One question that comes up for us as therapists is, What does responding to a child's concerns about illness, death, and loss, done well, really look like? Acknowledging that there is an incongruity between "doing well" and experiencing loss, we offer the following as a relatable example.
Recently, Lexi, a mom of three young daughters, reached out to talk through how to best support her children who would be learning that their Uncle Stan was diagnosed with an illness that was serious and life-threatening. Of special note was the fact that he would soon begin a treatment from which he would have side effects that would cause him pain, loss of his hair, and significant weight loss.
During her first few sessions with her therapist, Lexi was beside herself with upset. She loved her brother and did not want to lose him. All she could talk about was her love for him and for his family. It was clear to the therapist that she was experiencing his diagnosis as a death sentence and she was unable to envision him ever getting better. As the therapist listened, he tried to help her balance out her fear-based emotionality with some optimism and hope given that there were medical treatments available to Stan. Lexi could not take any of this in; she was simply overwhelmed with emotion.
Fortunately at home, Dave, Lexi's husband, also listened as his wife let her feelings flow. And flow. With the help of these supports, Lexi gradually found some calm and, within this more emotionally quiet and thoughtful mindset, became able to recognize that all was not hopeless as there were steps her brother could and was taking. Though it took a lot of determination, Lexi and Dave talked through what they might do directly to support her brother's family. They also recognized that it was time to tell their girls something about what was happening with their uncle and why Mommy and Daddy were so upset. Notably, they waited for some internal calm before they turned to focus on their daughters' emotional needs.
Deciding that she would visit her brother and his family, though daunting, enabled Lexi to get clarity on what she could do for Stan. In turn, this helped her feel more hopeful because by making a plan, she recognized that joining Stan in his illness and being nearby was her best way of being useful to him. She could help support her sister-in-law, too. As Dave said, what more could someone do? If she set this plan in motion right at the beginning of his illness, she could establish her way of being with Stan and, at the same time, also show her daughters a thoughtful way to handle such upsetting and scary situations.
Knowing the plan, Lexi and Dave sat down with their girls on the next free weekend afternoon. They explained the important news about Uncle Stan. They told the truth, not with all the facts, but in enough detail for the girls to feel filled in and comfortable that they were part of the support their mom needed to care for her brother, their uncle. This was a way they could contribute, even though they could not visit Uncle Stan in person. Before she left, Lexi clearly laid out for them what she would be doing while away and how she planned ahead for them and their father. She helped them make pictures and get well cards, another way they could participate in caring for their uncle. She prepared and froze a few of their favorite meals so they could have them while she was away, and she lovingly talked about the special time they were about to have with their dad.
While Lexi was away, she called home as close to the same time as she could every day. In this way, the girls could depend on hearing from their mom. During the calls, she recounted what had gone on for Stan and his treatment, how their aunt and cousins were doing, and how she was doing. Though she made the days sound more upbeat than they actually felt to her, she left in some details so the girls would not be surprised if Stan's health got worse. These moments of telling were the most difficult for Lexi. Somehow speaking with her daughters and thinking through how they were taking in the information made the situation more real for her and left her feeling weepy afterward. She worked hard to keep her strongest emotions for her private conversations with Dave. Lexi was never dishonest with the girls, just less thorough in what she described.
It was as hard for Lexi to leave Stan as it had been for her to face him, but she knew a week was a long time to be away from the girls at such a time as this. With illness the topic of their conversations, she knew the girls needed to see her, hear her, and care for her as they together shared their sadness and hopes for their uncle's health. She made sure to take a picture of Stan and the family on a better day, so the girls could have a first-hand look at all of them. She knew that, soon enough, when Stan had recovered from his first treatment, they would have a family Zoom call. Because of their ages and because of Stan's susceptibility to illness, it would be a while until the girls could see him in person.
The afternoon Lexi returned home was filled with hugs and kisses, just staying close and enjoying each other. By the close attention they paid her, Lexi recognized her daughters' concern for her health and well-being. All week, Dave had been telling her what a close eye the girls were keeping on him when they thought he might have caught a cold. During the therapy session Lexi made sure to keep, she learned from her therapist that it was not unusual for a child, once aware of illness, to become hypervigilant about others' health. Understanding this, Dave and Lexi made an extra effort to be reassuring and very clear on how they were feeling and how they were caring for themselves. Over the next few days, Lexi fielded all sorts of health-related questions from her girls. She could tell they were really trying to understand what was going on. Most importantly, Lexi recognized that it was imperative that she keep her emotionality to a minimum in these conversations so she could focus on her daughters' concerns. She made sure to clarify her daughters' questions so her answers addressed their wonders and worries and not her own suppositions. As difficult as this was, the closeness between them felt somewhat healing of her own distress. And when she couldn't answer, she let Dave do the talking, simply nodding and cuddling as they stayed close together.
Over the next 9 months, a pattern of activity evolved. Lexi would go to visit Stan, taking care to set up the girls and Dave well, and would call reliably throughout her stay. Unfortunately, Stan never really had the hoped-for remission that would have enabled a visit with the girls, though there were several Zoom calls and the cousins came to spend time with them. Throughout this time, Lexi helped the girls make cards, pictures, and even special foods they could send over. She was always willing to answer her daughters' questions, though she stuck with her therapist's guidance that you don't need to tell the whole truth all of the time, but enough of the truth so that the girls found understanding in the answers and reassurance from the care shown them. When Lexi wasn't sure how to answer, she would explain she needed to think about the answer because it was not in her mind at that moment. Importantly, she always came back with a thought-through answer, often with Dave's help, and conveyed it in an emotionally contained tone.
Sadly, Stan passed away 11 months after the diagnosis. Lexi was overwhelmed with grief when she took the call. She knew his health was not getting better but had remained hopeful it was not getting worse. Her sister-in-law sounded strong when they spoke, and Lexi took strength from her. When the girls came home from school, she and Dave were waiting with the news. Of course, her tear-streaked face gave her away, but the long cry with Dave after the call permitted her more clarity and self-control than she thought she might have. They were able to hold their children together as they all cried and cried. It felt very sad for all of them. From the inside, though, Lexi knew that by keeping her daughters informed and up to date, she had brought them to this moment of truth with honesty and care.
Though there is no perfect way to bear this part of life, staying close to the person who is ill, sharing loving sentiment and actions with those who are connected, and being honest and loving with one's children is the best way of going through it. From her therapist, she had heard the words, "The best antidote for loss is togetherness." Now those words made sense to her. This is really what she and Dave had done with the girls and with Stan and his family. They had stayed close and very together. It was exactly the way they went forward to the funeral and the time with their extended family. Lexi thought that if this was the way it was going to be, and she knew this would not be the last time, close and together was the best way for them to do it. Close and together gave them the strength to face their loss, mourn it, grieve it, and realize more about what they had and even still had with each other, including Uncle Stan.
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