Dr. Nick Dewan discusses grief.
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Grief
Featured Speaker:
He is a member of the physician leadership team within the BayCare Health System providing input to the hospitals, medical group, accountable care organization, and insurance-based initiatives. He has the respect of national hospital, managed behavioral health, community mental health, and consumer advocacy groups, and sits on the Council of Healthcare Systems and Finance of the American Psychiatric Association. Dr. Dewan is also a member of the Board of the Positive Coaching Alliance of Tampa Bay. He is a graduate of the Medical College of Ohio, and completed his residency in psychiatry at Los Angeles County-USC Medical Center and UCSD School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. He is also a board certified physician executive and a former collegiate tennis player and coach.
Nick Dewan, MD
Dr. Nick Dewan is a pioneer and an accomplished physician leader and sports psychiatrist with a nationally respected track record in health care value improvement and information technology. Currently, he serves as Chief Medical Officer for the Behavioral Health Division of the BayCare Health System. In 2015, he published his third book on information technology “Mental Health Practice in a Digital World: A Clinicians Guide”. His clinical experience includes work in emergency, hospital, outpatient, addiction medicine, and sports medicine settings. He is a sought after speaker and is interviewed by local and national media on behavioral health issues and sports performance topics. His work on clinical guidelines, performance bonuses for quality, efficient use of healthcare, best practice adoption, and patient empowerment and technology positions him as a leading expert in an era of accountable healthcare.He is a member of the physician leadership team within the BayCare Health System providing input to the hospitals, medical group, accountable care organization, and insurance-based initiatives. He has the respect of national hospital, managed behavioral health, community mental health, and consumer advocacy groups, and sits on the Council of Healthcare Systems and Finance of the American Psychiatric Association. Dr. Dewan is also a member of the Board of the Positive Coaching Alliance of Tampa Bay. He is a graduate of the Medical College of Ohio, and completed his residency in psychiatry at Los Angeles County-USC Medical Center and UCSD School of Medicine. He is a Diplomate of the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine. He is also a board certified physician executive and a former collegiate tennis player and coach.
Transcription:
Grief
Introduction: Here's another edition of the BayCare Health System Podcast Series, BayCare HealthChat with Melanie Cole.
Melanie Cole: Welcome. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing grief. And while it's not easy or always easy for people to discuss this, it's really important that we hear the information that we're going to get from our guest today. Joining us is Dr. Nick Dewan. He's the Chief Medical Officer in the Behavioral Health division of BayCare. Dr. Dewan, it's a pleasure to have you join us again. Tell us a little bit about grief. Is this a normal reaction? Does everybody experience it the same way? Tell us a little bit about it.
Dr. Dewan: The most known theory and or study of grief is something called a Kubler-Ross model. That was back in the late sixties. She published her book in 69 on death and dying. And back then the stages that were described where people go through a normal, predictable grief reaction or grief process. That includes things like being in complete shock or denial and disbelief, getting angry, sort of pardoning for that person to be there. Then they fall into this sadness of the reality of the loss. And then there's this sort of, acceptance stage, now some people can go through this quickly. Some people can feel the initial denial and anger at the same time. So it doesn't have to be a linear kind of process. But over time that model has been pretty well accepted. And there've been lots of studies on this sort of process of grief, and people do experience these losses. And the initial reaction is this cannot be, there's just no way, how can this be? And that's really that sort of shock and disbelief phase.
And some people are longing for that person and they're saying, you know, they're not really gone. I can still feel their presence. So that is such a strong, strong initial reaction to grief. And here in healthcare, unfortunately, we see that. We take care of patients who are say terminally ill or we have people that are in serious accidents or people that have had sudden heart attacks. And we see that reaction in the people we serve. So it is a normal part of just humanity, is going through the stages and we try to help people that go through these stages. And there are of course some people who usually take more than six months and that's when it becomes what we call, we give it a clinical term of complex bereavement. When it goes beyond six or 12 months, where you're still suffering and you're still down in the dumps and you're still longing for someone. So grief is natural, it's a natural human condition, but if it persists for six to 12 months and you're not able to function in life, that's when it becomes a medical issue that we get concerned about.
Host: So you mentioned the stages of grief, Dr. Dewan. First of all, as you tell us these stages and how we're going through them, can you prepare ahead of time? Like I know my father is 96 I know that this is something that's going to happen soon. Who knows how long, but is there a way to prepare and certainly sudden death is not something any of us can ever prepare for and affects us in a completely different way than something we are expecting in a way. Does that make sense?
Dr. Dewan: Absolutely. And I think we have people living longer and longer than we've ever had before. So you have people that are in this what I would call sandwich generation where you have the elderly parents and then of course you have kids. And I think the most important part of preparing for the loss is to have those conversations about the past, about the relationship, you know, is there anything undone that you want to talk about or is there anything, any business to be addressed? And I'm not talking about business like running a business. I'm talking about interpersonal business, like going over what has happened in the past, were there things you would've done differently, having that honest conversation. Because a lot of times people say, oh I wish I could have said this. I wish I could have spent more time. I wish we could have resolved this sort of discomfort we had, or I wish I could have just told them that I loved them a lot. So I think we can think about all the regrets that people would have and say, well, for each of these regrets, potential regrets, what am I going to do that if and when this day happens, I'm going to feel comfortable that I spent the amount of time I wanted to spend.
I had those emotional connections that I needed to have. I was able to go over the past and walk through some of the, maybe the difficulties that was there and I was able to understand this person's perspective of end of life. And if you go through those stages, you feel comforted and that other loved one in your life feels comforted that they're at peace inside. And I think that's the most important thing is there that sense of peace and comfort inside. And obviously this happens in say the area of palliative care or hospice where you have these very deep emotional conversations with individuals who are able to see the end of life with a sense of humanity and dignity, and that's the real purpose of having these conversations. Historically, this wasn't a very popular thing to do or it was one of these things, Oh, I don't want to talk about this. I don't want to even think about this. And as we've started being more, what I would call open about these conversations, it really is a healing process and so you can do proactive healing basically before there's a loss.
Host: Well, I couldn't agree with you more, and as someone who did everything that you just mentioned, I can tell the listeners it does work and it does help. How do we talk to our children about it? How do we, if we have an elderly relative, if we have somebody who has a terminal illness and it's someone that is close with them, how do we get them involved in that process? As you said, this used to be taboo, but now it's something that we all are learning to come to grips with and to discuss. How do we bring the children into this?
Dr. Dewan: I think you have to think about what stage of life. What I think of child are we talking elementary school, middle school, teenagers, you know, college, and I think at each stage of what I call being a child or an adolescent or young adult, they're going to have different perceptions. The younger you are, the more unreal it seems. How can this be possible? What do you mean there's an end? Parents and grandparents should live forever because that's how young people think. It's a forever world. There is no reality to it. Whereas in the teenage years, that's when you can have an honest conversation about your great grandparent or your grandparent has a severe medical condition. We don't know how long they're going to be and let's have a conversation about what are you feeling about that? What are you thinking? If you want to spend more time now would be a good time to do that. Just so the other person experiences you and leaves this planet with a sense of love and closeness, and I think that's really the message to give to younger people. When they leave, they need to leave with a sense of connection and love. The same love you have for them. They have for you, and that's the emotion they leave earth on. And I think that's the real communication to young people.
Host: That was beautifully put, Dr. Dewan. What a great way to look at that. Now if someone has died and we're grieving, we're mourning. Some people say, Oh no, no, don't talk about them. Now, it's been two weeks or three months or six months. Is that morbid? Are you supposed to talk about them? Is that a good thing? Does that help your mental ability to deal with the loss of that person or does it make it a little bit harder when you have to think about them?
Dr. Dewan: There's two ways to look at this. Number one, people talk about who they have lost. They can talk about it for the next 10 years. What really happens in those conversations is you always have that little tear in your eye when you're talking about them and that's okay. But then you transition into, Oh, do you remember the time how they drank that coffee? And they put the jam on the toast and how the peanut butter spilled. So you tend to have very positive sort of memories of the person. You still feel the sense of loss, but saying you can't talk about something is not good for your health. It's better to talk about that person. Now, there is a minority of individuals who are so, so what I would call preoccupied one year later, 18 months later, just so preoccupied that they're immobilized, they're melancholic, they're confused about their own life. That's when it's not good and that's when you seek professional help. But for the majority of people, it's normal. It's okay, it's fine. It's a way to cherish their memory and it's a way to cherish your relationship with them.
Host: It certainly is. So wrap it up for us, Dr. Dewan, with your best advice as someone who is an expert in this, tell us a little bit about, you mentioned when grief was an illness and when you need to seek professional help, but how best to treat it, how best to go about when we've lost a loved one and obviously sudden death again is something different. But what would you like the listeners to know about grief and dealing with it?
Dr. Dewan: I think number one, you have to (a) remember the person and (b) tell your friends it's okay to talk to me about it. I'll let you know if it's getting too tough. If you have a certain spiritual kind of focus, it's okay to bring that up in sort of that context. It's okay, tell your family members, it's okay, let's talk about this. Because everybody's afraid of sort of upsetting a person who's lost. And that's the last thing you're going to do when you bring that loved one up because they're going to want to talk. And if they don't want to talk, they'll tell you. So my message is, it's okay to share. It's okay to ask somebody, Hey, if you're not the person that lost somebody, but you know somebody that did, it's okay to say to them, Hey, I'm really sorry about your loss. I'm here for you. Tell me about the person you lost. And if they're comfortable talking about it, they'll share it and they'll feel better. So don't be quiet. Don't be internally preoccupied. Allow yourself to what I would call, breathe the loss. And if you're a friend of somebody, allow them to breathe the loss. It's important.
Host: Well, it certainly is. What a great segment and so informational. Dr. Dewan, thank you so much. You're a great guest as always, and that concludes this episode of BayCare HealthChat. Please visit our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts for more health tips and updates, please follow us on your social channels. Until next time, I'm Melanie Cole.
Grief
Introduction: Here's another edition of the BayCare Health System Podcast Series, BayCare HealthChat with Melanie Cole.
Melanie Cole: Welcome. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing grief. And while it's not easy or always easy for people to discuss this, it's really important that we hear the information that we're going to get from our guest today. Joining us is Dr. Nick Dewan. He's the Chief Medical Officer in the Behavioral Health division of BayCare. Dr. Dewan, it's a pleasure to have you join us again. Tell us a little bit about grief. Is this a normal reaction? Does everybody experience it the same way? Tell us a little bit about it.
Dr. Dewan: The most known theory and or study of grief is something called a Kubler-Ross model. That was back in the late sixties. She published her book in 69 on death and dying. And back then the stages that were described where people go through a normal, predictable grief reaction or grief process. That includes things like being in complete shock or denial and disbelief, getting angry, sort of pardoning for that person to be there. Then they fall into this sadness of the reality of the loss. And then there's this sort of, acceptance stage, now some people can go through this quickly. Some people can feel the initial denial and anger at the same time. So it doesn't have to be a linear kind of process. But over time that model has been pretty well accepted. And there've been lots of studies on this sort of process of grief, and people do experience these losses. And the initial reaction is this cannot be, there's just no way, how can this be? And that's really that sort of shock and disbelief phase.
And some people are longing for that person and they're saying, you know, they're not really gone. I can still feel their presence. So that is such a strong, strong initial reaction to grief. And here in healthcare, unfortunately, we see that. We take care of patients who are say terminally ill or we have people that are in serious accidents or people that have had sudden heart attacks. And we see that reaction in the people we serve. So it is a normal part of just humanity, is going through the stages and we try to help people that go through these stages. And there are of course some people who usually take more than six months and that's when it becomes what we call, we give it a clinical term of complex bereavement. When it goes beyond six or 12 months, where you're still suffering and you're still down in the dumps and you're still longing for someone. So grief is natural, it's a natural human condition, but if it persists for six to 12 months and you're not able to function in life, that's when it becomes a medical issue that we get concerned about.
Host: So you mentioned the stages of grief, Dr. Dewan. First of all, as you tell us these stages and how we're going through them, can you prepare ahead of time? Like I know my father is 96 I know that this is something that's going to happen soon. Who knows how long, but is there a way to prepare and certainly sudden death is not something any of us can ever prepare for and affects us in a completely different way than something we are expecting in a way. Does that make sense?
Dr. Dewan: Absolutely. And I think we have people living longer and longer than we've ever had before. So you have people that are in this what I would call sandwich generation where you have the elderly parents and then of course you have kids. And I think the most important part of preparing for the loss is to have those conversations about the past, about the relationship, you know, is there anything undone that you want to talk about or is there anything, any business to be addressed? And I'm not talking about business like running a business. I'm talking about interpersonal business, like going over what has happened in the past, were there things you would've done differently, having that honest conversation. Because a lot of times people say, oh I wish I could have said this. I wish I could have spent more time. I wish we could have resolved this sort of discomfort we had, or I wish I could have just told them that I loved them a lot. So I think we can think about all the regrets that people would have and say, well, for each of these regrets, potential regrets, what am I going to do that if and when this day happens, I'm going to feel comfortable that I spent the amount of time I wanted to spend.
I had those emotional connections that I needed to have. I was able to go over the past and walk through some of the, maybe the difficulties that was there and I was able to understand this person's perspective of end of life. And if you go through those stages, you feel comforted and that other loved one in your life feels comforted that they're at peace inside. And I think that's the most important thing is there that sense of peace and comfort inside. And obviously this happens in say the area of palliative care or hospice where you have these very deep emotional conversations with individuals who are able to see the end of life with a sense of humanity and dignity, and that's the real purpose of having these conversations. Historically, this wasn't a very popular thing to do or it was one of these things, Oh, I don't want to talk about this. I don't want to even think about this. And as we've started being more, what I would call open about these conversations, it really is a healing process and so you can do proactive healing basically before there's a loss.
Host: Well, I couldn't agree with you more, and as someone who did everything that you just mentioned, I can tell the listeners it does work and it does help. How do we talk to our children about it? How do we, if we have an elderly relative, if we have somebody who has a terminal illness and it's someone that is close with them, how do we get them involved in that process? As you said, this used to be taboo, but now it's something that we all are learning to come to grips with and to discuss. How do we bring the children into this?
Dr. Dewan: I think you have to think about what stage of life. What I think of child are we talking elementary school, middle school, teenagers, you know, college, and I think at each stage of what I call being a child or an adolescent or young adult, they're going to have different perceptions. The younger you are, the more unreal it seems. How can this be possible? What do you mean there's an end? Parents and grandparents should live forever because that's how young people think. It's a forever world. There is no reality to it. Whereas in the teenage years, that's when you can have an honest conversation about your great grandparent or your grandparent has a severe medical condition. We don't know how long they're going to be and let's have a conversation about what are you feeling about that? What are you thinking? If you want to spend more time now would be a good time to do that. Just so the other person experiences you and leaves this planet with a sense of love and closeness, and I think that's really the message to give to younger people. When they leave, they need to leave with a sense of connection and love. The same love you have for them. They have for you, and that's the emotion they leave earth on. And I think that's the real communication to young people.
Host: That was beautifully put, Dr. Dewan. What a great way to look at that. Now if someone has died and we're grieving, we're mourning. Some people say, Oh no, no, don't talk about them. Now, it's been two weeks or three months or six months. Is that morbid? Are you supposed to talk about them? Is that a good thing? Does that help your mental ability to deal with the loss of that person or does it make it a little bit harder when you have to think about them?
Dr. Dewan: There's two ways to look at this. Number one, people talk about who they have lost. They can talk about it for the next 10 years. What really happens in those conversations is you always have that little tear in your eye when you're talking about them and that's okay. But then you transition into, Oh, do you remember the time how they drank that coffee? And they put the jam on the toast and how the peanut butter spilled. So you tend to have very positive sort of memories of the person. You still feel the sense of loss, but saying you can't talk about something is not good for your health. It's better to talk about that person. Now, there is a minority of individuals who are so, so what I would call preoccupied one year later, 18 months later, just so preoccupied that they're immobilized, they're melancholic, they're confused about their own life. That's when it's not good and that's when you seek professional help. But for the majority of people, it's normal. It's okay, it's fine. It's a way to cherish their memory and it's a way to cherish your relationship with them.
Host: It certainly is. So wrap it up for us, Dr. Dewan, with your best advice as someone who is an expert in this, tell us a little bit about, you mentioned when grief was an illness and when you need to seek professional help, but how best to treat it, how best to go about when we've lost a loved one and obviously sudden death again is something different. But what would you like the listeners to know about grief and dealing with it?
Dr. Dewan: I think number one, you have to (a) remember the person and (b) tell your friends it's okay to talk to me about it. I'll let you know if it's getting too tough. If you have a certain spiritual kind of focus, it's okay to bring that up in sort of that context. It's okay, tell your family members, it's okay, let's talk about this. Because everybody's afraid of sort of upsetting a person who's lost. And that's the last thing you're going to do when you bring that loved one up because they're going to want to talk. And if they don't want to talk, they'll tell you. So my message is, it's okay to share. It's okay to ask somebody, Hey, if you're not the person that lost somebody, but you know somebody that did, it's okay to say to them, Hey, I'm really sorry about your loss. I'm here for you. Tell me about the person you lost. And if they're comfortable talking about it, they'll share it and they'll feel better. So don't be quiet. Don't be internally preoccupied. Allow yourself to what I would call, breathe the loss. And if you're a friend of somebody, allow them to breathe the loss. It's important.
Host: Well, it certainly is. What a great segment and so informational. Dr. Dewan, thank you so much. You're a great guest as always, and that concludes this episode of BayCare HealthChat. Please visit our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts for more health tips and updates, please follow us on your social channels. Until next time, I'm Melanie Cole.