You know I love Hollywood as much as the next person, but I'm beginning to think I can't trust everything I see in the movies. Examples...
1. The average woman is 5’10” and weigh 110lbs, no matter their genetics, what they eat, or whether they exercise.
2. If I jump out of a fast moving car I’ll be fine as long as I just tuck and roll.
3. Love, at first sight, is a pretty common thing.
4. If you don’t find love at first sight, don't worry because you’ll find hate at first sight followed by antics, cute misunderstandings and high jinks that will miraculously turn into love.
5. Aliens look a lot like us but with a different face shape, bigger eyes, or a strangely wrinkled forehead. And they speak English. Obviously.
6. Death, unless due to a zombie apocalypse, is usually a pretty peaceful experience where family members have meaningful moments and everyone reaches a place of acceptance.
As much as I love television and movies, sometimes I worry about the impact of mischaracterizations and dramatizations on our beliefs and expectations. Movies and television are often our first contact with things we know very little about - like say, aliens, or love, or jumping from moving trains. There are no *actual experiences may vary* disclaimers, so when we see things happen in a movie that we haven’t experienced in real life, the movie-reality starts to shape our understanding of actual reality.
Sure, sure, it doesn't take long for most of us to realize that #1 - #5 on the above list don't hold up to reality, but interestingly #6, Hollywood's representation of death, is a belief that's a little more resistant to change. Despite the 6 o'clock evening news telling us otherwise, despite watching friends or co-workers go through terminal illness, complicated hospitalizations, and challenging caregiving experiences, many people continue to believe in the Hollywood ending.
Truthfully, we can't blame everything on Hollywood; that would be far too simplistic an explanation. In actuality, we all do our part to perpetuate this belief. In broader society, it's taboo to talk about the realities of death in anything above a whisper.
Even those of us in the healthcare, hospice, mental health, thanatology, and social work fields, who know very well what the worst case scenario can look like, often choose to gloss over the unpleasantries of death. Understandably we advocate for every person's right to a "good death" and we tell you to plan and prepare and we show you serene images of peaceful goodbyes because this is our wish for people.
Now I want to be very clear, this post isn't meant to undermine anyone's efforts to prepare. Please make plans I implore you because preparation gives you your best shot at having that meaningful Hollywood-like 'good death'. However, it's not fair to suggest a peaceful and controlled death is possible, without also acknowledging that death, in and of itself, is not controllable. As important as it is for you to plan, it's also important for you to expect nothing but the unexpected.
This is important to acknowledge for so many reasons. For our purposes mainly because when we don't, those who've experienced losses far worse than they ever imaged wind up feeling alienated and alone. Not only alienated and alone but robbed of an experience that everyone else seems entitled to.
If you can relate to this at all you may have thought at some point - "Look at all these stories and depictions of people experiencing death in the same way that my loved one planned for, yet my loved one didn't get a 'good death'. How is this fair?" Well, it's not fair...but you are not alone...and it's not your fault...and there's probably not a lot you or your loved one could have done to change things. Remember, death has its own plans.
And I promise you, for every person who we encounter who experienced that ‘good-death’ for their loved one, there is at least one (and usually 3!) who didn't. Heck, a literature review on surrogate decision makers (those who had to make end-of-life decisions on behalf of their loved ones) found that only 10% perceived the death as a good death. That leaves a lot of people struggling with feelings of guilt and regret, traumatic memories, thoughts of the world being unfair, and the secondary loss of missing out on that meaningful Hollywood moment - all of which are factors that can negatively impact a person's grief.
It would be difficult for us to create a comprehensive list of all the factors that might complicate a person's experience or cause distressing thoughts, memories, and emotions in grief. I'll briefly discuss a few below, but please know this list is not all-inclusive:
1) The illness was more traumatic than anyone could have imagined: It can be incredibly traumatic to watch a loved one's body shut down. The wasting, fluids, blood, strain breathing, bedsores, and on and on can be overwhelming, unexpected and extremely distressing. This is a normal part of death, but this doesn't make it any easier to witness. Although physicians and nurses do everything they can to keep their patient's comfortable, it doesn't change how hard aspects of disease and death are to witness.
2) The person's loved one was scared, angry, confused, detached, agitated, or hostile: The brutality of watching a loved one suffer in this way is hard to put into words, but it is something so many face when a disease takes over or when treatment and medications impact neurological functions.
3) The person's loved one said terrible things: Although this can happen due to #2 mentioned above, there are other circumstances that can lead to troubling final conversations with loved ones. Sometimes the person who is dying appears angry or hostile towards everyone, but sometimes this hostility seems specifically directed at certain friends or family members. When mean or hurtful things are said at the end of a person's life, they cannot be fully discussed, processed or understood later.
4) The family feels they held out hope for way too long: It's very common for family members to feel as though they were naïve to hold out hope and as a result, they lost the opportunity to “come to terms” with the impending death.
5) Withdrawing treatment was distressing: Palliative medicine has come a long way, but an “extubation” (removing the ventilator) isn’t always pretty or peaceful even with a clear advance discussion, comfort care plan and palliative medications in place. It is not uncommon to worry that a loved one struggled, lingered, or suffered.
6) The loved one wasn't ready to die: Though people who are dying sometimes find ‘acceptance’, many people hold out hope or fight bitterly until the end. When the family is ready to accept a person's death but the person who is dying is not, the family may wind up feeling confused or unable to say the things they wish to say to the person who is dying.
7) There was never a Hollywood moment: Many people are never able to have a conversation in which they share a meaningful moment, resolution, or love for one another. Oftentimes those who expected a moment yet never had one, feel this as a secondary loss.
We have articles on a lot of different kinds of emotions, but if you are struggling with feelings of guilt, regret, and anger you may want to start with the following posts...
You might also want to read our post on anticipatory grief, as it may offer some insight into things you were experiencing but didn’t even realize it.
Alright, there it is for today. As always, you keep the conversation going – leave a comment to share your thoughts, experiences, or whatever else you care to share! And don't forget to subscribe to all our posts come right to your inbox.
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