Coping with Disastrous Events

Information from Hospice Foundation of America (Download this information as a tipsheet for your organization):

The earth starts to shake and buildings begin to buckle as people struggle to get to safe places. The water pulls back dramatically from the shoreline, only to come crashing back inland much farther than normal, sweeping cars, furniture, people and pets in its path. Sirens sound the alarm as dark clouds gather; a tornado forms and bears down on homes, schools, and businesses.

After the initial, awful event takes place, what happens next? Where do we turn for help? How do we cope?

Key things to remember

A tragedy has taken place, changing – without warning – your entire world. Disasters take away homes, businesses, jobs, pets, friends, family members, familiar landmarks, and schools. Along with those things go our sense of stability, routines, familiar ways of doing things, financial security, not to mention the people and pets that are taken away by injury, displacement or death.

Grief responses

It is normal to be in shock; that is to be numb. The very fact that this happened so quickly may make it seem unreal. It becomes real through talking about the event and losses, viewing the affected area, visiting the injured, or attending funerals or other rituals. Because we are all different, there is no one “correct” way to respond to such loss, but there are some common reactions that many people experience. It is normal to feel fear, anger, anxiety, deep sadness, and despair. These grief responses are simply our way of coping with the sudden changes. At first, it can all seem overwhelming as if a tangled knot of emotions is swirling around inside our minds. Over time things settle a bit as we take steps to make sense of the many losses and develop strategies for coping.

What you can do?

Recognize that you need support. Talk with others who have gone through similar circumstances, learning from their experience how to cope and move forward. Reach out to area mental health professionals, online peer support groups, faith community leaders, family members and friends. Contact your local hospice for bereavement support groups and grief educational events.

Recognize that others need support, too. This may include friends, family, neighbors and colleagues who were also affected by the same event. Refer them to the support resources you have already identified.

Help for children

Don’t forget about the children in your life! It is easy to think if children have a place to sleep and food to eat that they are being cared for. Children who have witnessed a disaster event may be as affected and in need of support as adults. But that need may be overlooked, especially if a child is quiet and doesn’t ask too many questions. While some children may want to talk about their reactions and needs resulting from the event, others may want to simply be near caring adults, and may find comfort in drawing about the event or engaging in play therapy or music therapy. A child may grieve for familiar routines, play areas, neighborhood friends, favorite toys or comfort items such as pillows, blankets or a favorite pet. When talking with a child, remember: tell the truth about what happened; use simple and easy-to-understand language; assure the child that their feelings are accepted; and encourage the child to ask any questions. Be especially sensitive to children who have questions of faith and spirituality. If it is your child, share the ways that your faith helps you cope with this crisis. In cases where you are dealing with children from other families, this is not a time to proselytize. Listen respectfully and help them identify the adults in their family and faith community who may be able to help. They may find it difficult to make sense of such bad things happening to them and the people they love. As a caring adult, you do not want to encourage a child to assume guilt that any of this happened because he/she was not a “good” boy or girl.

When should you get help?

As explained above, it is normal to be in shock, to feel sad, upset, angry, or unsettled, to want things to be the way they were before, to miss people, pets, routines, homes, etc. Those who have witnessed disaster events may feel all of these emotions, and others, for some weeks or months. Concern begins to build when these feelings become crippling, meaning you are unable to function at home, school or the work place. If you find yourself or loved ones pulling away from family and friends and routines, showing little or no emotion, or being overwhelmed with sadness to the point of failing to eat, shower, change clothes, and talking of not wanting to live, then it is time to immediately consult a physician, a grief counselor or a mental health provider. These professionals will find the best resources to meet the needs of the bereaved individual, whether that is through individual counseling, work with a therapist, beginning or changing medications, or participation in a bereavement support group.

Tragedies and disasters are indeed terrible events in our lives. The very nature of them – happening so quickly with little or no warning – makes it difficult for the survivors. There is no time to prepare, no thought that things might change or even could change so quickly, and perhaps little experience in dealing with such an event. Not only does this make coping with the event more difficult, but it also means that we have to stretch beyond our daily patterns to find resources and new ways to live and learn. Thus, the lasting lesson of any disaster is to be flexible. Be willing to ask questions and search for the support that you and your loved ones will need to go forward in a world that has suddenly changed.

Philip Carpenter, MDiv, Program Officer, HFA
Download this information as a tipsheet for your organization.

Treating the Child, Not Just the Cancer

Yesterday’s New York Times' Patient Voices highlighted childhood cancer. Not one of the parents whose children had died from cancer mentioned hospice care. This is hardly surprising; hospice is an option rarely offered by physicians while the focus is on fighting the disease. When children are involved, physicians’ referrals to hospice can be even rarer*.

Last year, however, with the signing of the federal Patient Protection and Affordable Care law, the decision to enter hospice care has been made easier for parents and their children’s doctors. The law allows children with a life-limiting illness who are eligible for Medicaid or the state-based Children's Health Insurance Programs to receive hospice or palliative care, without having to cease curative treatments such as chemotherapy.

Joanne Kenen writes in Kaiser Health News how this type of concurrent treatment works in Massachusetts, where it became available in 2006 as part of the state’s own health insurance overhaul. The National Hospice and Palliative Care Organization (NHPCO) and the District of Columbia Pediatric Palliative Care Collaboration (DCPPCC) have released the Concurrent Care for Children: Implementation Toolkit to assist states interested in expanding their pediatric hospice and palliative care services.

Allowing children who are facing these serious diseases to receive the benefits of hospice and palliative care, while at the same time pursuing curative treatment options, is a welcome turn of events and will offer support to families and children undergoing the challenging journey of life-threatening childhood illness.

Spanish Language Videos Available

HFA’s Hospice Information Center has two Spanish-language videos available on its website: Comprendiendo el Duelo (Understanding Grief) and Comprendiendo el Cuidado en un Hospice (Understanding Hospice).

These videos, featuring Maria Villalobos, are available at no charge and can be embedded on your organization’s website.

Choosing Hospice

Rick Telander writes in the Chicago Sun-Times about baseball Hall of Famer Harmon Killebrew's announcement that he is entering hospice care.

I always have wondered about the metaphors we use when confronting death. We ‘‘fight,’’ disease, ‘‘battle’’ injuries and go to ‘‘war’’ against impending demise.

. . .


So I read with interest 74-year-old Hall of Fame slugger Harmon Killebrew’s recent statement that his ‘‘continued battle with esophageal cancer is coming to an end.’’

By that, he meant he no longer was going to undergo treatment for the disease, which was diagnosed in December and soon will kill him. Killebrew, who ranks 11th on the all-time home-run list with 573, will enter hospice care, take medication for pain and let the cancer that his doctors have called incurable run its course.http://www.blogger.com/img/blank.gif

‘‘I am very comfortable taking this next step and experiencing the compassionate care that hospice provides,’’ he said in his statement. ‘‘I look forward to spending my final days in comfort and peace with [wife] Nita by my side.’’

I look forward to .  .  .

So different. So wise.

See HFA's Choosing Hospice page for more information on hospice care.

Adolescence, Identity and Spirituality

HFA Senior Consultant Kenneth J. Doka, PhD, MDiv, writes in the Religion section of the Huffington Post adolescence, identity and spirituality.

Throughout adolescence, the adolescent struggles with three core issues: independence, intimacy and identity. It is the latter process that underlies spirituality. As part of identity, the adolescent, now capable of critical thought, asks, "What do I believe?" Adolescents are well aware of what they have been taught by parents, family and spiritual leaders. The question now becomes what beliefs will become part of their personal identity -- that is, what beliefs they will personally own. In short, the adolescent says: I know what my parents taught me, what my priest, pastor, minister, rabbi or imam taught me. What is it that I believe?

Moreover, as adolescents begin to develop critical thinking, they are encountering their own spiritual questions. "Why do people suffer and die?" "Why do disasters occur?" While these questions may have been encountered earlier in their lives, there now is greater depth to that reflection.

This post is adapted from Living with Grief^®: Spirituality and End-of-Life Care, available from the Hospice Foundation of America's bookstore. This book is a companion piece to the Spirituality and End-of-Life Care educational program.

The End-of-Life Paradox

HFA Senior Consultant Kenneth J. Doka, PhD, MDiv, writes in the Living section of the Huffington Post the different places adult children and their parents may be in wanting to discuss end-of-life concerns.

It seems that whenever Marian visits her dad, he wants to go over certain things: where his will is located, where to find his stocks and bank book, and even where to find the charcoal suit that he wants used when he is laid out in his casket. To Marian, such conversations are morbid, distressing and perplexing. At 82, her father is relatively healthy, independent and maintains an active life. Why does he always seem to focus on death -- especially when she is around?

Often adult children experience what I call this end-of-life paradox. Their older parents want to speak about the logistics of death in detail. Or, maybe they want to review end-of-life care plans contained in advance directives, just at the time when it is most difficult emotionally and spiritually for their adult child to listen to such conversations.

Read about Advance Care Planning on HFA's website at http://www.hospicefoundation.org/advancecare