Amanda Wilde (Host): Grief is a normal response to loss and pain. But while it is natural, grief can be extremely challenging to process and survive through. Olivia Miller is here to shed light on this powerful emotion and share ways to cope and support. She's the Bereavement Coordinator and grief Counselor at Prisma Health's Hospice of the Foothills.

 This is Flourish, a podcast brought to you by Prisma Health. I'm Amanda Wilde. Olivia, welcome. Thank you so much for being here.

Olivia Miller: Amanda, thank you so much for having me.

Host: Olivia, this is not an easy question. But in your experience, what would you say is the true meaning of grief? What is it?

Olivia Miller: So, we really feel that grief is the internal experience of deep sorrow in response to a loss. So really, what we're feeling like anxiety, loneliness, pain, those types of things.

Host: And there's all shapes and sizes of grief. I think it's interesting that it is a thing, but it is also an action. In other words, it's a thing that sits in you like a heavy lump, but it is also a process that you go through. Can you talk about different types of grief?

Olivia Miller: Yeah. So really, we feel like grief can be that response that we have to any kind of a loss. It doesn't just have to be a physical death, right? It could be divorce, maybe loss of a job or moving, loss of a friendship. But definitely, grieving is that outward expression of our grief, the stuff that other people see.

Host: I imagine grief can affect your health. Does it make you more prone to sickness?

Olivia Miller: What's interesting is, I think, yes, it can. It all depends on how we care for ourselves. Typically, after we have some sort of a major life change or maybe it's a death or another type of loss, that rattles our daily life and functioning. And so, we can very easily maybe not be getting good sleep or good nutrition or physical activity. Once one of those becomes compromised, that can really impact us. And then, there's just the stress component as well. We know that stress has physical consequences.

Host: Right. It's the thing we talk most about triggering illness, isn't it? And then, there's this process we call the stages of grief, but it's not a linear process, is it?

Olivia Miller: No, it definitely is not. So, when people talk about the stages of grief, they're typically referencing DABDA, which stands for Denial, Anger, Bargaining, Depression, and Acceptance. And those stages were developed by Elisabeth Kübler-Ross. She was a physician who worked with people who are dying, and she actually developed those stages for the person who is dying. They were then modified for grief, because there definitely are some similarities, but they were never meant to be a linear staged progression. They just got put into textbooks, whether it was nursing textbooks or others, as like, "This is how you grieve." But I like to think of them more as aspects, variations, or flavors of grief.

So, some people may experience one of those. Some may experience all of them in their grief journey. But it's definitely an ebb and flow and we can kind of be all over the board. We could experience all of those in an hour. So, definitely not stage by stage. Grief is not something we can just go through and check off boxes and at the end be like, "Oh look, I'm done grieving." That is not how it works.

Host: Yeah. We always wonder, well, how long will the grief last? But I think there is an initial intense period of grief. Do you see that that morphs into something else, that it lasts a certain amount of time?

Olivia Miller: You were talking about the intensity part, I see that with pretty much everyone I work with. I think it's the initial shock. Even for people who maybe the loss has been longer, right? Maybe it's been a progression over time, like with Alzheimer's or a chronic disease process. But there is the shock when the person dies. And it takes time for our brain to just wrap around what has happened and absorb it and figure out what's going on. We're so used to that person having always been there and just knowing they're going to walk through the door. We're going to wake up and turn over and they're going to be there. That's just been conditioned. It's our muscle memory. So, there's time that it takes just to understand, really comprehend emotionally and physically that our person is gone. I think once that settles in, then we really begin the active grieving mourning of processing, "Okay, what does it mean for me now? What does my world mean now to not have this person here physically anymore?"

Host: So even though we have heard you can grieve for a person In a chronic illness situation or other situations where something is terminal, we know death is coming and so we hear, yeah, people grieve while that person is still alive,. But does that really help at all with the stage you're talking about, the adjustment?

Olivia Miller: It can and it can't. It depends, I think, on how actively the person is involved in the pre-grieving. We call that anticipatory grief. So if people are really engaging with that process, that can definitely help in the initial time after a loss that can help with the initial shock. But there are a lot of people who won't even confront that, you know, who maybe there is this chronic disease process, but they are just in denial that it's happening or maybe are always holding out that their person is going to be healed. So, it can be helpful. I have a lot of clients that I work with who, say, have lost a loved one due to Alzheimer's or dementia. I had a woman just last week who shared with me, "I'm grieving twice. I grieved them as I was losing them, as they were losing their cognition. And now, I'm grieving them now that they're no longer here."

Host: It's such a heavy loss. That's why people like you are so very important. Can you talk about some strategies for living with grief? Is there a right way to grieve?

Olivia Miller: Well, I tell people there's really no right or no wrong way. The caveat to that, of course, is if the person grieving is harming themself in some way or harming somebody else, yes, that's the wrong way to grieve. But as far as a right way, I mean, we have to go through it. We really have to just go through it.

 Things and strategies that we've found helpful. There's research on this idea of a continuing bond, so finding some way to stay connected to your loved one. There's this fabulous book that was recently published called The Grieving Brain, written by a neuroscientist and clinical psychologist named Mary-Frances O'Connor. And she goes into continuing bonds and talks about continuing that emotional and spiritual connection with your loved one, that death removes the physical, but it does not get rid of the emotional or the spiritual. So, however we can find a way to nurture that bond and carry on that memory of our loved one, keep their memory alive in our life, that only is going to help us.

I encourage my clients, if this feels comfortable to them, talk to your loved one, you know, have a conversation with them, ask for their guidance and advice. All of those things can only be nurturing and supportive to us as we go through this experience of grief.

Host: Yeah. When you talk about nurturing the bond, it makes me think of death more as a transition and not a hard stop. But for those who can't seem to get out from under, what can you do if you're debilitated by grief?

Olivia Miller: I would encourage that person to seek the help of a licensed counselor. I think when we're debilitated, where it's impacting our daily functioning, we need professional support at that point. You know, like we were sharing, grief is a natural experience and a natural response to a loss. But sometimes it can become complicated, and it can become more than what we should be able to work through on our own. I deal with a lot of cases of traumatic loss. So, an example where the death is a traumatic event, maybe it's a motor vehicle accident or a stroke or something along those lines. And if the grieving person has experienced that or has experienced trauma in the hospital setting, like witnessing an intubation or an extubation, there can be lingering PTSD from that, right?

 So, finding a therapist who's specialized in trauma or complicated grief is a good place to start. I am a trauma-trained clinician, so I'm able to do that with my clients. But there are definitely those times where we need more, we need more help. Also, thinking about finding a support group to lean on other people who are going through a similar process. You're never going to find someone who has, A, experienced exactly what you have or, B, is responding or reacting to it in exactly the same way. Our grief journey is totally unique to us. It mirrors the relationship that we had with our loved one, but we can find people with whom there are commonalities and that can help us, just to know that we're not alone in this.

Host: Right. Because it can feel very lonely. And if you're wanting to support someone who's grieving, how can you do that? And are there things you shouldn't say and do?

Olivia Miller: Oh, yes. I have this conversation so frequently. The first thing as far as what you can do or what you should do to support someone, show up, period. Don't wait for them to ask you to show up and don't tell them, "Hey, call me if you need anything," just show up. They're not going to ask you to. You know, they're not going to want to feel like a burden. So for you just showing up, taking a meal, taking a card, sending flowers, sending a text saying, "Hey, I'm thinking about you today. I just want you to know you're in my heart," that is, I think, the single most best thing we can do, because grief is so isolating.

I think everybody that I talk with, you know, loved ones are showing up during that first month. You know, whether they have a funeral service or a memorial or whatever, there's a meal train for the first month. And then once the end of that, it's like, "Everybody else moves on. But I, the grieving person, I have not moved on. I'm just getting started." And so, we need that support after the first month.

As far as things that you shouldn't say or do, there is this little poem. It's called My Friend, I Care, and it was written by Joanetta Hendel. And it goes through a whole list of like, "Don't say these things," you know, don't say these things to grieving people. As far as things I would recommend, you know, don't use platitudes. Don't tell people they're in a better place or, you know, they're not suffering anymore. It just doesn't help. And it can be very invalidating of how that person feels. Just let them talk, give them the space to talk, listen. Usually, the best thing that we can do is just to be there. Be comfortable sitting with silence. We don't need to lessen somebody else's pain just so that we feel more comfortable.

Host: So, we really have to watch that because it's so automatic. Just like saying, "Call me if you need anything" is so automatic. Do you have any advice for specifically helping children through grief so that they don't internalize that trauma in a way that is destructive?

Olivia Miller: Yeah. My number one tip would be to, if possible, try to prepare them as much beforehand, if that's possible. Sometimes it's not, right? But as a caregiver, whether you're a parent, a grandparent, whoever's caring for the child, having conversations about death and dying. Using really concrete terms. Using the words death and dying, not talking about passing away or going to sleep or going to a better place. Kiddos need those concrete terms to really understand. They're very literal. Also, you know, if the death has already happened, including them in the funeral or service planning process. Giving them a part to play. Maybe it's just making a poster board with pictures, but giving them some sort of role and involving them in that ritual.

Also, coming up with a good plan for them to return to school, making sure that the school knows that there has been a loss in the family. Maybe even identifying a safe person, whether it's a teacher or someone that they trust at school that they can go to if they're having an emotional time or what we call like a grief first. They have a safe person to do that with and the school knows what's going on so that they can help. Also, doing just meaningful activities with them. Anything involving art usually is a great way for kiddos to process some of their emotions and what they may be feeling.

Host: I like these suggestions so much, because they are actual actions you can do as you are probably grieving yourself, but that also are actions for the kids. And so, we always feel so helpless in these times and it feels better if you can do something and these real actions you can do.

Olivia Miller: Definitely.

Host: You are the only bereavement coordinator and grief counselor at Prisma Health's Hospice of the Foothills. I just want to get a sense of what that means. What does your caseload look like?

Olivia Miller: We have approximately 1,600 people die on our hospice service in the upstate every year. That number can fluctuate. But for each one of those patients, we identify a bereaved or a loved one to follow, to give support to. Sometimes it ends up being multiple family members. But typically, I have about 1,600 people that I'm following on a daily basis. And I offer support to families for an entire year after the loss. That can be individual counseling, it could be a support group, phone calls, we have mailings that go out. But yeah, that number, it can be a little daunting. I have to just remind myself every day, like, all you can do is what you can do and that's enough. And I'm grateful to be able to provide this support for our families.

Host: Well, Olivia, thank you so much for giving some concrete actions and resources for us to grab onto, as well as raising awareness about how we absorb and adjust and cope with grief. Thank you so much for being here.

Olivia Miller: Oh, you're so welcome. Thank you for having me.

Host: That was Olivia Miller, Bereavement Coordinator and Grief Counselor at Prisma Health's Hospice of the Foothills. For more information and to listen to additional episodes of Flourish, visit prismahealth.org/flourish. This is Flourish, a podcast brought to you by Prisma Health.