In 1969, Elisabeth Kubler-Ross, a Swiss psychiatrist, introduced the five stages of grief in her book, On Death and Dying. She identified the stages as denial, anger, bargaining, depression, and acceptance. Interestingly, it has been realized that these stages are applicable to any loss, including an illness, losing a job, divorce, relocation, changing schools, and death. What I find particularly striking about her philosophy is that the stages do not necessarily occur in a linear fashion, nor are all the stages experienced by those undergoing a loss. I had always hoped when you arrived at acceptance, the task would be complete. Hoping doesn’t make it so. This is a crushing blow.
Historically, a diagnosis of cancer was received with fear, apprehension, and the anticipation of moving closer to mortality. Regardless of your discipline on the oncology clinical team, you cannot escape the inevitable fluctuations of emotions expressed by those you encounter in practice. As a patient receives the diagnosis, they experience a loss. As their loved ones learn of the diagnosis, they experience a loss. As an employer learns of the diagnosis, they experience a loss, and so on.
Health-care providers know inherent in the cancer journey are infinite losses which may or may not be visible to the naked eye. Some are expected and others are unforeseen and without warning. The unanticipated are often the most emotionally challenging. We literally witness these challenges in everyday practice. Along with this reality we observe the person with cancer, as well as their loved ones, navigate the loss at their own pace through the stages of loss. How we engage and support those in our care is critical to their psychological well-being amid these turbulent moments.
As with the stages of loss, a cancer diagnosis is not a linear journey. The peaks and valleys are in some ways out of our and the patients’ control. However, the ways these ups and downs are addressed are what we can guide and empower. Remaining compassionately present with or without verbal exchange can sometimes be our greatest offering.
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