The short conversation on the phone left my husband, Martin with a look of shock. “What was that about?” I asked. Martin stood in silence, took some forced deep breaths and softly spoke. “There’s been an accident. A terrible accident.” As it turned out, one of my son, Max’s dear childhood friend was killed in a car crash hours before. He left a party in the early morning hours feeling it would be safe to drive. He got into his car, still slightly intoxicated from the night before neglecting to put on his seat beat. He drove off and almost immediately crashed into a tree.  He wanted to get home; it was such a short distance. This was a great kid who made a terrible decision.

My son was on his way to a concert in Boston, ready to savor his last night in town and then finish up the packing in the morning. Martin called him to tell him of the tragedy so he didn’t read it on facebook or hear it on the news or from a friend. Somehow we thought perhaps we could soften the blow from the sickening news. He began to wail over the phone. He uttered a sound I had never heard come from him before. I could hear the ghoulish cries even as I stood several feet away from the phone.

How could this be? They were such great buddies. So many childhood memories shared. Max came home, locked himself in his room and sobbed. One by one Amy, Martin and I offered to talk to him or just be with him. “I need to figure this out alone. I need to think. I need…” His cries could be heard throughout the house. Amy left to walk the dog, just so she could shield herself at least temporarily from Max’s anguish.

My heart aches for the family that suffered the greatest loss of all. Their lives forevermore changed and broken. My heart aches for the young man with such promise that will never see age twenty. My heart aches for my son who lost his dear boyhood friend along with his innocence. No one is impervious. Yes, we need to train our children to be ever vigilant in making good choices and decisions. Even then we cannot save them from senseless catastrophe.

Last night I found myself murmuring prayers for the unspeakable loss of this family and for the protection of my own children.

How do you best protect your children from catastrophe?

Years ago I conducted workshops and seminars to physicians at the Boston University School of Medicine. The well-attended meetings were about “Who Takes Care of the Physician?” This subject continues to warrant attention, however I’ve come to realize that nurses, aides, home health care providers and our reliable family members, also need to be cared for. They too need tools for their own self-care during these stressful times.

Of course the primary focus is on the sick or post-operative patient, but little attention is paid to the family members that are in the trenches day in and day out with their loved ones. The responsibilities thrust upon the spouses and children can be not only overwhelming, but disorienting and exhausting.

Effects on Family Members

• Fear of the unknown; fear that the family member may never be the same
• Guilt over whether there might have been something you could have done to prevent your family member’s diagnosis
• Helplessness; feeling that there is nothing you can do to really make a difference
• Anxiety over whether the recovery will be sound and complete as possible
• Depression over family member’s inability to live their life the way she used to before the diagnosis
• Frustration about one’s own sleep deprivation, lack of control of one’s own time, and the litany of demands needed on the part of the patient – and shame with feeling the need to take care of the self when needed by the impaired loved one

Ways For Family Members to Manage Successfully while Care Taking:

• Know that recovery involves a partnership of the patient and caretaker.
• Share your feelings of frustration with a friend, loved one or, if appropriate, the person you are caring for.
• Share your positive feelings too as in reminding the patient that you love them and are willing to do all that you can to help them.
• Get an education. This will help you be more patient, compassionate, and understanding. It will also prepare you for any physical or psychological changes your family member may have to endure.
• If you are not the primary caretaker make your visits short, positive and upbeat.
• Keeping in touch with friends and other family members enables you to get the morale and emotional support needed.
• Make time for yourself. Build in the coverage you need so that you can take breaks when needed to rejuvenate and care for your own physical and psychological needs. Lose the guilt.  The timeout will make you a more effective and loving caretaker.

When have you had to be a caretaker? What psychological impact did the role have on you?

Getting a difficult medical diagnosis is challenging at best. Elizabeth Kubler Ross wrote extensively about the five stages of grief that accompanies the experience of loss. Although her work originally described the reaction to the death of a loved one, the same cycle applies to those experiencing health issues requiring surgical intervention.

Elizabeth Kubler Ross’s Five Stages of Grief:

• Denial: “This can’t be happening to me.”
• Anger: “Why is this happening? Who is to blame?”
• Bargaining: “Please God make this not happen and in return I will ____.”
• Depression: “I’m too sad or down to do anything.”
• Acceptance: “I’m at peace with what happened.”

This is a simplistic model of what any of us experience when we are struck with a tough reality that we need to integrate into our consciousness. The process of getting a difficult diagnosis or dealing with any loss issue is considerably messier and less predictable than the one Kubler Ross describes. Nevertheless all of these five stages appear eventually on the horizon of one’s experience.

Learning about a difficult medical diagnosis can be challenging, but like most things, being prepared makes the process a lot less daunting.

How to prepare for surgery and manage post-operatively:

• Keep a positive attitude. People who are facing surgery undoubtedly experience fear, worry and anxiety. Keeping a positive attitude can help lessen those emotions. Write a few affirmations pertaining to your surgery and repeat them often. Focus on a positive outcome. When your mind wanders away from a positive outcome, give it a gentle nudge back. Peggy Huddleston illuminates mind-body techniques that help patients mentally prepare for surgery and in turn, heal faster.

• Use meditation as an effective tool to mentally prepare for surgery and to handle difficult situations after surgery. When meditating focus your thoughts on breathing, calmness, and healing.

• Talk about your fears and apprehension with a relative or friend. Verbalizing your feelings can make a profound difference on your inner experience, even when nothing changes externally. A partner or friend you can talk with openly and honestly will diminish the intensity of complicated feelings around a surgery.

• Rely on your faith. If you are religious put your trust in God and leave the surgery in His/Her hands. Ask family members and friends to pray for you during the surgery and afterwards for a full and speedy recovery. Even if they do not share your religious beliefs you can still derive benefits from other’s prayers. Have faith in the surgeon’s ability as well as your body’s ability to heal.

• Consult with your physician regarding any concerns you have about your health condition or the surgery. He/she can answer any questions you may have and help to alleviate your fears. Your physician will understand your feelings and will be happy to reassure you in any way possible.

• Surround yourself with loving, supportive people. You may feel like keeping your upcoming surgery to yourself but it may actually be best to share the information with friends and co-workers. If they are aware of your health condition and surgery they will no doubt support, encourage you, and offer their assistance to help you and/or your family. Knowing that you have people who love and care for you can be the best preparation.

• Get informed. Learn everything you can about your health condition and the surgical procedure. Being informed is being prepared.

• Talk to other people that you trust who have had the same surgery. Glean from those conversations kernels of information that might be of value to you while keeping in mind that no two people experience a surgery in the same way.

What strategies do you employ to get through periods of grief and anxiety?

Given the recent revelations about the Sandra Bullock and Jesse James scandal and the less recent revelations about Tiger Woods, it is impossible to escape the age-old topic of infidelity.

Sandra Bullock is known as America’s sweetheart. Her story broke on the heals of winning the coveted best actress Oscar award for her performance in The Blind Side. Her glorious win morphed into suffering and grief when the allegations of Jesse’s multiple affairs became known.

Tiger Woods and his wife, Elin

The widely reported stories have stirred compassion and empathy for Sandra Bullock and Elin Noregren Woods while piquing the attention and disgust of ordinary Americans.

Most of us think of Hollywood as the epicenter when it comes to infidelity and compromised values. The truth is however that this behavior happens in our own communities, perhaps even in our own homes, yet on a much quieter scale.

What are some clues that your partner may be having an affair?

Noticing changes of behavior like these can be tip offs that your partner is having or thinking of having an affair:

• renewed interest in sexual activity and experimentation
• extreme secretiveness and defensiveness
• sudden attention to appearance and preening, loss of weight
• intense need for self-gratification

This is a good time to have a serious dialogue with your partner, if that has not already begun. Therapy is a valuable way of intervening.

How to move forward in the face of infidelity?

Infidelity constitutes a breach of the agreed upon rules of an intimate relationship. It undermines the integrity and trust in a relationship. Usually infidelity involves deception about physical intimacy outside of the relationship, but emotional intimacy can also be implicated as a form of betrayal or cheating.

The question that comes up is ‘can the betrayal of infidelity be overcome?’ It doesn’t really make a difference if you are an Oscar winning actress, the wife of the world’s best golfer or the wife of anybody, for that matter. In my experience the suffering felt as a result of a spouse’s betrayal is one of the most emotionally painful experiences a person can endure. Worse yet is when a partner wishes to continue the extramarital affair.

While a partner may eventually be able to forgive this breach in trust, the memory of the betrayal is never forgotten.

The path to reconciliation

The path to reconciliation begins with an authentic apology and display of true remorse. There needs to be a willingness on both sides to work at repairing the damage incurred and at the ongoing communication within the marriage.

It is also important for both partners to examine their own behavior because it is too simplistic to lay all the blame on the one who cheated. There is a dynamic in a marriage or partnership that involves the actions of two people. Both players need to take ownership of their behavior.

That said, there is the stark reality that regardless of what was going on within the relationship, one person chose to step outside of the boundaries and break the trust.

For many there is no going back after the rupture caused by infidelity. There are also many other couple who choose to work through the pain and rebuild their relationships. They examine the experience of infidelity and use it as an opportunity to self-reflect, grow and change behaviors.

The ultimate decision to end the marriage or to go deeper and work on the relationship is an exquisitely personal decision. Therapy, insight and introspection help tremendously, but in the end your gut trumps all.

Sandra Bullock and Elin Noregren are dealing with serial adulterers, men who are “addicted to sex” and cheating. Seems to me that the odds are wildly against their marriages working out, as their men are claiming to have no control over their own behavior. It is tough to change or manage a behavior when you feel powerless over that behavior.

What are your thoughts about whether a marriage can work after infidelity.

Everyone is talking about the disaster on Tuesday night that struck the capital of Haiti and the surrounding areas where approximately two million people live. The 7.0 magnitude earthquake essentially destroyed the capital. The death toll may reach tens of thousands of residents and those visiting the island nation. One geophysicist said the earthquake’s power rivaled that of several nuclear bombs.

Correspondents in Port Au Prince and its suburbs reported whole blocks of collapsed buildings, with bodies lining the road as Haiti awaits assistance. People are disoriented and desperately seeking medical attention, water, food, shelter and electricity.

This kind of tragedy evokes powerful emotions and a collective sense of loss, pain, and suffering. No one escapes the ripple effect produced by exposure to this massive destruction. “The reports and images that we’ve seen of collapsed hospitals, crumbled homes and men and women carrying their injured neighbors through the streets are truly heart-wrenching,” President Obama said.

Earthquake devastation in Haiti

When we are faced with tragedy of this proportion and are unable to attend directly to the fears and cries of others, we experience a collective sense of helplessness. This helplessness can be expressed by our own feelings of anxiety, depression, withdrawal, shock, confusion or fear. Staying focused on problem solving or doing something, however small, is key to dealing with traumatic events, even when they don’t feel like our personal traumatic events. The immediacy of the media brings home the message to all of us: we are in this world together.

Talking about the earthquake with family and friends is also important.  It helps us to process the range of emotions we feel.

Taking action is the antidote to going numb and disconnecting from these events. There are many opportunities to help the victims of this disaster in Haiti. According to former president Clinton the most valuable way to help is by sending money. Every dollar makes a difference. Here is a link to some of the organizations that are involved in the relief efforts for Haiti; Impact Your World: How you can help.

What did you feel when you heard about the devastation in Haiti?

Last night I went to yet another shiva. In the Jewish tradition we practice the ritual of shiva when somebody dies. Family, neighbors and members of the community visit the person in mourning – in this case it was a close friend whose father died. We sit together, say prayers, share memories about the lost beloved and eat. We eat to remind us that there is still sweetness and pleasure to be derived for the living. Invariably the shiva turns to reflection, conversation, and sometimes laughter. The energy shifts to one of connection and love. Community is at the core of sitting shiva.

My friends and I have entered a new phase of life. We are a group of friends that evolved over the years from the countless carpools, school committees, fundraisers, sports activities, and back-to-school nights that we shared in raising our children. Most of us also shared the passages of our children as they went through religious rituals. Together we celebrate the happy occasions and blessings in our lives, help each other through difficult transitions and we mourn our losses together.

Now, we are smack in the middle of “the sandwich generation.” Our children are going off to college and launching into their own adulthoods while our aging parents are grappling with illness and death. It is a time of loss. Moreover it is a time when it behooves each of us to enjoy every sweet moment possible. The cycle of life has never been more apparent.

The last six months I have mourned the deaths of seven elders, two from my own family and the others from families of dear friends. Not only do we mourn the loss of our parents and elders but also the link with the earlier parts of our lives. We become more keenly aware of our own mortality, for we know as they die we move closer to the front lines.

We come together during this time of mourning, because it softens our pain and experience of bereavement in untold ways. It gives us strength and solace. We join in honoring a life well lived and appreciate our close friendships all the more. Loss is a guarantee as we move through life. The question is how do we navigate this extraordinarily difficult time with compassion and courage, without losing our balance?

How do you move through your own losses?

My mother asked me to come with my young family from our home in Boston to New York City to visit her and my father for Labor Day weekend. It had been a couple of months since we last saw each other. We exchanged words and I told her I was simply too busy to come for the weekend and we would have to arrange another time. I knew she was not happy. I also knew she did not understand how difficult it was to juggle two children and a busy professional life.

The following morning I received a phone call from my brother-in-law that my mother died. She was seventy-one years old and the picture of health and vitality. As I write this eleven years later, I can still feel the sense of shock and grief at her premature death. I feel her loss every day of my life, especially when there are life passages. I long to tell her about my daughter and my son and the way they are growing and flourishing. I long to tell her “I’m sorry” for not agreeing to come home that weekend. The irony is, of course, that I was home that weekend, but to mourn her death.

After the Shiva period, I stayed in bed for two weeks. I could not bring myself to see patients, to parent, to eat, to do anything except cry. I did not return any phone calls during that time and did not want to see or connect with any of my friends.

My husband indulged me in my mourning, until one day he came into our bedroom and said, “Randy, you need to wash your face. Pay attention to your children and get back in the office.” I could barely speak. I was not ready. Martin told me to just put one foot in front of the other and get started. “Start small Randy. You can do this.” He reminded me of myself as he said those words.

When my children came home from school that day, I had snacks waiting for them on the kitchen table and then a lasagna dinner for later. The mechanics of preparing food, the smells in the kitchen and the act of creating something nourishing for my family felt healing and grounding. It took me out of my grief and back into life for a brief span of time.

I scheduled two patients for the next day. I remember that sitting with them and connecting over their own suffering took me away from my own. Little by little I started to come back. I came back first to my family. My children and husband felt so precious to me. I knew in my heart they trumped all. It took about a month or so before I was back to my regular schedule in the office. Then finally I was able to let my friends in, when things did not feel so utterly raw.

Only then did I begin to feel the fullness of my life again. I felt grateful for all that I had, even in the face of the traumatic loss of my mother. I also forgave myself for not making our last conversation a sweet one. (Check out the posts on forgiveness for more information around steps for internalizing forgiveness.)

What comes to mind when you think of the loss of someone you loved deeply?