A is for Anger in Hospice

anger-1Entering into hospice care reveals the best and worst of us. Responses and relationships seem on edge: raw, exposed, and vulnerable.

Anger is alphabetically and dramatically near the top of an emotional volcano when a doctor announces there are only six months or less to live. Elisabeth Kubler-Ross famously identified anger as one of the five stages of dying. (And though her efforts have often been misconstrued—for example, the “stages” aren’t sequential and predictable—Kubler-Ross’ insights into dying, death, and grief are essential reading.)

But instead of anger as one of five “stages,” I wonder about four ways that I’ve witnessed anger erupt when a loved one faces death.

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1. Anger at God

People from any religion that worships a supreme being can have anger towards God for “causing” a loved one’s illness. Regardless of how much or how little faith matters to a believer, how could God do this to me, or to my beloved? I have witnessed similar rage towards God from eighty-something husbands learning about a wife’s stage four cancer and from parents whose pre-teen daughter has just been diagnosed with a life-limiting illness.

Age doesn’t matter. Don’t comfort anyone by saying a parent or spouse has “lived a long, good life.” Everyone wants another day, month, and year(s). Don’t try to reassure a parent watching a child slip away by claiming God has a plan or that the child is “needed” in heaven.

Anger at God is normal. It’s better to express it than repress it. And I hope, during the dying, or in the time of grief, that the angry person talks with a hospice chaplain or their rabbi (or pastor or priest or imam) about their faithful (or faithless) anger at God. No conversation will make the loss easier to take. No conversation should have a goal of making sense of the senseless. But every conversation about anger at God has a chance to help a grieving person honestly reveal their fears and to possibly begin healing.

2. Anger at the health system

Of course there’s anger at the health care system. On a trivial level, I recall a helicopter whisking me into a hospital after I broke my leg while backpacking. Moments after arriving in the emergency room, several nurses tended to me. One tried to give me morphine. She couldn’t find a vein in my arm. She tried again. Failed. Tried again. Failed. Finally a doctor did the drug deed. I know from personal experience how morphine reduces or eliminates pain! And I also know how angry I became when someone poked and prodded me, but couldn’t accomplish the “simple” task of inserting a sharp object into my flesh.

My emergency room experience was trivial. Many confront far more complex issues. Whether it’s the repetitive and confusing forms, callous medical staff, discovering your health insurance doesn’t cover your needs, or a zillion other troubling situations, anger at or about the “health care system” is no surprise.

And then you enter hospice. For many, the anger influenced by difficult encounters with “health care” means hospice will also be mistrusted. The staff at most hospices will understand this. And while every hospice makes mistakes, the good news of hospice is that it’s one of the few times when all of the medical staff works together. Every patient has a “team.” That team—caring for the body, mind, and spirit—will work together to meet your needs.

For many, anger towards the health care system is inevitable. Sometimes, though far from always, a hospice team can calm the disgruntled feelings and disappointments from a hospital stay.

3. Anger at the person you love.

  • What if twenty years ago, a doctor told your mother that she should give up cigarettes? But the smoking continued and a difficult death looms in your future. You’re angry with her! Still, how much you love this cranky, caffeine-addicted parent . . .
  • What if your husband persuaded you that retirement meant moving and now you own property that two can barely maintain? Soon, you’ll be alone in a place where you never truly wanted to live. You’re angry with him! Still, how much you love this love of your life . . .
  • What if, after loans never paid back, and multiple stints in drug rehab programs (paid by you, of course), your wayward son or daughter is ill and your home is where he or she returns to die? You’re angry with him or her! Still, how much you love this child . . .

Legions of feelings buffet us in the time of dying. Anger is often the one most perplexing. How dare we have anger towards our loved one! After all, they are dying. But it happens, and the three scenarios above are all “triggers” for anger to clash with other feelings during the dying and grieving. I hope there’s a way—perhaps with support from a hospice chaplain or social worker—that the anger can be expressed while your dying loved one can engage in honest conversations with you.

Anger is a legitimate response to the actions (or lack of actions) taken by a loved one. The worst thing is to “bury” the anger when you have a chance to talk and heal. Unlike your loved one, anger has a way of returning to life later during grief.

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With these first three, I imagine some anger could be resolved. Maybe healing will happen with a person’s faith in God or in relationships with other loved ones.

Maybe. But in hospice, we also walk into homes where there is . . .

4. An angry, dysfunctional family

Angry spouses have yelled at me. Angry parents have glared at me. Angry siblings have ordered me to leave the room. I’m enough of an optimist to imagine that if an individual is lugging around a temporary anger at an indifferent God or a faceless health care bureaucracy that their time in hospice may reduce his or her negativity.

However, while I believe every family has “dysfunction,” some appear permanently derailed by miscommunication, blaming, and an anguished history. Every new day includes a new conflict.

It’s unlikely that anyone on the hospice team will “heal” a family forever at war with itself. While I could list many reasons why it happens (but would never come close to identifying all the reasons), the chaos of dysfunction is an unfortunate reality for some siblings or spouses or blended families. All a hospice staff can do is try to address the patient’s immediate, urgent physical needs.

I wish it were not so.

I wish doctors and nurses could prescribe the perfect pill and reduce the anger . . . for the whole family. I wish social workers and chaplains could say the perfect words or quote the perfect scripture and replace the anger with compassion . . . for the whole family.

Oh how I wish . . .

Even as the anger momentarily or continuously “erupts,” I hope your hospice team will work to make sure a patient—you or your loved one—can die with dignity.

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(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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Comments

  1. Thank you for this one Larry! Some of your posts are a remembrance of difficult moments moved through and an understanding reached although at times I can feel that pull to revisit and wallow. #3 triggered an unexpected wound. No one wants to deal with the pain of pending loss but the rewards are worth it. Healing is possible.

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