Auntie Dot.
She's the family favorite. All the kids adore her. She was the one who took them to the carnival, the fall fairs and the water parks. Dot never missed a game, a performance or a birthday. So... how in the world do we tell them about her terminal diagnosis? It will break their hearts.
Do we have a good working knowledge of Dot's condition, her prognosis and her treatment? If not, we need to. By telling the truth, accurately and with great sensitivity, we give the kids the best chance of being able to successfully process this very sad situation. How we deliver the news depends on many factors… Who are we telling? What are their ages, level of emotional development and support systems?
Maybe the issue isn't a terminal illness. Perhaps it's that Gram is moving to assisted living, a nursing home, or out of state to a family member's home, or that she is having serious surgery and will have to go to a rehab center for a while before coming home. Whatever the situation, it is interrupting the "normal experience" that children have when issues come up for their elder loved ones.
What's the big deal in how we present this to the kids?
In truth, it's a huge deal. "Distress tolerance" in adults is often directly related to childhood experience. Life is full of stress, and at times, distress. Our ability to manage this life experience is the role model for our children and even grandchildren. If we fall apart when things don't go exactly the way we want them to, those watching may well, in turn, adapt that behavior as their coping strategy. The good news is that even if our experience growing up was not grounded in helping us handle difficulty or learn "distress tolerance," it doesn't mean we can't develop this skill as an adult so that we can demonstrate and model it for our children.
Painful realities require painful discussions and yield responses of pain. As you embark on these conversations: plan ahead. You need to know how much information is necessary and how much is too much. Kids don't need all the details; in fact, it can be frightening and cause them to shut down. Measure the amount of information you are sharing. Stay in the "now" and don't project too much into the future. It's always OK to say, "I don't know, but we can find out." Validate feelings: anger, sadness, disbelief, or numbness. They are all part of how we manage inner pain.
Keep the conversation going… it is NOT a "one and done."
There may be many parts where you can peel the so-called onion and go deeper. Take your cues from their responses. If they ask questions, chances are they can handle more information. If they look as if they are guarding themselves with physical posturing, they may have information overload. Maybe you will need professional help to process all that is going on. As you would consult an expert if a child were in physical pain, the same principle applies to emotional pain.
Feelings of safety and control will be challenged during times like these. Help kids, according to their age and development, retain control over what they can — allow them to have input on simple things like meal planning or where to go for a meal, which activity they want to participate in, and doing homework right after school or after dinner. Remind them that there are situations where we don't have as much control as we want, but there are still areas of life where we can influence outcomes.
Checking in… asking about feelings… and sharing your own.
What does "support" really mean? Encourage communication with your family, trusted others, and friends. Celebrate the little things. Create moments where you can "shelve" the pain, even for a quick trip to your favorite ice cream place. And the oxymoron: make room for the pain. It requires courage to feel. Validate the myriad of feelings that go along with bad news. Reference the stable areas of life and what kids can count on. Animals and nature are miracles of healing… make them available.
Keep in mind that self-care for all is a critical component in managing distress, pain and sadness. When your children see you creating your own self-care, it models for them more than you could ever say. As the old saying goes, "I can't hear what you are saying because your actions are speaking so loudly." If you can't manage it alone, don't. Help is a phone call away.
Joanne MacInnis, RN, is the founder and president of Aberdeen Home Care, Inc., of Danvers, a concierge private duty home care agency in business since 2001. With 35 years of nursing practice, management and administration experience focused on home care and hospice, Joanne and her team specialize in advising and supporting families addressing the elders in their lives retain dignity and quality of life.
