“I’m ready to die,” Mr. G. announced to his wife who was standing at his side. She understood this need as she had witnessed the decline from a lung disease which first stole the living out of life and then stole the life out of everything else as he fought to hold on for her. With tears sliding down her cheeks, she gave a nod that was nearly imperceptible. She was ready to let him go. I asked if I could pray for them. We held hands as we each felt confident in his heavenly homecoming. The place with no more tears and a new heavenly body.
His oxygen was switched to a nasal cannula. He was made comfortable and given morphine to diminish his “air hunger.” Not long after, I came to his room after being called by the nurse. His wife held his hand, head resting upon their entwined fingers as he slept. I walked in and she raised her head. Weariness was etched in her face. We stood on opposite sides of the bed as we watched his heart rate slow and finally stop. As Mrs. G gave Mr. G a final kiss, her tears were gone. It was time for rest, for both husband and wife. In the face of a long, difficult death…Rest. Is. Good.
I share this patient’s story for it demonstrated the beauty of having the opportunity to say that last goodbye. Yet, for so many, this doesn’t happen. Our hearts have been torn apart as loved ones are separated this past two years and death is in the company of strangers. However, the tragedy of death without goodbyes occurs every second of every day. Sudden deaths, far-away deaths, lonely deaths, violent deaths, and accidental deaths rob those left behind of their final goodbye.
The term closure in the context of grief implies accepting the reality of loss. It is not meant to deny the hole left in one’s heart by the death of the one who left their imprint there. When one has not had the opportunity to say goodbye, the acceptance of loss is more difficult. Harder still is the final last which is marred by harsh words, unspoken love, and bitter regret.
If you or someone you know is experiencing the trauma of the unspoken goodbye, here are 7 steps to help you navigate these harsh waters of grief.
1.Accept that this grief is unique.
There is not a right or wrong way to journey the path. However, the best way is to journey together. Do not isolate.
If you seek to comfort these grievers, sit with them, stay with them, hold their hand, be ok to be silent and speak when they are able. Do not state, “I know what you feel like,” in your desire to comfort. You can’t fully know.
2.Acknowledge all the moments of life which were shared prior to that final moment.
Our relationships are more about the moments than the momentous. If you focus on those through photos, shared stories, and reflection you will begin to remember the life of love that was more important than the words not said at the life which ended abruptly.
3. Agree to seek forgiveness.
Forgiveness heals the soul and is beneficial for good health. You may have regrets for words spoken or unsaid. Forgiveness begins with you. Forgive yourself, forgive your loved one now gone, and forgive those whose actions resulted in your loved one’s death. It may seem impossible in those first days, weeks, months, and sometimes years but the practice of forgiveness will set you free from the bondage of regret, guilt, and hate.
4. Allow yourself time to say goodbye in other ways.
Funerals and memorial services are an opportunity to say goodbye. However, solitude with the deceased loved one gives an opportunity to speak all that you would have liked if given the opportunity. Goodbyes may occur graveside or when alone in a favorite place shared with the deceased. Writing a letter allows one to express love, loss, and regrets. Journaling has been a powerful tool in times of great distress.
5. Access tools available for your unique grief.
There is not a timestamp for grief. However, the gut-wrenching, sleep-taking, mind-numbing acute grief will evolve. If grief continues to prevent you from performing normal daily functions after six months, then you may be experiencing Prolonged Grief Disorder (PGD). Research reveals that PGD is more common in those who have lost loved ones suddenly and especially if that death was due to accidents, violence, and most notably suicide.
There are different targeted therapies for PGD centered around cognitive-behavioral grief-targeted interventions. Self-care that is meaningful to you should be continued as soon as you are able.
6. Approach each day with gratitude for the time you had with your loved one.
Keep a gratitude journal for the laughter and the sorrows you shared. Sometimes you may just be grateful to have survived another day and that’s okay.
7.Ask for help.
Friends and loved ones want to be there for you but may not know what to do. Ask them for the practical help needed when life continues. Ask about grief groups through your community or faith family.
My heart is heavy for you as I finish writing. I feel the weight of your grief and I know how these words may seem meant for someone else, someone who can breathe in the midst of their pain. If that is you, please hear me, I am praying for you now and I will continue to pray for you. Beloved, you are not alone.
 American Psychiatric Association. (2021, November 10).Tips for Understanding Prolonged Grief Disorder. APA offers tips for understanding prolonged grief disorder. Retrieved January 17, 2022.
 Jordan, A. (2014, April 4).Prolonged grief disorder: Diagnostic ... - dartmouth college. www.Dartmouth.edu. Retrieved January 17, 2022
Dr. Pamela Prince Pyle is a Board-Certified Internal Medicine physician who studied at Oklahoma State University, North Texas Health Science Center, and completed her training at Baylor University in Houston. She was one of three physicians selected in 1992 by Carolina Health Specialists (CHS) to begin the first hospital-based internal medicine practice outside of a university setting in the United States.