Listen to thisLeanne is only eight but in looking at her, you can tell she has lived enough to be sixteen. She is here in the hospital visiting her mother who is dying of cancer. There is no hope that her mother will leave the hospital “probably she has only a week or so left. Since her mother arrived two weeks ago, Leanne has come every day to sit with her. Her mother is too weak to talk so Leanne usually just sits quietly. She doesn’t read, talk or watch television. She just sits. No one else has come to visit.
She always comes alone. I’ve never seen anyone bring her or pick her up. She arrives shortly after the time school gets out and she leaves just after supper, which her mother doesn’t eat. Leanne tries to encourage her and occasionally her mother tries to take a few bites but usually she takes only a little liquid as she wastes away in this bed.
This evening as I entered the room, Leanne was crying silently, holding her mother’s hand as her mother slept. Leanne looked up at me as I entered the room and I could see the pain and the questions. “How are you doing tonight, Leanne?” I asked as lightly as I could while still respecting her experience.
We had exchanged a few words on other days as I wandered around the hospital providing support to sick children and their families. Usually I said hello and Leanne just nodded, like a serious adult in a child's body. But tonight felt different.
“My mother’s dying, isn’t she? My daddy says not to worry but she’s dying, isn’t she?” She looked me straight in the eyes as she asked, and I wanted to lift her up and tell her the same thing her daddy had told her. I wanted to protect her from the desperation I thought I felt there. “No child should have to experience this,” was the silent thought I heard.
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Situation response
This scenario has a familiar ring to it because it is one that I have
seen many times in my previous work as a clinical psychologist in
hospital settings. It’s funny how this particular situation, even though
I’ve encountered it before, never becomes an easy one for me to deal
with. In every instance I find myself recalling an incident that
occurred to me when I was in high school in a small town in north-eastem
Alberta.
One of my classmates, the most popular guy in grade 11, died in a sudden and unusual accident. This was my first experience with death and I expect this was the case for most of the other students. It was incomprehensible to all of us that this person who was so full of life, vitality and humour was no longer there.
It was customary in this small town to have an open-coffin wake that extended through the entire night before the day of the funeral. I recall going over to the coffin with some of my classmates a number of times during the evening to look at our friend. Not wanting to accept that he was gone forever, we would speculate that he was just pulling another practical joke (he had a reputation for humorous stunts) and would rise and get out of the coffin at any minute. It didn’t happen.
The next day, during the lengthy funeral which was conducted in a language I didn’t understand, my mind began wandering and I recall casting a glance at my dead friend's younger sister. She was about eight years old and had experienced loss before as her mother died when she was very young. She had been raised by her father and her brother and now the person to whom she was most close was also gone. I studied the numb expression on her face and wondered how someone so young could be that controlled and expressionless. She hadn’t cried during the wake and she wasn’t crying now. She stood stiffly beside her father and looked directly forward at some invisible and infinite point.
The funeral procession made its way from the church to the graveyard and, as the coffin was being lowered into the grave, I struggled with the sadness that was welling up inside me. I glanced again at the eight-year-old sister. Her posture and expression were still frozen in disbelief but as her father threw the first shovelful of earth into the grave I noticed a stream of tears glistening down her cheek. She also was realizing the finality of death.
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First session
Always, when I am faced with a child experiencing grief and loss, I
think of the simultaneous confusion, fear, despair and vulnerability
reflected in this little girl’s tear-stained face as she realized that
her brother was gone forever. This image was pressing on my mind as my
eyes and Leanne’s engaged. “My mother’s dying, isn’t she?” Leanne was a
similar age as the little girl in my memory and she even seemed to look
the same. Was this just my imagination or was it the expression in the
eyes that was similar? There was that same desperation and fear in
Leanne’s eyes that I had first seen many years before.
I found myself being a little surprised at Leanne seeking confirmation that her mother was dying at this late a point in the process, but I guess the fact that her father did not visit the hospital indicated that he was not coping very effectively with the situation and was not able to openly discuss matters with her daughter.
Leanne was asking for some accurate and honest information about the situation, but I felt that it would not be a good idea to discuss it here. I bent down on one knee so that our faces were level and said, “Leanne, let’s go down to my office at the end of the hall and I will answer all of the questions that I can about your mother’s illness.” She nodded and went over to her mother and kissed her gently on the cheek before taking my hand and walking down the corridor with me. We walked without speaking, our footsteps sounding ponderous on the hard floor. Her little hand felt cold in mine and there was a sense of desperation in the tightness of her grip that matched the look I had seen in her eyes.
As we entered my office, I asked her if she would like to sit on the cushions on the floor in the corner that was a play area, or in one of the chairs located around a small coffee table. The part of her that was closer to being sixteen years old than eight chose the latter. When she sat down in the chair I moved into the one beside her. She again took my hand and the tightness of her grip signalled to me that she was preparing herself for something that she needed to know for sure, but didn’t want to hear. In a small voice, just barely above a whisper, and with her eyes locked onto mine she repeated her earlier question, “Is my mother dying?”
“Yes,” I said softly, feeling her hand tighten in a sudden spasm and then becoming limp. Her shoulders slumped, she fixed her stare on a heartshaped glass paperweight that was on the table, and her breathing became heavy. We sat silently for a minute or so as she searched for a place to put this expected but unwelcome information.
Without shifting her tired, defeated posture she asked her next question. “When?” she asked softly.
“We can’t know for sure,” I replied, “but it will likely be within a week or two.” Her little hand went into another spasm, but this one was not as pronounced as the first. Otherwise, she remained motionless.
We shared another silence. Remembering something that I had learned in Western Samoa, where silence is an honoured form of communication, I resisted the impulse to start talking simply to fill the void. It was important to have Leanne control what information she needed as well as when. After a long pause, the silence was interrupted by what seemed like the deafening sound of the beep of my wristwatch marking the hour. I found myself being annoyed at this intrusion that so insensitively announced the passage of an hour. Time itself is so insensitive. Leanne is struggling with the fact that her mother has only two more weeks to live and my watch is clamouring to all that one hour of this time had already passed. I looked at Leanne and she gave no indication of being bothered by the sound, or even having heard it.
Glancing at me quickly and then returning her focus to the paperweight on the table, Leanne said, “Will it hurt my mommy when she dies?”
“No,” I said, “the pain caused by your mother’s cancer will end and never return.” I was trying to find a description that was accurate and appropriate for Leanne’s developmental level of understanding as she was approaching the age where children are in a transition from concrete to more abstract thinking. I waited to see if this explanation was adequate or if she wanted more information.
I have observed that adults in these situations often give children more complex information than they are ready for or need. I have found that simple, developmentally appropriate descriptions provided in an open ended manner usually work better because the child can control the amount and type of information required and will set the pace if given the opportunity. Too much information in the first session usually overwhelms the child and is not helpful. However, in subsequent sessions they usually will want to get more complete information and clarifications and are prepared to explore their reactions and feelings. The first session is not usually the best time to do this.
A shorter pause and then, “Will I catch the germs from my mommy and get cancer and die?” Leanne asked, still clutching onto my hand.
“No,” I replied, putting my other arm around her and giving her shoulder a gentle, reassuring squeeze, “you can’t catch cancer from people who have it, so you can give your mommy as many hugs and kisses as you want. I’m sure she would like that.” Leanne turned in her chair to face me.
“But I thought that my daddy wasn’t coming to visit my mom in the hospital because he didn’t want to catch cancer,” she said with a note of puzzlement in her voice.
“No, that isn’t the reason why he is not coming to visit,” I said. “You know how he has been pretty tired and sad lately?” I continued, “Perhaps that’s why he hasn’t been coming to the hospital with you to visit your mother.”
She nodded thoughtfully as she struggled to process all this new information and then her expression seemed to change ever so slightly. “Leanne, would you like me to call your father and see if we can set up a time for the three of us to get together and talk about this some more?” I asked. She quickly nodded in the affirmative.
As I glanced into her teary, blue eyes I saw a little girl who was numb, overwhelmed and afraid, but perhaps just a little less desperate “or was that just what I wanted to see.
Subsequent sessions
It would be important to do everything possible to arrange to meet with
Leanne’s father immediately to explore how he is coping with the
situation since his behaviour suggests that he is having difficulty.
While I would agree to see him alone for the first session, if that were
his wish, I would want to work with them together as soon as possible.
In regards to Leanne, the following are some of the factors that I would want to explore in regards to her ability to cope with the pending loss of her mother:
I would work with both Leanne and her father to prepare them to cope as effectively as possible with the death of Leanne’s mother. Leanne would undoubtedly have many more questions that would need exploration and feelings that would need expression. I would want to facilitate Leanne’s and her father’s understanding of the grieving process and how it might be different for each of them. With Leanne I might choose to use short-term non-verbal therapy techniques such as art or play as an adjunct to the regular sessions and I would offer her opportunities to create rituals to say good-bye and remember the loss in a concrete way. In any event, I would assist the family to develop a continuing support structure that is appropriate to their needs and would schedule follow-up visits to check on how they were progressing for at least one year after the death of the mother.
It is understandable that our first reaction to children facing loss is often one of wanting to protect them from the hurt. However, loss and grief are a natural part of the life experience of each person and only through the resolution of the child's grief can he or she move on to new growth and development.
Experience is not what happens to you. It is what you do with what happens to you. – Aldous Huxley
This feature: Ferguson, R.V. (1993). Situations in Child and Youth Care: Leanne’s question. Journal of Child and Youth Care, 8, 3. pp. 101-105.
