By Nicole Alber, BSW Bereavement Coordinator, UnityPoint at Home Hospice 
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Grief is the emotional suffering you feel after someone or something is taken away. It is a natural and necessary response. The feeling may be overwhelming. Often, grief is associated with the death of a loved one. However, grief can be associated with any loss. Examples would include: loss of heath, such as a cancer diagnosis, serious illness of a loved one, divorce, loss of financial stability, miscarriage, retirement, death of a pet, etc.
What are the 5 Stages of Grief?
Elizabeth Kubler-Ross, a Swiss Psychiastrist, wrote her book On Death and Dying, where she introduced her five stage grief model. Since writing the book, Kubler-Ross notes that everyone may not experience all of these stages or any of these stages. In addition, she notes that these stages are not linear. Not linear, meaning this is not a process we move through in sequential stages. Grief is not something we start after a loss and reach an endpoint after we have gone through the states. Grief is always with us.

• Denial is the first stage of grief. We may go numb and the world becomes meaningless and overwhelming. During this stage, we are in a state of shock and denial. These both help us to cope and make survival possible. As time passes and you become stronger, the denial begins to fade.
• Anger is the second stage in the five stages of grief. It is common to feel anger towards your friends, family, doctors, yourself, etc. It may be a necessary part of the healing process. Under the anger you feel, is the pain. It is normal to feel abandoned during this time.
  
• Bargaining is the next stage and it can happen before or after the loss that is causing you grief. It is the ‘what if’ or ‘if only’ statements that begin to play like a record in our minds. For example, “What if we would have found that tumor sooner?” These thoughts cause us to find fault in ourselves.
  
• Depression is the stage where our attention moves to the present. This stage often feels like it is going to last forever. Often, it feels like we are in a fog of sadness. We begin to withdraw from visiting loved ones, participating in activities we love, etc. It is important to know that depression is not a sign of mental illness as depression is normal when going through grief.
  
• Acceptance is the stage about accepting the reality that someone or something has been taken away. It is about recognizing that this is a new normal. It is not to be confused with the notion of being ‘okay’ with what happened, or this new reality but instead, accepting it. At this stage, we may learn how to live with it. Many times, we feel that we are betraying our loved ones as we begin to enjoy our life again. Although our loved ones cannot be replaced, we are able to reach out to make new connections.
  

What are Common Symptoms of Grief?
Symptoms of grief can include physical symptoms, spiritual symptoms and social symptoms. Examples of these symptoms include: anger, anxiety, crying, difficulty sleeping, fatigue, feelings of detachment, guilt, headaches, loss of appetite, worry, etc.

What are Ways of Coping with Grief?
The most common methods of treating grief include counseling and medication. Counseling provides you with different coping strategies that help you deal with grief in an effective way. Counseling includes bereavement groups, individual counseling and support groups. Secondly, medication can be used to help you operate more fully during the day or sleep at night. Seek treatment from a health professional or mental health provider if you are having a hard time coping with your loss.
In conclusion, grief is just as unique as each of us. It does not come with a time frame or end on a certain day.

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​A Survivor Story by Kim Ehlers

I was pregnant with our 4th child, and I felt a lump in my right breast. The needle biopsy came back negative. Yay! Fast forward seven months. I felt another lump. On December 20, 2006 I had a lumpectomy…not for one lump, but FIVE!

At the age of 32 with a loving husband, and now four kids, ages 6, 4, 2, and 7 months, I was diagnosed with HER2+, hormone-receptive breast cancer. My lymph nodes were clear. Yippee! Based on the results, a double mastectomy was the best choice. I had always wanted a breast reduction (DDDs are heavy to carry around). Not exactly how I dreamed that would end up happening. But, when something tries to kill you, you eliminate the threat. (I should have been CIA.)

Things moved fast. By January 15, 2007 both breasts were gone. In February, I met with Dr. Masri. We chose an abdominal CT just to make sure the cancer wasn’t in other areas. My lymph nodes were clear…I wasn’t worried. Then the call came that Dr. Masri wanted to meet with me that same day. I’m sure my heart stopped. But, off I went to see the man who would help save my life. I thought for sure they were going to tell me the cancer was in my ovaries. Nope. Surprise! My cancer had metastasized to my liver!

​With an encouraged second opinion, my treatment ended up being six months of chemotherapy and Herceptin. I had two masses in my liver. One vanished with chemo. The other shrank by half (and I didn’t lose my hair). In July 2007, I had radio frequency ablation that fried the remaining liver tumor. I also had breast reconstruction and a hysterectomy in 2007. During treatments, I continued to work as a labor and delivery nurse at Covenant Hospital (now MercyOne). I avoided working on the days that I knew I wouldn’t feel well. I had family, friends, and colleagues who helped with the kids and my sanity, not to mention my amazing and supportive husband who stayed by my side through it all. In July 2007, I was classified as cancer-free.

In 2013, I was diagnosed with breast cancer again. I felt a lump because I continued to do self-breast exams even though they were fake. This time, the cancer was only in the breast. Treatment consisted of chemo (not so lucky with keeping the hair this time) and then radiation. Oh, and I had to lose the breast implants. Again, family and friends rallied with me. Through both fights, I used faith in God, humor and a positive attitude to get through. And, jigsaw puzzles – they kept my mind from wandering to thoughts that would not help me heal or kick cancer to the curb. I am a breast cancer with mets to the liver survivor. Nothing scares me now except spiders.

​For fighters and supporters, remain as positive as possible. Bad days will come. Just make sure they go.