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Eva's bereavement: every cloud ...

Janet Webb
BSc(Hons) RGN
DiPN(Lond)
Practice Nurse
Lindum Medical Practice
London

I once worked part-time in a care home for young disabled people, and one of the residents came to the office to say he was going out and would be back late. Genuinely impressed, I said "Oh James, you do look smart". Obviously affronted, he said "Well there's no need to sound so surprised!"

Since then I think twice before making comments – after all, who am I to express an opinion?

When Eva came into my room, I was again so impressed that I remarked, "Oh Eva, you do look nice!" – I then quickly remembered James and added "… as usual, I mean." She laughed, thankfully. I hadn't seen her since the long-expected death of Bill, her husband, several weeks earlier. Bill had died slowly of cancer, but had also suffered strokes and had COPD.

For some years Eva had nursed him at home, and until fairly recently would bring him to surgery in his wheelchair for all the various monitoring appointments. She seemed tireless in her good-natured caring.  

Eva really did look so much nicer than I'd seen her look before though. She was wearing new clothes which fitted her perfectly and flattered her newly-revealed nice figure; a red jacket over tailored trousers and a pretty top. She'd had her hair styled and highlighted, and wore make-up and smart high-heeled shoes. She looked like the "after" photo on a TV makeover show, and I was taken aback.

Because I hadn't seen her for a while I said how sorry I'd been to hear of Bill's death. She looked around conspiratorially and said "Can we talk?" I told her of course she could, at which she went on. "Well, don't be sorry. He was a horrid man for the 42 years we were married and I've done my duty. Now it's my turn to live and I've got a lot of catching up to do."

She went on to tell me how, as a teenager, devoted to romantic novels, she had fallen for his masterful dominance, thinking him strong and manly. "It wasn't until after I was married and expecting our Terry that I grew up and realised he was just a bully after all. That's what he stayed the rest of his life. I lost all respect for him; I didn't even like him in the end." I'd asked whether she'd ever considered leaving him, and she admitted she had dreamed of packing her bags and starting a new life when Terry had left school, but the year before he left school was when Bill had his first and most severe stroke, the one that had confined him to a wheelchair and meant he had to give up work. Much as she resented him, Eva could not bring herself to leave him then, and compassion took over. She said she cared for him as she would anyone who needed help, even looking on it as a job, acting the role of live-in housekeeper. He would never have allowed her to get a job in "real life", so she seemed to have managed to make her life tolerable by pretending.

I'd had no idea – but then why should I have? She hadn't confided in anyone, feeling, she said, ashamed and embarrassed. Her sister now thought she was suffering a grief reaction, and kept telling her she needed help. Indeed, a feeling of numbness and sense of unreality can be a reaction to bereavement.1 But Eva, meanwhile, had joined a local art group, and had bought a computer and started a course at the library to learn how to use it – her grandchildren had already taught her how to email them and surf the net.

She had come that day to talk about travel vaccines, as she was going to Greece with her son and his family, a willing babysitter for the two children while Terry and his wife went out.

Bill had been a big, clumsy man, tall as well as overweight, hemiplegic and dyspnoeic. Eva had always seemed quietly practical, helping him without making a fuss, but now I thought about it, I never remember actually hearing them chat or laugh together. Their conversation had been perfunctory, to do with the task in hand. Eva would wheel Bill in, help him off with his coat, hand over his prescription orders, then sit at the back of the room while Bill was consulted. The pair had had considerable input from the community nursing team, with carers helping Bill in and out of bed, and towards the end with hospice staff visiting. I wondered whether any of them had been aware of Eva's opinions. I reflected again how much younger she looked now, and realised it was partly because she was smiling and animated.

I reflected how easy it was to stereotype ill and dying people as sad victims of fate, bravely battling their disease and smiling through the pain: and then how cinema always portrays the dead mother as having been beautiful and kind, the dead husband as loving and handsome, devoted to his wife and family. It stands to reason that unpleasant and cruel people must get ill and die, but somehow we can't seem to recognise that, and turn them instead into pitiful victims.

I wondered whether I had pigeonholed the couple as happily married in tragic circumstances, despite, in hindsight, not having any evidence of this, because stereotypical behaviour is easier to predict, and therefore not surprising or threatening. Perhaps that means I have to apply less thought to problem-solving, since I have effectively denied any problem other than the sadness of terminal illness and pain. In "imposing" this problem on them, I would then have a sort of "power" over their situation, by knowing what to expect of them and knowing that the terminal illness care provided by the community and hospice teams were competent to help. Instead, I now wondered whether Relate, or assertiveness counselling for Eva might have helped.

Eva's mourning had already happened – had been happening for most of her married life. She had been mourning the life she had imagined would be hers, the happy marriage to a loving man. Now she was free to live her own life without the guilt or trauma of divorce. She said it must be awful to do it the other way round, to live the last years of life heartbroken and lonely, pining for a happy married life lost forever.

Just as she was going, she told me she'd done something "very naughty". On Bill's memorial stone, under his name and the years of his birth and death, she had had the inscription "Blessed release" carved above a design of flowers. She chuckled as she said that referred to her release, not his.

Reference
1. Cruse Bereavement Care. 2008. Available from http://www.crusebereavementcare.org.uk/about_bereavement.htm