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Introduction

So we are continuing our conversation on the 7 Domains of Grieving, this complex and often overwhelming process that most of us will experience someday. Grief is the powerful feeling of sadness that may come when we lose someone or something, but grieving is the process of working through that loss.

Now, in the Emotional Domain, which we're exploring today, the emotions can be sadness, anger, frustration, love, guilt, and despair.

Dr. Jones: In The Scope virtual studio today is Jackie Shifrar, who's going to help us think about the emotional aspect of this process. Jackie's a nurse practitioner in women's health who's had a practice taking care of women for 43 years, she has her own experience with grief and grieving that she'll share and we will try to understand what can happen. Jackie, thanks for joining us.

Jackie: Thank you, Kirtly, for inviting me.

Dr. Jones: We're going to be talking about how suicide affects a family. If this is a difficult process for you, please listen another time, skip this part, or go on to our other domains.

Jackie's Journey Through Grief

Dr. Jones: So, Jackie, this is a hard way to start the conversation, but can you help us understand how you came to think about grief and grieving, how you came to this experience?

Jackie: Yeah. The loss of my awesome son, Nicholas, who was 29, who was a PhD student at Penn State, Pennsylvania. Recognized that he was suicidal, and he really sought out help. Initially, he saw his counselor, and they quickly admitted him to a psychiatric hospital in Pennsylvania.

I believe it was two to three days after being in the hospital, he hung himself in his hospital room. He then was transported to Allegheny Hospital in Pennsylvania, where we had to take him off life support. So this was very devastating for me and my family and my husband and his brother. So that's where we started.

Dr. Jones: So that's a big and a really hard start. You actually had some really hard decisions to make because although he tried to commit suicide, did commit suicide, but he was brain dead and you had to make some decisions when you went out to Pennsylvania.

Jackie: Yeah, because they did all the MRIs, the testing, and basically, if we didn't pull him off life support, he wouldn't be a functional person. So we had to take him off life support, which was very difficult. But in a way, that was what we needed to do.

Dr. Jones: I mean, I was there with you. I have to tell those listening that I've known Nick since he was a baby, so he's a dear, dear boy to me, too. But Jackie, can you talk to us a little bit about what happened in terms of your early grief and what are some of the physical signs of the grief that you experienced?

Jackie: Well, initially, I think it was a combination of a lot of anger, and the other thing is guilt, of course. I felt so guilty. I called Nick every day, every morning, every evening. And the one morning that I didn't call him . . . I usually called him at 7:00 because there was a time difference. So I called him at 7:00 in the morning and usually at 4:00 or 5:00 in the evening. But the one morning I didn't call him, that's when they actually ended up calling me and said that they found him, that he had hung himself.

So I feel guilty, number one, that I didn't call him. Number two, that when he was initially at the hospital, I didn't go there. But it was really a tough time because it was COVID, and the restrictions were such that we couldn't even go in there. Even when he was in the hospital on life support, because of COVID we couldn't even see him. We only were allowed one visitor, which was my husband, Ken.

And then when we had to take him off life support, they allowed me to go in there a couple of hours before we had to . . . And that was the only time I was able to see him. So COVID really put a big piece of all of this stress on us.

Dr. Jones: We talked a little bit, Jackie, when you were early in experiencing this, about the physical symptoms that you had. And not only were you feeling so sad and so angry and guilty, but you were sick. Jackie, you were sick.

Jackie: I couldn't eat. I lost 50 pounds. And if anything, out of all this, I guess now I'm skinny.

Dr. Jones: Yeah, you are skinny. You didn't have 50 pounds to lose, Jackie.

Jackie: Well, I mean . . . Yeah, so I lost 50 pounds. My appetite still isn't the best. I couldn't sleep and I was just really sad, but I felt that I was able to still function. Nighttime was always hard because I cried every day. I would think about him every day, every night when I would go to bed, every moment when I would wake up in the morning. So I think that the constant remembrance of Nick really took a toll.

Navigating the Complexity of Grief

Dr. Jones: I know you were sad, but can you talk about the difference between being depressed versus being sad? Can you talk about that?

Jackie: I feel that when you're grieving, yeah, I'm depressed, but I think it's more sadness. When I look at depression, as a clinician, we always have an evaluation tool where we check the boxes and then we get a number, a grade of, "Are you really depressed? Do you need therapy? Do you need medical treatment? Do you need to be in the hospital?"

And for me, I thought I was grieving because I felt very functional. I went to work, I got up in the morning, and I took care of myself physically. I was able to go and be very functional at work. I was able to keep my relationships with my friends. I didn't totally withdraw.

So I have had women who have experienced the same loss as I have, who have lost a ÑÇÖÞ×ÔοÊÓƵ, and I could see there is a difference between depression and grieving.

One woman who I've known, she really was depressed and she actually attempted suicide, I mean, she's fine now. She's doing great. But to me, there's significant depression.

And I'm sure that there are some statistics of men/women who have experienced the same thing that I have that actually have been successful in committing suicide from the loss of a ÑÇÖÞ×ÔοÊÓƵ.

Dr. Jones: Well, I think of it as grief is the loss of the other, and you're focused on the other, what you've lost, but depression is the loss of yourself. And nothing is worth living for. Nothing is worth it anymore. And so it tends to be this . . . it's turned more inward.

And as I watched you in your grieving process, it was still turned outward toward Nick. It was toward what you had lost. And it wasn't all about you, Jackie. It was all about Nick.

Jackie: Yeah. And as I said, I feel that I was able to function. And I think going to work has probably been one of the best things for me to keep my mind off of it. That's one of the things, is to try to keep my mind off thinking about him. But that's still hard.

Reflecting on Coping Strategies

Dr. Jones: But I think you've been very willing to share your experience, so I have learned a lot from you as you've talked about it with me. I mean, as I go through my own grieving process. And I think part of your work has been the willingness to share what's gone on with you so that other people might learn a little bit. Has that been helpful?

Jackie: Yeah.

Dr. Jones: Well, people talk about complicated grief as something that goes on where you've actually turned the grieving inwards and it lasts more than six months. And I'll say that I grieved the loss of my dad when he died when I was 20 for 10 years. And thinking of his death can still knock me off my socks.

So do you think that there's a time course that's the right one or the wrong one? People say, "Am I normal? Is this too much? Am I normal when I'm grieving like this?" What do you think about that?

Jackie: That's one of the things I always talk to my therapists about, because I feel like, "Why am I still struggling and still crying and still thinking?" Everybody's different. That's the best I can say, is it's just time. It's always going to hurt, but it's going to hurt less over time.

And I think it's what you do as an individual because of this loss to honor that person who was lost, whether it be some kind of dedication or just something.

Dr. Jones: I think of the loss of a ÑÇÖÞ×ÔοÊÓƵ. You and I have taken care of women and infertile women over these many years together. You said something about the loss of a ÑÇÖÞ×ÔοÊÓƵ versus the loss of a parent.

Jackie: Well, I've lost my parents, and it's kind of the loss of a parent is the loss of the . . . What was it?

Dr. Jones: It's like the loss of the shared past for me, when I lost my daddy.

Jackie: Yeah. It was the loss of the past. Then you talk about the loss of a spouse, the loss of the present. And when you lose a ÑÇÖÞ×ÔοÊÓƵ, it's the loss of the future. And Nick was such an incredible young man. He was so smart. He had a master's degree in divinity, and he was working on his PhD. He was a poet and just such a kind young man and gifted in so many ways. And I just feel that at some point, he was going to have some kind of a great profession, get married, have kids.

So that loss of the future, with enjoying at this point in my life . . . to me, it's your kids and your grandmother and great-grandkids. And that, to me, is lost.

Dr. Jones: It is a loss. We've talked a little bit about people who miscarry, who are pregnant, particularly if they've been trying to get pregnant for a while, and they've lost . . . Maybe it wasn't even a fetus that they lost, the pregnancy that they lost, but they lost in their heart. That was a ÑÇÖÞ×ÔοÊÓƵ. It was a ÑÇÖÞ×ÔοÊÓƵ that they cuddled, it was a toddler that toddled, it was a kid in school, it was their future, a wedding.

So you lose all of this, the idea of what a future is going to be, that we all hope for our ÑÇÖÞ×ÔοÊÓƵren. The loss of a ÑÇÖÞ×ÔοÊÓƵ, they say . . . I hope I don't have to experience this, but it's the worst. It's the worst.

Jackie: Yes, and I agree. As I said, I think this is probably the biggest challenge of my life. I mean, illnesses are tough, and I think many people lose ÑÇÖÞ×ÔοÊÓƵren from illnesses, and cancers. I guess there's just something about suicide that is, to me, a little more challenging because he made that choice. Cancer, unfortunately, they don't have the choice. But suicide, I think, is a little different in a way. I mean, it's still a loss, but suicide, to me, is a little tougher.

Dr. Jones: When we lose ÑÇÖÞ×ÔοÊÓƵren or family members who have a disease, we're often with them at the end. But almost by definition, suicide is a lonely act. And the very thought that your ÑÇÖÞ×ÔοÊÓƵ was alone just tears your heart out.

Jackie: Yeah. And the thing about it is he reached out to us and he recognized that he was struggling, and we wanted him to get the help, which he followed through. And so he was doing the right thing. That's the other tough part of it.

Dr. Jones: Right. He was on suicide watch and it wasn't enough.

Jackie: Right.

Dr. Jones: In your own case, did you reach out for help as you were trying to figure out how you were going to carry on? And you did. I know you still saw patients and you still reached out to family and friends, and you've been a great friend to me. But did you reach out for help for you?

Jackie: For me, the outpouring of love and support from friends, it's just amazing. I have connected with some that Nick knew that I never knew that reached out to me and have developed friendships with them.

I mean, one woman lives in England. Another woman lives in Penn State, where Nick was living, and she and her husband loved Nick dearly. I think the connection was more because Nick was into the Jewish religion. That was one of the big connections. But he would go over their house and they just loved him dearly. So it's amazing.

And then actually, there was a professor from the ÑÇÖÞ×ÔοÊÓƵ of Chicago, where Nick graduated with his master's degree. He lives in Jerusalem, and he has connected with me several times. He actually felt very guilty that Nick lost, and he felt like he should have done more for him.

So I've connected with a lot of Nick's friends that I've never met before. Also, I've connected with a lot of Nick's close friends from high school, and I still keep in touch with them, and that's been helpful. I mean, the friends are a big thing.

I did a lot of reading also. I read a lot of books on grieving and suicide. There was one book in particular that kind of hit me. It was the book "Unthinkable" by Jamie Raskin. Jamie is a congressman in, I think, Maryland. And Jamie lost his son probably a couple of months after Nick passed. He committed suicide, and so he wrote this book.

He kind of felt guilty that he didn't recognize . . . His son died at home in their house, and so he felt guilty that he didn't recognize that his son was that depressed to take his own life. So reading was also very helpful for me. Lots of reading.

Dr. Jones: Well, that guilt, which is that sense of anger turned inward toward yourself . . . You mentioned that you saw a therapist who kind of gave you some ideas about how you might manage the complexity of your grieving and some of your actions that maybe were making it better and maybe were making it worse. Can you talk about that?

Jackie: After Nick's passing, I just pulled out a lot of things, kind of memory things, things maybe I gave him, lots of pictures and candles. I'm into the lottery, and I used to light one of the Jewish candles. I can't remember the name of the candle, but it's a traditional thing for the Jews. I buy a lottery ticket, and then with the drawing, I would light the candle and then put my lottery ticket and think I would win the millions of dollars.

So I had a lot of things that were constant reminders. And my therapist said to me, "You need to just take them away. At some point, you can always bring them back."

There was one thing that I did keep. It was just a teeny little plaque that Nick bought, but he never sent it to me. And when I unfortunately had to go through all his stuff in his apartment, I found it. That's the only thing I have left. And it says, "Mom, to the world, you might be one person, but to one person, you might be the world." And so that's the one thing that I've kept, and I have it by my bedside.

Dr. Jones: Well, it's been three years now?

Jackie: Yeah.

Dr. Jones: And we just had a celebration of life. Do you feel that that was helpful, or did it just stir things all up over again? How are you doing since then?

Jackie: I think it brought up a lot, and it was really hard, but I think it was a good thing. Nick was cremated, and really, I know how people go on Memorial Day and go see the grave, and there was never really a grave. So the good thing is we got a memory tree. It's an elm tree that's at Red Butte Garden, and that's kind of one of the things that will be helpful. So I can go and just sit and think of Nick.

The other thing was he was an incredible poet. He must have had hundreds of poems. And so for the celebration of life, for everyone who attended, I put together a poem book of all the poems that Nick did.

But also, there were several poems that were written, number one, by my sister and also one of Nick's good friends, Phoenix. And also, Kirtly, you know what you wrote for Nick, which was amazing, and that also is in the poetry book.

So that was very helpful for me, but it was very hard. It took me three years to do it. Not that I did it every day, but pulling out all those poems and reading them, I thought, "You are amazing. All those poems were just amazing. How did you do all this?" There were so many of them.

Finding Meaning and Moving Forward

Dr. Jones: So how are you moving forward now? I mean, what keeps you going now? Where do you see bright spots?

Jackie: Work is still very good for me. I work with a great group of physicians, practitioners, medical assistants, and ancillary staff. And I think that being at work, I don't think of Nick that much. On occasion, sometimes it may come out with patients about what's going on with their lives, or patients who I've talked about, they'll ask me, "How is Nick?" because I would always brag about my kids to my patients. So I think work has been very helpful.

Friends are also still helpful. Not that we talk about it, but just being social and talking about other things outside of Nick is helpful.

And then just my physical activity, being passionate about biking and cycling. Last week, I biked to the top of Big Mountain, up Emigration. And then this past weekend, I went up to the top of Millcreek. And then my next plan is to go up to the top of Snowbird. So my biking is passionate and I'm also passionate about pickleball, which I think those activities keep my mind off things.

Conclusion

It's been a gift, a hard gift to have you share, be able to be part of watching you grow and become this incredibly much stronger person through your own efforts. You're a monster bicyclist and a pretty wicked pickleball player. But you're an artist, and your artwork and your jewelry have become more informed by your experience. So in many ways, it's been a gift to be able to hear what you've been doing.

And we have just touched on the emotional experience of grief and the process of grieving today. If this has called up powerful emotions for you or your own thoughts of suicide, please reach out for help. The National Suicide and Crisis Lifeline is reached by dialing 988.

Jackie, thanks for helping us today to think about this. We do this to help remember Nick and all the other ÑÇÖÞ×ÔοÊÓƵren we've lost.