Coping With Grief from Difficult Diagnoses or Medical Errors

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Stages of Coping with Grief from Difficult Diagnoses or Medical Errors

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Life brings tragedies. If you or a loved one have ever been diagnosed with a terminal or life-long, chronic disease, it may be a tragedy in your life. Hearing the words "cancer" or "Alzheimer's" or "diabetes" or "Parkinson's" or "heart disease" will mean you have not just physical coping to do, but mental and emotional anguish, too.

Medical mistakes and errors in healthcare create millions of new victims every year. People become debilitated for a short period, or a lifetime. Hundreds of thousands die. For those who have suffered from medical mistakes, or those whose loved ones are victims of malpractice, the results may be life-changing. They are tragedies, too.

How we cope with our tragedies, and their effects on the rest of our lives, defines how we live our lives from that moment on. The effects may be a combination of physical, mental and emotional.

Sometimes the way to get past them is very clear. For example, an antibiotic may kill a hospital acquired infection. Other times, they are less clear because of unknown prognoses. In all cases, there will be mental and emotional effects we must deal with for ourselves and for our loved ones, too.

Some of us wonder whether we are normal. Coping becomes something that seems impossible to some, and a quest for others. If you have been diagnosed with a terminal disease, or if your quality of life has been destroyed by a medical error, how can you get past the anguish and grief? And how are you supposed to cope?

You may be surprised to learn that there are actually guidelines to help you understand and get through the grieving process, setting the stage to help you begin coping, too.

The Five Stages of Grief from Dr. Elisabeth Kubler-Ross

The five stages of grief were developed and described by Dr. Elisabeth Kubler-Ross in 1969 in her book, . Those stages are denial, anger, bargaining, depression and acceptance. They are called the Kubler-Ross Model and are sometimes referred to as DABDA.

Before we look at the model, we'll look at the "rules" that go along with them so that as you begin to understand each stage, you'll better be able to determine where you are within them and what you have to look forward to if you have a tragedy or a difficult diagnosis to cope with.

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Underlying Rules about the Stages of Grief and their Transition

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Here are the rules that apply to the Kubler-Ross Stages of Grief. When you understand their underlying rules, you'll better understand how to determine your current standing, and what stages you'll still need to transition through.

Rule #1: They can be applied to anything that brings you grief

Perhaps it will be your own bad diagnosis, or maybe you were the victim of a medical error. Or, maybe you have lost a spouse, or even your dog has died. Even when a partner breaks up with you or your home has been destroyed by Mother Nature -- anything that brings you grief will cause the Kubler-Ross Model to apply to you.

Rule #2: The stages may, or may not, be chronological

For example, if you suffer a medical error, you are likely to be angry first, before you deny it has happened to you. According to the Kubler-Ross model, that's not the order the stages of grief usually take, but that may be your experience.

Rule #3: You may not experience every stage

You may accept your new situation and move on without ever being depressed, or you may be relieved when you are finally diagnosed with something and never deny that you are really sick. More than likely, you will transition through all of them, but you may not be aware that's what you are doing.

Rule #4: You may relive some stages

Especially in the case of a chronic illness diagnosis, you may continue to return to the bargaining stage each time you show new symptoms or suffer side effects.

Rule #5: You may get stuck at one stage

A good example is someone who has lost a loved one to a medical error who never gets past the anger. Or someone who is depressed over the loss of a loved one and stays depressed for many years to come.

Rule #6: No two people deal with these stages in the same way or at the same time

If your loved one has been diagnosed with a terminal disease, he or she will go through these stages, but not necessarily parallel to the way you will. If you have lost a child to a medical error, you may stay stuck in one of the stages while the child's other parent continues moving through the stages.

Different rates of transition do not mean one person is grieving more or less. They are, simply, different rates of transition, as individual as those who grieve.

Now that you understand how those rules apply to the stages, let's look at the stages of grief (also called the Stages of Death and Dying or the Stages of Loss.)

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Elisabeth Kubler-Ross's Five Stages of Grief, Stages 1, 2 and 3

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Now that you understand how those rules apply to the stages, let's look at the DABDA stages of grief (also called the Stages of Death and Dying or the Stages of Loss.)

First Stage of Grief: Denial

When we first experience the loss, we may be in shock and feeling overwhelmed. We set our feelings and emotions on a shelf, and just begin going through the motions of life. We know intellectually that we have more to learn, and decisions to make, and activities to undertake, but, at least initially, we try to appear as if nothing has changed and life is not affected.

Usually you can't begin to move to the next stages until you begin to get past the denial stage.

Second Stage of Grief: Anger

Believe it or not, if you turn angry, then you are already past at least one of the stages (denial), because you can't be angry if you haven't admitted to yourself that something horrible has happened. Your anger may be conscious, or it may be unconscious.

Anger will rear its ugly, but necessary head in many different ways. You may be angry at yourself (I should have never eaten red meat or sugary treats!). You may be mad at the perpetrator of your medical error (if that surgeon had been more careful, my spouse would not have died!). You may be angry at Mother Nature for taking something dear away from you. You may even be mad at God because you can't fathom that a loving God would allow such a tragedy.

Experiencing anger is one way we cope with pain. Especially if we can define who or what we are focusing our anger on, it gives us blame to hold on to. When we can blame, then we actually have something we can do with that anger.

Among those who have suffered from medical mistakes, that anger and blame stage is a place they often get stuck. This is where many people begin to learn about patient empowerment. It's also where many people make the choice to file malpractice lawsuits.

Third Stage of Grief: Bargaining

This is the "if only" stage that will be targeted to ourselves, or toward someone we think can help. It's a stage where we attempt compromise in hopes of making the tragedy go away, where we want to trade our reality for something else and may even make a promise to be sure it will never happen again. This is the stage that those who suffer guilt can get stuck in, or may return to over and over again.

"If only I hadn't done such-and-such" or "I promise never to do X again."

Bargaining is the stage where many people use prayer, hoping that whomever their God is will help them out of their situation, making promises to their God that if the problem is reconciled, they will do something good in return.

Link to descriptions of the last two Stages of Grief.

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Elisabeth Kubler-Ross's Five Stages of Grief, Stages 4 and 5

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Now you are past the first three Stages of Grief (although you may not go through them in order), we are on to the final two stages.

Fourth Stage of Grief: Depression

Believe it or not, getting to the point of depression may indicate that you are actually coping with your grief -- a good outcome. When you get depressed over your tragedy or loss, it shows that you are in the very earliest stage of accepting it, and that you are almost ready to deal with it. You feel the emptiness, the sadness, the fear, the regret and the uncertainty, but you are still mired in them. The emotions are still incredibly intense and extremely difficult to deal with.

But in a way, it's good news that you are at the depression stage. The ability to experience those emotions as you deal with your depression may mean you are preparing yourself for the final stage -- acceptance. It may be difficult to believe, but that dealing is a very hopeful sign that you will, at some point, get past your grief.

Fifth Stage of Grief: Acceptance

First, know that acceptance in no way means that whatever tragedy or terrible event you have dealt with was OK or that it was right. It just means that you are ready to move on -- to deal with your reality. It's a disconnection process from the emotions, and development of the "it's time to get on with it" point of view. It's the place where you know you are coping.

Acceptance is a triumph. It frees us from the shackles of anger and blame, or the constant debilitation from depression. It lets us take advantage of the silver linings, too. For those who are lucky enough to survive the grief of a medical error, it allows us to reprioritize our lives, focusing on our most important relationships and defining what truly constitutes quality of life. For those who suffer a terminal situation, it allows them to find the joy in the time they have left.

When we understand the stages of grief and the way they play out in our lives, then we understand that no matter what our emotional reactions to tragedy or loss, we are reacting in very normal ways, and that there may be still more ways we will react at some point in the future which will lead us toward better quality of life.

Footnote: Sixth Stage of Grief

A sixth stage of grief is perhaps the most liberating stage, and occurs for those people who begin to take their experiences and create something positive for others from them. It's called "proactive survivorship." It was not identified by Kubler-Ross, but may be the most healing of all stages of grief.

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