and Fentanyl patches? 

Here is the actual knee, with its two TINY sutures. Don't let the looks deceive you: a cushy recovery was needed. 

Actually I know exactly what she thought. Nina was pretty direct about things like that. But, though I never became even a half-decent patient, I learned to be a good caregiver to Nina. I remembered when she took her meds, reminded her about anti-nausea or anti-anxiety options, helped her track her pain levels so we knew when to ask for bigger pain patches. It was not only necessary, but that level of caregiving was my way of staying close to her, feeling necessary and vital to Nina as she got closer to dying and I faced down the idea of life without her. 

I had lots of help this week (I know Hilary Clinton meant it about childhood, but it will take a village to raise me until the day I'm lowered into the ground), but it’s weird doing the caregiver-patient dynamic alone. Not only is it an added reminder of loss, it involved so many of the instruments of Nina’s illness it was hard not to feel a kind of flashback sensation. It was so striking that at one point in my opiate induced haze I wondered if I had cooked the whole thing up subconsciously, maneuvered myself into surgery as some sort of weird grief pathology. Like I needed to go through it at some level. I am reassured by the orthopedist’s notes indicated my meniscus was in tatters, but part of me still wonders if some of this isn’t too coincidental to be purely happenstance. 

Whatever the precise etiology of my knee injury – grief neuropathology or just aging jogger syndrome -- there’s no question I did it to myself. And there’s also no question that it has already taken me longer to be ambulatory than it took Nina after they grafted a metal cage into her spine – she stood and walked the next day; I’m still using crutches. Make of that what you will. I don’t think there’s any connection, personally. 

Only the lonely (need to read this post, and maybe not even them?)

 

To be grown up is to sit at the table with people who have died,

who neither listen nor speak;

Who do not drink their tea, though they always said

Tea was such a comfort.

From Childhood is the Kingdom Where Nobody Dies, by Edna St. Vincent Millay

Loneliness isn’t actually a disease. I checked the DSM-V. But it’s got to be comorbid with a shockingly high number of mental health issues (off the top of my head: depression, anxiety, eating disorders, bipolar disorder, schizophrenia, substance abuse, etc.). It’s also, not surprisingly, comorbid with mortality. This is both apodictically correct and verified with empirical research: when people I love die, I suffer from loneliness. These findings will surprise exactly no one. 

The tricky part about being lonely is that it’s not really about being alone – we all know that, but sometimes forget until we’re actually lonely. I have lots of people in my life: friends, family, colleagues, the woman who runs the coffee shop and remembers more about my kids than I do. I am not alone. But I suspect many of the loneliest people are found in crowds and most of my loneliest moments aren’t cold, long, solitary winter nights (though it WOULD be nice to have some company then – not saying I’ve never considered (and rejected) professional cuddlers). 

Of course being alone CAN make you lonely, but loneliness as I’ve come to know it isn’t so much being by myself as being without someone in particular. And the kind of loneliness caused by grief isn’t just about that person’s unavailability – as in unrequited love – but their annihilation, the total absence of a person and the relationship in all its multifaceted existence in my life. Lonely is what we feel when the one thing we want or need is a specific person who doesn’t exist anymore. 

The startling thing for me about loneliness is how many different ways there are to feel it. Pull on any thread in the ole grief sweater and you’re bound to bare your whole lonely torso completely. Picking out a new minivan is a lonely activity if you’ve only ever bought cars with your partner – even if you bring two kids and a father-in-law along. But so are smaller life events, like deciding what to have for dinner, or which pictures to hang on the living room walls. 

Fun fact: Only the Lonely = not just a song made famous by Roy Orbison, but also
a 1991 cinematic vehicle for John Candy and Ally Sheedy. You're welcome.

Raising kids is an obvious vortex for loneliness. For the widowed, even if the village it takes to raise your kids is ready, willing, and able -- as in my case -- I’m still left child-rearing without the other half of the parental unit. Nothing in my life feels quite so lonesome as holding the parental tiller for two boys who need their mother eve more than I do. That’s true whether we’re deciding on bedtime reading or discussing the birds and the bees. Which: yipes -- I’m sorry in advance to their future partners for whatever it is I’m doing to these poor guys. Hopefully you’ll be very skillful?

Every shot like this one is a game of emotional Where's Waldo
played looking for the dead. 

Everyone who’s lost a partner probably craters a little internally like me with each milestone their child hits. We memorialize the dead plenty, but we can’t sufficiently account for their absence from every living moment – we just look at past photos of the family intact, while taking new ones with an imaginary chalk line overlaid in each in the shape of the dead.

One of the times I miss Nina the most is during our annual trip to Cape Cod. It’s inescapable and obvious, a place so saturated with memories of her that it would be weird if I didn’t feel lonely for her. But some of my most intensely lonely moments have been without any obvious context cues: sitting in bed reading, looking at my iPhone calendar, grocery shopping, driving home from work. These moments are ordinary in every way except that I feel like I might peel the skin off my face, douse myself in kerosene, and run screaming into a campfire to try to relieve the crushing loneliness. Sometimes I wind up sobbing from sheer desperation at the idea that those moments might go on and on forever. 

Cumulative loneliness is the worst. Anyone can get through short bouts of being lonely, especially if there’s an end in sight. But an open-ended future with no promise of extinguishment for loneliness is daunting to me. I’ve tried to be honest with myself about how hard this is for me – I don’t like being lonely one bit and don’t feel particularly well-equipped to cope with it. Not that anyone comes naturally equipped to lose their person, but I can already identify ways in which my reactions to being lonely has influenced my behavior in problematic ways. 

Relationships are a landmine for any widowed person. Part of that is just the general emotional upheaval of loss. It’s the worst kind of roller coaster: badly constructed, unpredictable, poorly maintained, and never inspected for safety. Not the ideal conditions for relationship formation. 

There’s more to it than just damaged sustained, though. In my case, I’ve realized the potential availability of a relationship is like a narcotic – and I’m a bit of an addict. Since Nina died, I’ve had massive withdrawal symptoms and the obvious solution is to indulge my need for intimacy, attention, support, and all the other loneliness-countering properties of relationships. But I’ve also learned that I’m not emotionally equipped for a relationship right now. 

The problem isn’t that I’m lonely and seeking a relationship as a stopgap or palliative measure. I'm not trying to rebound from grief. But, even when I am confident the relationship is solid irrespective of loss, it's fraught. The feelings of desire and intimacy in a newly forming relationship make the same kind of shape as the void left by grief. There’s no way to tell where one starts and the other begins. Even if a new relationship is healthy and strong, it can mask the pain of a loneliness that it cannot cure. It’s a weird catch-22 (which is a tautology) (which is itself an abusive use of elaborate diction). 

I'm not sure how anyone knows when they’re “ready” for a relationship under any circumstance -- I wasn’t “ready” to be in a serious relationship when I met Nina by any rational criteria, and were together nearly 18 years when she died -- but whatever signals this readiness, I’m pretty sure the standard caveats don’t apply after loss. It’s not just the passage of time. I know plenty of people who dated and even remarried happily soon after losing a partner. But there is at least there is an indeterminate quotient of time + other things I need to work out whatever my stuff is that needs working out. 

It’s more of an emotional state of readiness than just waiting for pain to subside before the greenlight. I await the silent, mysterious tumblers that shift our perspectives as we pass through different stages of life clicking into place. I wake up occasionally and things that had me twisted in knots just seem less fraught. I can’t make this happen willfully, but it’s happened enough that I’d call it a pretty regularly event. Eventually, after some combination of time, effort, and experience, the wound no longer smarts quite so much, which in turn makes me stop avoiding whatever I perceived to be causing the hurt, which alters my behavior or thought process in innumerable, imperceptible ways. 

I’m hoping the loneliness will be tied to the mechanics of one of these tumblers. That, even if I’m not savvy to the inner-workings, my gears are set to the right ratios. That one day I’ll wake up and not feel it so keenly -- and not because I’m “over it” or confused by the throes of a new relationship, but because I stop feeling quite so alone. It’s not that I won’t miss Nina then – I expect that every time I think of her for the rest of my life I will have some degree of loneliness – but I hope my perspective will have shifted enough that I don’t feel armed against the possibility of new connection or blind to its potential to obfuscate my grieving. 

In the meantime, I did what any sensible widower would do: I made a playlist of songs about loneliness and listened to it while I watched lengthy slideshows of family pictures with Nina in them. When the kids weren’t around. And the housekeepers were gone. And the dogs weren’t looking at me with accusatory need. And my work was done for the day. And I was left actually, truly alone for a bit with my loneliness, which after all is an artifact of the most significant and dearly loved part of me and my life.

LINK: Only the Lonelys Playlist

Relatively speaking about grief (and other mistakes I've made).

Relativism is not a helpful mode for grieving. By nature it has no fixed position, which is problematic when someone’s already adrift because one of the central fixed points of their life – a loved one -- is gone. Bare relativism isn’t that helpful generally: how many idiotic conversations have been started in college classrooms (mostly by White men…sorry, some of us are working on it, I swear! #Kavbros #Squi) comparing the Holocaust to the Middle Passage or the Irish Potato Famine. These aren’t dumb conversations because of the topics’ importance -- everyone is clear that they were exponentially tragic. But the attempt to quantify them, the comparison of their relative magnitudes, is the world-historical crime against humanity version of a pissing contest and world historically stupid. To have the conversation is to have lost it. 

It’s ok to share your suffering or have exchanges with other people about theirs. This is an essential component of coming to grips with loss or tragedy of any kind. But avoiding direct comparison should be a major priority any time loss or trauma is the subject of conversation. Grief is not social currency. You don’t need to bring any of your own to participate in supporting or bearing witness to someone else’s. 

There are I don’t know how many posts on my online widowhood support group about some well-meaning friend who, in trying earnestly to identify, compares the grieving person’s experience to their own loss – sometimes of a great-grandparent or beloved pet. I encourage everyone in ABSOLUTE terms to avoid this. This isn’t to denigrate these other losses. Just because you haven’t lost an intimate partner, a child, or a parent doesn’t mean you haven’t suffered. These “relatively peripheral” losses may seem to the person enduring that loss -- with a grandparent or pet-shaped empty space in their life – pretty huge and plenty painful. The mistake isn’t in the type of grief being compared, but the comparison itself. 

The rules of comparative grief apply with equal force to those of us who are widowed. Our grief is particular, but not unique. Or, rather, all grief is unique, because, like people, it is idiosyncratic and context dependent. We all follow our own grief groove. But the fact we all suffer is not unique. The minute I start to think that I need some special dispensation or privilege for my suffering, I enter into very flimsy emotional and analytical territory. 

Who suffered more, the person who lost a spouse? The one who lost a child? The one who lost both spouse and child at once? Or the one whose child murdered their spouse and child? These questions lead quickly to a dusky absurd drawing room in a Faulker novel and they all end in the same blind alley as the Holocaust-Middle Passage palaver. All of these hypothetical people have searing hypothetical wounds. Trying to compare them only denigrates an already fraught process and makes an added burden of what is most often intended to be an empathic gesture – the attempt to say “I too have suffered, I too have grieved.” 

I don't know who made this image, I saw it several places, but I love the combination of empathy and thoughtfulness it suggests. 

The problem is that grief is hard. I have dealt with grief a lot in recent years, and I still find myself wishing I could rewind and erase the tape from a conversation I just had where I put my foot in my mouth about someone else’s suffering. There’s not some secret garden of understanding that only the aggrieved have access to that holds the key. 

The key with grief, as with most things, is present awareness: remembering the many threads that get severed when someone dies, the cascading losses that grief entails. It’s complicated, but if we act with an awareness that grief is pervasive an unpredictable, we are more likely to treat grieving people carefully (as we would want to be treated in a like circumstance, as I never tire of telling my kids! #goldenrulebrokenrecord). 

Before I have an encounter with a person who’s suffering, I try to remind myself, prepare myself. I do this already in many situations: when I talk to your boss, during a job interview, meeting with a child’s teacher, or even trips to the doctor. We all arm ourselves with information and context so that we will be receptive to the information we receive and able to offer useful or opportune responses. I’ve learned that I can do this for grief, too. Here are some of the things I’ve learned: 

1. Talk about the person who died. It’s 99% likely that the grieving person wants to do this, even if it’s hard for them and they can’t do it on their own. In fact, if it seems difficult for them to bring the subject up around you, that may be all the more reason to do so – you can grant a form of social “permission” or an overt marking of the subject as safe. Obviously, you shouldn’t drag someone into an unwanted discussion about loss, but a gentle signal that the topic doesn’t make you uncomfortable is a pretty safe bet. 

Bringing up a loss in the immediate wake of someone dying is fairly straightforward. But, even after months and months, I still think about Nina continually. I am not as consumed by the subject now as I was immediately after she died, but it’s still present with me all the time, even if it’s below the surface. That’s all the more reason why bringing Nina up might be good for me – as time passes, there is much less focus on the loss, which can feel a bit like I’m still mired in grief while the world “moves on.” Discussing it can be a welcome outlet, a renewed form of permission. 

2. Don’t look for the silver lining. Grief has no silver lining, except sometimes in darkest jest (“well, at least since Nina died I don’t have to argue about what I want to watch on Netflix…”). A good shorthand is that any sentence that starts out with “At least…” is probably a no-fly zone. At least what? There are no compensations in death and dying. Even if the person who died was problematic, it’s likely that the aggrieved is not celebrating. That’s for cinematic villains. The truth is, the more complicated the relationship, the more complicated the grieving can be. Don’t search for a silver lining.  

The ultimate "at least" approach to death. 

3. Unless it is an accepted core belief that the person currently feels and has expressed to you, don’t say anything about the dead person “being in a better place,” or the like (unless it’s a Good Place reference and the aggrieved is a fan of the show. In that case, go forking crazy, benches!). They may not believe in an afterlife and, even if they do, the “better place” is still potentially just a different flavor of the “at least” no-no. Grief can impact people in foundational ways, and a belief in the afterlife, or God, or anything related to the metaphysics of death and dying can be affected as much as anything. You can’t know, even if you know the grieving person well, how a statement about the afterlife is going to fall on grieving ears. 

What do you think the afterlife looks like? A grieving person may or may not need to know. 

4. Which leads to another generally sound approach: allow the grieving to guide you. If they want to engage the metaphysics of death, by all means, oblige them. But take their cues. In the religion example, if they are sure that not only does heaven exist, but they know which room number their beloved occupies, don’t quibble about the liturgy. If they have cast god from their hearts, the throes of grief are not the context to bring them back into the fold. 

This is applicable to a number of other areas as well – including how to talk about the person who died. Beyond that, if the person wants to talk about the specific circumstances of their loved one’s death, you can engage and try not to make them feel awkward about it. While dying isn’t always part of our everyday conversations, it will almost certainly be at the front of a grieving person’s mind. The truth is that dying IS an everyday occurrence, just not for all of us all the time. Be able and prepared to have the hard conversations when you engage, particularly with someone whose grief is raw and/or recent. Don’t retreat into small talk or steer around the tough stuff if that’s where they are. It will be too easy for them to follow suit if they feel your discomfort. 

5. When someone is grieving, they may not always be themselves, but it may not always be obvious. There isn’t always a black dress, streaming tears, or hairshirt to show you a person’s inner pain. They may be highly functional in many regards, but then plotz completely in unexpected ways (hypothetically speaking, of course: I am amazingly functional and would never succumb to such capricious weakness!). 

I guess the advice here is: see grief as a larger framework than just the memorial service, sitting shiva, the wake, and the immediate aftermath. Read loss into your understanding of the person’s larger narrative, both in terms of the impact of grief being spatially-emotionally broader than just the dead person not being there (the cascading impacts), and temporally lasting beyond the immediate loss. It can be as simple as: be patient and understanding, but in view of grief specifically. I’m not sure I can define how specifically, but I’m virtually certain that if you do it, this will make the person who is grieving feel better and more supported. 

6. Be both a ready and prepared helper. Never ask a person vaguely what you can do, or “is there anything you need?” Don’t put the onus on them, just do something and try to make it as seamless as possible. Reduce the amount of thought or leg work the person has to do. If you cook a meal, make arrangements for delivery and try to pack it in things they won’t have to return. If someone has established a meal train or other procedure stick to that, rather than freelancing.

Before you send anything, check to see whether the family has indicated preferences (“in lieu of flowers, please donate to the United Way, e.g.). I can’t tell you how good this feels on the receiving end when it’s properly executed – the weight lifted by not having to think or organize a thing is tenfold when someone is stricken -- and I have been fortunate enough to feel this feeling many times. It’s not just a boost in feeling emotionally supported, it’s a practical benefit and a much needed one at that. 

Also remember that what people need is not always material. Sometimes it’s just company, or to be left alone. Often it’s just unspoken understanding. Listen and be patient. Whatever else you do when you’re dealing with someone in pain, you should try to hear what they are communicating, even if it’s not overt. There is a tendency to try to make a contribution, bring something to the table, literally or metaphorically. But don’t be so eager to contribute that you miss what people actually need or want. Give space to grief, and even to silence, which can be awkward and painful. But grief, like life, I have found, is sort of endemically awkward and painful.  

  

Okay, these are my hortatory blah blah blahings on grief. Take them for what they’re worth (technically nothing, this blog is non-monetized). Be gentle with yourself and other people. And I look forward to each of you doing exactly what I need now forever, amen.*

*Non-religious invocation, not an invitation for a disquisition on my faith.