Grief and Guilt: ‘I can’t believe I did that’ edition

Understanding Grief / Understanding Grief : Litsa


When we train physicians, nurses, and other hospital staff on providing good end of life care, we always start and end by reminding them of one thing. The care they provide and the interactions they have with families will stay with family members forever. This isn’t hyperbolic. In grief, many people will play back the circumstances immediately before, during, and after a death over and over again. They will revisit those moments and replay them, sometimes picking them apart. Grief and guilt (or at least grief and regret) can become deeply intertwined in those moments.

We have talked about grief and guilt or regret many times before. If you want to check out some of those other articles, we have a full list of guilt, grief and regret articles here. Today we are specifically going to talk about some of those regrets that come up around a death. To understand this chronic replay of events that can happen in grief, there are a couple of concepts you should know.

The Acute Stress Response

In the immediate time of crisis surrounding a death, our brains often flip into crisis-mode. That crisis mode is more formally known as an acute stress response. It is our brain’s evolutionary mechanism for helping us out in times of danger – we release stress hormones. We go into a fight, flight, or freeze response. This was incredibly useful when being threatened by predators. When the danger we feel is the deep emotional risk of losing a loved one and having to live without them, the acute stress response isn’t always so useful.

We aren’t going to get into the details of the acute stress response, because we have a whole article about it. We strongly recommend you read this post on The Role of the Acute Stress Response in Grief before you go any further. It digs into some of the common acute stress experiences like shutting down, derealization, depersonalization, arousal, avoidance, and dissociative amnesia.

Cognitive Appraisals in Grief and Guilt

A cognitive appraisal is our subjective interpretation of a given situation. In the 1960s Richard Lazarus explained that cognitive appraisals impact the stress of a given situation. He said the stress a person experiences is subjective and correlates to their unique interpretation or “appraisal” of the event. We naturally appraise things like whether a situation is a threat or challenge (what Lazarus called a primary appraisal) and whether we have the resources or ability to cope (a secondary appraisal).

Let’s look at this in practice. Imagine that my coworker and I both are laid off from our jobs due to budget cuts. Our circumstances outside of work are largely the same. We both have some savings, family support, and strong skills in high-demand fields. We were both good employees. When learning about the layoff, she reflects on the situation and thinks, “wow, this is awful. But I have savings, so I will be able to pay my bills for a couple of months. I have been through hard stuff before, so I can get through this. My work experience is strong. I just need to start looking for another job”. I, on the other hand, think, “wow, this is awful. Without a paycheck, I’ll never be able to pay my
bills. It’s a tough job market right now, I probably won’t get hired. I’ll never fully recover from this”.

In this situation, the same thing happened to each of us. But I am likely going to experience a more intense stress response because my appraisal of the layoff is that it is a greater threat and that I have fewer resources to cope with it. The objective reality of the situation is not what created the different intensities of stress. The way we appraised the situation did. These appraisals can have a significant impact on grief and guilt.

Counterfactual Thinking in Grief and Regret

We have an entire article that digs into hindsight bias and counterfactual thinking that I strongly suggest you read. But the Cliff Notes can be summed up with a description found in that piece: “counterfactual thinking is thinking things like ‘what if?” and “what might have been?”. It is the act of coming up with alternative outcomes that are counter to (or different than) the facts. Many times our counterfactual thinking follows an “if-then” pattern.  Some examples:

“If I hadn’t slept late, I wouldn’t have missed the bus.”

“If I had gone to that party like I wanted, then I wouldn’t have aced my math test.””

When it comes to grief and guilt, these ‘if-then’ thoughts often come up around the thing we did or didn’t do. We think if something had been different, the outcome would have been better. It is easy to imagine that the alternate reality would be the perfect outcome we wish for, instead of the reality we’re living. We look back and think things like:

“If I had gone on that business trip with my husband, I would have been with him to call 911 more quicly and he wouldn’t have died”.

The reality, of course, is that the alternate ending in this counterfactual reality might not have actually been a better outcome. I might have been on the trip and he still might have died.

How do these things come together to impact guilt or regret? Let’s walk through some of the common situations people share with us. Even if none of these applies to you exactly, there is a good chance you may be able to extrapolate to your own thoughts of grief and regret or guilt.


Why didn’t I do CPR?

My thoughts: In a circumstance where my loved one collapsed in front of me and I didn’t start CPR, my appraisal might be that I was not a responsive or capable person. I am fearful of what this means about me and my ability to care for others. I might blame myself, telling myself that if I had started CPR my loved one would have survived.

The reality that is missed in this appraisal: the acute stress response often causes a person to freeze, leaving them feeling unable to act and sometimes depersonalized from a situation. This is a result of a normal biological response, directly resulting from the surge of stress hormones. It is not a personal failure or a sign that I am not a responsive or capable person. It is a sign that I had a normal stress response to witnessing a trauma. The other reality my appraisal misses is that, even if I had done CPR, I don’t know what the outcome would have been. My loved one still might have died, as 9 out of 10 people who have a cardiac arrest outside of a hospital do (according to the American Heart Association).

Why did I run for help instead of calling 911?

My thoughts: I can’t believe I had my phone in my pocket, and yet instead of thinking to pull it out and call 911, I ran to find someone else to help me. What is wrong with me? I am a terrible person that I didn’t try to help myself and just ran for someone else. How can I ever be trusted in an emergency again? If only I had called 911, she probably would have made it.

The reality that is missed in this appraisal: Though I said to myself ‘I didn’t help’, the reality is that I was trying to help by finding someone else. That acute stress kicked in and my brain was not working the way it normally would. My flight response kicked in. I feared I couldn’t fix the situation and ran for help. With hindsight bias, it is easy to look back and think the alternative thing to do was either easy or obvious. But in the situation, I was doing the best I could with what I had at the time (including that brain full of stress hormones!). I did try to help my loved one, even though it was in a way that my calmer brain doesn’t agree with.

Why did I push agressive treatment for so long?

My thoughts: I was so selfish. The doctor told us after the accident that there was no hope for a meaningful recovery. Why did I keep him on the machines for so long? I just prolonged his suffering. How could I have been such a terrible wife and decision-maker?

The reality missed in this appraisal: The acute stress response sometimes includes our instinct to “fight”. This was such a shock to me when it happened. It is normal that I fought back against what the doctor was saying. I wanted to fight for him if there was any hope. That wasn’t me being selfish or wanting him to suffer. Though he may not have made a decision to be on the machines for himself, he also would understand that I made a decision that was important for me. I needed to know we gave him a chance to recover. That is not being a terrible wife.

Why didn’t I go in to see his body at the hospital/funeral home

My thoughts: I am such a terrible sister. How could I not have gone in to see him? What does it say about me that I didn’t want to say goodbye to him? If I had gone in to say goodbye to his body, I wouldn’t be suffering this much now. My grief and regret would probably be lessened.

The reality that is missed in this appraisal: Crisis, stress, and sadness turn us inward. Our evolutionary drive for survival means that, when we are scared or suffering, we often become intensely self-protective. This does not make me uncaring or terrible. It means I was trying to protect myself so I could still be present for other family and just survive those impossible days. Right now, when I am still feeling this incredible pain, I want to think if I had don’t something differently I wouldn’t feel this immense grief. The reality is that grief is always immense. I don’t know what it would have meant had I done things differently. It might have brought up other, even more difficult, things. I might have been less present for other things. There is simply no way to know.


There are countless other examples and these are just a few. If you have had something that you have gone back to time and again, questioning your action or inaction, please share in the comments. And consider how the acute stress response, your own appraisal of the situation, and counterfactual thinking may contribute to feelings of grief and guilt.

Want to read more about grief and guilt or grief and regret? Check out these articles:

 

Let’s be grief friends.

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12 Comments on "Grief and Guilt: ‘I can’t believe I did that’ edition"

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  1. Lynda  April 7, 2021 at 8:49 pm Reply

    My only sibling, Keith, passed away 1 year ago, this month, specifically, April 28, 2020. He lived in another state than I do. As well, it was during the COVID-19 epidemic. Both of these facts made it impossible to go see him in the hospital his last few days. My brother was ill with Congestive Heart Failure for several years, so, it wasn’t uncommon for him to be in the hospital. For this exact reason, he was very private about how ill he was. He did this because he didn’t want me to worry, especially knowing I was not able to be there anyway. This time, however, he completely opened up to me about his last 6 weeks or so about how ill he was. In fact, I was the one who finally convinced him to call 911 or else he might have died at home & he lived alone. I feel he opened up to me as a way of letting me know his time was short bc I found out later from his pastor that 2 weeks before he passed, Keith had told him he was ready to go. And although he knew I genuinely cared, by my insistence on him calling 911, I did not take the opportunity to say goodbye…to tell him thank you for so many reasons, to let him know it was OK to go and that I loved him more than anything in the world. And I only had 1 opportunity to do that. It was his 1st of only 3 days in the hospital before he passed. Because he was not conscious starting on the 2nd day. And he knew I could have because we text that 1st day because he could no longer talk. My brother did the one thing that many are not able to do. He remained clean and sober for about 35 years. I never even told him how proud of him for that. We were very close and visited each other throughout the years. So, although we never talked about his sobriety specifically, we showed and shared with each other the happiness if it. So, I know there was nothing that needed closure, except saying goodbye…a more peaceful thing to have closure on than a lot if issues families have to reconcile. This fact also leaves me feeling that although we were there for each other, always, at that at the very last moment, I wasn’t there for him.

  2. Penny  April 2, 2021 at 7:16 pm Reply

    I am in the middle of crazy guilt. I am glad I read this and will try to visit my Dad before he passes and my guilt will be worse. I was in charge of coordinating decisions on his care while in a covid locked down facility. I was convinced he needed hospice but had suspicion they were pushing me to this because he was harder to care for. Hospice gradually pulled him from all life sustaining meds and asthma treatments and he is being drugged with morphine and presently dying. So hard to not feel guilt. I let them do this. It can’t be reversed at this point, to much damage is done to his body. Dad doesn’t eat, drink, talk. 6 days ago he was using his walker and talking and smiling! They gradually gave morphine in place of his nebulizer treatments, then to help him get a good nights sleep. Dad has had asthma all his life, he has alway wheezed and the home he is in knows it . Hospice excuse was the treatment take too long, morphine is faster. His wheezing will kill him before morphine does. No lung specialist would prescribe morphine for asthma! He gets morphine 6 times a day and shows no distress or discomfort. He hardly moves! I put these people in charge of my Father. We were so close to getting him outside for a family gathering! I am angry and full of guilt. I want this family gathering and it is too late. I am one of 9 siblings, lots of grandchildren and great grandchildren. I was in charge and I can reverse my decisions!

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  3. Dawn M Stangle  April 2, 2021 at 5:20 am Reply

    My husband died just the other day after a devastating illness. He deteriorated quickly and I did nothing, getting short with him and frustrated. He was having chest pain and vomiting (he was on chemo). I thought the chest pain was from his constipation and straining to move his bowels. This is all my fault. I should have taken him to the ER sooner. This is so crushing I can’t breathe and feel so alone. We moved and I have no family close by. I was a terrible wife.

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  4. Linda  March 31, 2021 at 4:58 pm Reply

    My mom passed away on 8/8/2019 I was not able to see her , my family give me the news after 4 days ,I can’t get over I feel filthy guilty sad that that I never got to talk to her or see her again I think in her all the time I get too sad

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  5. Catherine  March 31, 2021 at 3:50 pm Reply

    My Daddy died of Covid one year ago, April 14th. He was alone in another state. I couldn’t be with him in the hospital so I didn’t fly from my state to his. I couldn’t have seen him in the hospital before he was on the ventilator. I couldn’t have seen him once he was. We agreed not to do CPR so as to not infect other people. Did I do the right thing? Protecting others over him? When he died, I couldn’t have been there. Still.
    I had him cremeted per his request and mixed his ashes with my mother’s. I never saw him again, not in the hospital, not in death.
    I had to have an online funeral service. I sold his house. Did I do the right thing? Is there a right thing?
    My what if and should haves dont stop.
    I have so many physical problems.
    I can’t seem to move on. I’m frozen.

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  6. JP  March 26, 2021 at 12:39 am Reply

    I regret not being with my husband when they unplugged the machine. I don’t think anything would have changed had I been there. Or maybe I think I would have been a more loving wife. He had been declared dead when I signed him up to be an organ donor so he remained on life support. But, then he wasn’t a good candidate for donation so, I gave approval to remove life support. And I wasn’t there…To me, he had been gone since the initial death pronouncement. It was a very difficult time.

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  7. Coco Lopata  March 25, 2021 at 7:52 pm Reply

    My husband was a Deacon in the Catholic Church, always at St. John’s in Severna Park MD and was a deacon for a good 20 years and he got dementia and it continued until I had to put him in a near by nursing home. He was be at
    Beautiful husband and deacon and he loved doing most anything for the church and we did. He got worse at the nursing home and seem to know anyone but me.
    Father had a beautiful funeral and funeral at the church. I felt fine and greeted each person. Then I came back to our condo and it hit me like lightning. I crying now. He died 7 Nov 2018 and am doing ok in some areas and bad in others. I started out helping with With a program at church and now just about every time of meeting is canceled.
    The big thing for me is my health is going down and I still get ahold of my eating. I am trying to stay in ministry as much as I can. I have many friends at church , thank you Lord and Mother Mary and my good friend St Padre Pio. (Something beautiful happened ). I came home after the funeral and mail was here. In the mail was a small package from St Pio and inside was a small blanket from Padre Pio. I grabbed that blanket and put it over eyes and sobbed. I was so happy
    St Pio remembered me. He is with me all the time and God and St Pio. I sleep with blanket and keep it close.
    Must quit. Thank you. I sent your article to our children. They have their own families and are ok. God bless you and your ministry. Coco Lopata.

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    • Margarete  April 8, 2021 at 5:56 am Reply

      Padre Pio is my friend too and I will pray for your peace and comfort. Life is so hard. Pray, Hope and Don’t worry. 🙏

  8. Maggie  March 25, 2021 at 6:11 pm Reply

    My son, Michael, Forever 23, passed in a car accident just after midnight on July 5, 2020. My “if/then” scenarios have no excuse in the crisis response, since I was not in crisis when I made the decisions I did that day. But my “if/then” scenarios are certainly of the “what might have been” ilk. They include: if my husband and I hadn’t spent the 4th of July evening with another couple at their home, then Michael would have come straight home after ending his shift at his new job and would still be alive. If I hadn’t gotten into a terrible argument the night before with my brother, then I would have been paying more attention to Michael before he left for work that day and maybe I would not have let him drive the convertible. If I hadn’t let Michael drive my cute, fun convertible, then he wouldn’t have been speeding with a friend on a hot summer night on dark country roads, and would still be alive. If it hadn’t been COVID, then Michael wouldn’t have been living with me and my husband in the countryside…and thus out driving on dark, unknown country roads, ending in a car crash. If I had been a better mother, then I would have protected my child from harm. The last one is the underlying sentiment of all of them: I failed to protect my child from harm. I failed to consider that he might speed in the dark. I failed to foresee the future. I understand that this accident was beyond my control and, deeper than that, that Michael’s soul’s plan of when, where and how to drop his physical body was beyond my control. I know intellectually that I cannot see into the future. Emotionally, however, I fall into if/then scenarios that are clearly held below the surface of intellectual understanding, as I am shaking and crying as I write this comment, guilt-ridden for not foreseeing this tragedy, angry at myself for all the “what ifs” that I could have done but did not. Would Michael still be alive if I had?

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    • JMG  March 30, 2021 at 9:37 pm Reply

      Each “if only” is a sign of how much love you have for your lost loved one. Drop the “if onlys” and focus on the love that motivates your thoughts about him. The love between you is still there. When the “if only’s” start to hurt again, see if you can remember they’re there to point you back to the love.

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  9. Trish  March 25, 2021 at 5:48 pm Reply

    I have been angry at myself and kind of ashamed that, the morning that Paul died at home next to me on the couch, I didn’t close his eyes. Maybe this sounds weird or not very important or whatever: it hurts and I’ve regretted it for over four years. He had been falling asleep with his eyes open more and more often until that last morning. I will never forget his cloudy, unseeing eyes and that they stayed that way until the funeral home came for him. I’m so sad I didn’t help him that one last time and I can’t seem to get over it. :<

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    • Hannah  March 30, 2021 at 1:58 pm Reply

      I understand your pain. It’s terrible and others may see it as irrational, but things like this really gnaw at you. I couldn’t bring myself to put my partners promise ring on her finger at the funeral parlour, the undertaker had to do it for me. I regret it so, so much and it still plays on my mind after three years.

      We can’t put ourselves through more pain than we are already facing. We know we loved them unconditionally and would do anything for them. Our minds just weren’t working how they would normally, it’s panic and this horrible overwhelming feeling that take over everything, so we couldn’t do the things we wish we had. I’m sure Paul wouldn’t think twice about you not closing his eyes, just as I’m sure my Ellie forgives me for not putting her ring on her finger. It’s forgiving ourselves that’s the hard part. But we must try to, and try to make peace with what really happened. We deserve peace.

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