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Discussion : Death and Dying

It is useless for me to describe to you how terrible Violet, Klaus, and even Sunny felt in the time that followed. If you have ever lost someone very important to you, then you already know how it feels, and if you haven't, you cannot possibly imagine it.
-Lemony Snicket, A Series of Unfortunate Events

Counselors must understand and prepare for the life-changing decisions and reactions that may accompany a client's process of transition and adjustment during times of grief. In addition, identifying how personality, family dynamics, and particularly culture might impact each client is crucial when working with grieving families. Failure to make conscious connections with cultural boundaries and beliefs during this time can lead to further emotional distress for and among family members.

Consider for a moment, the culture of the Hmong, a people originally from various mountainous regions of Asia who immigrated in droves to the United States seeking refuge from the mid 1960s through the 1990s. For as far back as records indicate, the Hmong have viewed the human body as a vessel in which the spirit lives.

When the body dies, the spirit leaves the body and traces one's life back to its place of birth. To start the spirit on its journey, the Hmong employ a specific process that is to be carried out during one's passing. This ceremony contrasts that of Western medical proceedings and can therefore cause a rift between cultures during this fragile time.

Similarly, many other cultures have distinct perceptions about using Western medicine and technology to lengthen life. As a counselor, how might you proactively support a family experiencing the many internal challenges related to grieving as well as those caused by external factors?

To complete this Discussion, review the case study presented at the end of Chapter 15 of The Life Span. As you read this case study, consider the emotional and behavioral reactions of each family member as he or she copes with the decline and eventual death of Victor, the family patriarch.

Post by Day 4 an explanation of the factors driving each family member's individual reaction to terminal illness and death. Then, explain two healthy coping strategies for this family system. Include developmental, resiliency, and cultural influences on coping with loss. Justify your response with references to this week's Learning Resources and the current literature. Be specific.

Case Study

Isabelle and her husband Victor lived together for 53 years in a small, close-knit Italian American section of a big city. Victor made a living for the family working as a forklift operator. Isabelle, a stay-at-home mother when her children were young, returned to work as a sales clerk once the youngest two children entered high school. Isabelle enjoyed her years of full-time mothering, but she also loved the social interaction and camaraderie she found in her job.

The family has four grown children, Paul, 51, Sophia, 49, and twins Lenore and Joseph, 45. Paul and his wife own and operate a small restaurant in a nearby suburb. They have two young adult children. Sophia, also married with two children, teaches in a middle school about an hour away from her parents' home. Lenore has recently remarried after a divorce. She lives with her second husband and her three children in the city. Joseph is a salesperson who has never married but who lives in another state with his longtime partner, Joanne.

At this time, the family is struggling to come to grips with Victor's recent death. After years of robust health, Victor was diagnosed with pancreatic cancer. During the last 4 months of his life, he was in and out of the hospital as his health demanded. Isabelle tried to care for him as best she could, but it was very difficult.

The side effects of Victor's treatment protocol left him feeling ill and in need of constant care. The family members tried to help, but the greatest burden fell to Paul because in this family the oldest child is perceived to have the most responsibility.

As time went on and it became clear that Victor was dying, Isabelle mentioned to her children that their father had not wanted any extraordinary measures to be used to keep him alive in his final illness. Victor had never put this in writing, but Isabelle was sure of his wishes. Victor's family physician, a deeply religious man, Victor's older brother, and Joseph all strongly disagreed with this plan. They believed that every effort should be made to save Victor's life.

One night, Victor lapsed into a coma and was having trouble breathing. Joseph prevailed upon his mother to allow the physician to insert a ventilator. Joseph's siblings were very upset about this turn of events, for they believed it caused their father unnecessary suffering. Victor died several days later.

Now 4 months after the death of her husband, Isabelle is grieving the loss of her spouse. She lives alone but is seriously contemplating asking her son Paul to let her move in with his family. She quit her job at the department store because she felt she was unable to concentrate well enough to perform in a satisfactory manner. She has been unable to sleep through the night, and her mind keeps returning to memories of Victor during his illness.

Relationships are strained among the children. Neither daughter speaks to Joseph or Joanne because of their disagreement about Victor's care. Joanne believes that Joseph should "move on" and concentrate on her and their life together. Lenore avoids calling her mother because she does not want to hear her repeat the same troubles over and over again.

She uses her hectic schedule as a full-time mother as an excuse. Sophia is somewhat more attentive, but she is also uncomfortable listening to her mother's reminiscences. She wants to believe that her mother is still the same vibrant person she has always known, so she discounts the sadness she hears in Isabelle's voice. Paul is overwhelmed by the responsibility he feels for his family, his business, and his mother.

He knows his mother is grieving, but he cannot find a way to make her feel better. For her part, Isabelle feels that she has come to the end of her life as well. She believes that she will end up like many of the other lonely widows she knows in her neighborhood.

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