Caring for Bereaved Patients: Title and subTitle Break"All the Doctors Just Suddenly Go"

On September 19, 2001,¹ Holly G. Prigerson, PhD, and Selby Jacobs, MD, MPH, introduced Mrs A, a 77-year-old widow of 2 years whose husband, a well-respected public figure, died of renal failure after a protracted course of diabetes and heart disease. Exploring Mrs A's trajectory of grief and the reconstitution of her life through community involvement, her continuing personal relationships, and political activism, they distinguished normal from complicated—ie, pathological—grief reactions and recommended approaches for physician interactions and communication with bereaved patients. The authors reviewed the evidence of benefit for social support, skill building, active daily routines, and narrative disclosure by bereaved patients. Finally, Drs Prigerson and Jacobs offered suggestions for professional intervention with bereaved patients and guidelines for psychiatric referral of complicated cases.

Mrs A continues to be cared for by Dr M. In December 2001, following the third anniversary of her husband's death, Mrs A and Dr M were reinterviewed by a Perspectives editor.

I'm feeling extremely sad and feel this anniversary of his death much more keenly than I felt the previous ones. My rabbi and Dr M tell me that it's because of what's going on in the world and because of September 11. I wasn't thinking about the anniversary until about 10 days ago, and then I began resorting to some tears. I feel very alone. The friendship with my gentleman friend has deepened, but he's not my husband. I am not his wife, but we have a very warm and good relationship with each other. I am not mired in the grief. I am seeing a therapist who deals with older people and with grief problems. The depth of the grief is not always with me, but the grief is never going to go. I hope that next year it won't be as difficult. Many things remind me of him, particularly Thanksgiving, which was the last holiday that he shared with us. I would very much like to have a sign from him. I don't know in what form or what happens to us after we die, but I think about that quite a bit. My children are still having a hard time dealing with his death, which I think is unusual after 3 years. My kids are very busy. They try to help me as much as they can and I do appreciate that. But everybody has been very sad. People come up to me wherever I go and tell me he was so wonderful. This makes it even harder to get over it. I continue to be active in political areas and see the people with whom he worked. There are a number of levels on which my remembrance and grief are operating.

Both Mrs A and her family are quite insightful in their ability to process this painful event. She's done a good job, but it is very painful for them all. I think she has more perspective on grief, and it has raised issues of her own mortality. I regret that in the last year her original psychiatrist died, which did not help. I talked to her about being overcommitted. I think that her initial community involvement and political activities were a good defense, but now it seems like it is too much, and she's exhausted. I have counseled her to think about each of them, to decide which to continue.

I trust that things will get better. I've decreased some of my community activities. I think that if I weren't quite so tired it wouldn't be as difficult. I had thought that doing a great deal would be helpful, but I'm not sure if I'm doing too much and that's exacerbating it. The grief recedes a little bit but it's never gone.