The stress of loss
Losing a loved one is hard on everyone, and it seems we can never be ready for it. Over fifteen years ago mom passed away unexpectedly, and now my dad has gone after a four-year battle with Alzheimer’s. Although I thought I was adjusting to the idea, and in a way I was already grieving the loss of my father as I knew him before Alzheimer’s, it feels different than I thought it would.
It is just difficult any way you look at it. When people you love are gone, it leaves a vacuum where a warm loving soul once was in your daily life, and it hurts. With a deep ache beating in your chest, your heart sobs in silence. Pain is stressful, whether the cause is physical or emotional, and that stress has predictable influences on health. Stress can weaken us physically, weaken our immune system, or aggravate an auto-immune disease, such as lupus. Sustained stresses like grief, stretch out their load on the normal endocrine balance, that is already somewhat out of whack when a person has auto-immune disease.
The part of our body chemistry that produces a surge of helpful chemicals to sustain us during a fight-or-flight situation or crisis, becomes very strained during periods of prolonged, sustained stress. This crisis mode response can only continue for limited time, while glands pump out “emergency” help. After a while, a body’s chemical response to continued stress becomes weaker and weaker, and the person experiencing sustained stress has a seriously reduced ability to cope in the face of continued pressure. For someone with lupus, ongoing presence of stressful situations become the perfect environment for lupus to flare. So, it becomes especially important to communicate well with our doctors about the major life events we are experiencing and about how these stressors are impacting physical health.
The storms of life
Over the years, many helpful articles about employees going through life’s most stressful events have passed over my desk in human resource magazines and legal management journals. Usually they merit at least a few minutes of my attention, since employees routinely drop by my office, sit down with a sigh opposite me, and start to talk about the major events taking place in their personal lives. Sometimes, employees have multiple stressful events raining down on them at one time, and some face virtual storms of stress, and even rarely an occasional emotional or spiritual hurricane!
My heart goes out to these burdened co-workers, and I privately pray earnestly for them, because I know personally how hard it can be to cope when flood waters of stress wreak havoc and bring unexpected mayhem. It is no wonder these overwhelming events are commonly called “the storms of life.”
The different responses people show to these events get my attention, and often I’m motivated to start a conversation about what they are experiencing. Ever since reading an article years ago about how stress affects people physically, I have been especially focused on how it impacts employees, friends and others in my personal life when they go through unusually stressful circumstances. What I see most often is employees who struggle with either the severe illness or death of a family member, face surgery, are moving, their spouse has lost their job or they are having turmoil or difficulty between members of their household.
I too, have had my share of these stressful situations, and some of these have triggered past lupus flares and at times some lasting escalation of lupus severity.
Measuring the stress of life’s events
A couple of research psychiatrists, Thomas Holmes and Richard Rahe, studied over 5,000 people to understand better how stress affects health. They developed a time-honored list of the most common stressful life events that people routinely face, assigning a “stress score” to each type of stressful event. The total score falls into one of three basic ranges of impact. People with lupus or any other auto-immune disease may easily find that their stress score indicates a moderate or high likelihood of illness. The items on the list may seem obvious, but reviewing it was thought-provoking for me.
Striking up a conversation about the effects of stress on people who are going through rough times usually starts by mentioning that they are experiencing one or more of the major stressful life events on “the list:”
|Life Event||Stress Score|
|Death of a spouse||100|
|Death of a close family member||63|
|Personal injury or illness||53|
|Dismissal from work||47|
|Change in health of family member||44|
|Gain a new family member||39|
|Change in financial state||38|
|Death of a close friend||37|
|Change to different line of work||36|
|Change in frequency of arguments||35|
|Foreclosure of mortgage or loan||30|
|Change in responsibilities at work||29|
|Child leaving home||29|
|Trouble with in-laws||29|
|Outstanding personal achievement||28|
|Beginning or end school||26|
|Spouse starts or stops work||26|
|Change in living conditions||25|
|Revision of personal habits||24|
|Trouble with boss||23|
|Change in residence||20|
|Change in schools||20|
|Change in working hours or conditions||20|
|Change in church activities||19|
|Change in recreation||19|
|Change in social activities||18|
|Minor mortgage or loan||17|
|Change in sleeping habits||16|
|Change in eating habits||15|
|Change in number of family reunions||15|
|Minor violation of law||11|
|TOTAL EVENT RELATED STRESS SCORE:|
Add up the numbers of stressful events that apply to you in the past two years to get your own score: _____
How might the level of your life stress be likely to effect your health? If you are a lupus patient with active disease (53), high medical costs (38) and have lupus affecting your ability to keep up with recreation (19), your social life (18), and pain keeping you from sleeping well (15), you could easily have a score over 140. Add just one more event on the list, like moving (2) or getting pulled over for a traffic ticket (11) and you have a moderate risk of illness.
Score of 300+: At risk of illness.
Score of 150-299: Risk of illness is moderate (reduced by 30% from the above risk).
Score <150: Only have a slight risk of illness.
Read More about the Holmes and Rahe Stress Scale @ Wikipedia.
The speech about stress
As the manager of a government legal department, when an employee goes through these rough times, one of my roles is to approve sick leave, bereavement leave or vacation, or to encourage them to otherwise take care of themselves. After pointing out that they are going through one of life’s most stressful experiences, the advice is usually down-to-earth and pretty simple: 1) breathe, 2) drink, 3) sleep, 4) rest and relax.
Why? Breath deeply, because so often people seem to psychologically hold their breath during intense stress, and deep cleansing breaths help reduce the effects of stress. Drink plenty of water because it helps the brain function, supports the immune system and flushing out toxins from the body (usually I am the one who goes around offering glasses of water to everyone.) Get enough sleep and rest, because stress is exhausting and emotionally fatiguing, and lack of sleep just increases stress even more. If proper to my relationship with the person, I also suggest prayer, Bible reading and hymn singing in the times when sleep just doesn’t come, because finding spiritual rest through these alternative activities can help in the absence of sleep. Rest and relax, because they need to be reminded to give themselves some slack and to realize that what they are going through is a normal human response to stress, and to be expected.
Every new employee we hire gets a similar version of this speech as part of their orientation, along with explaining that almost every employee we have hired in the past 25 years (except one exceptional person who either listened especially well to my advice or was just an rare physical specimen) became sick within their first month on the job. Every employee gets the speech again as a friendly reminder, every time they go through something on the top half of the list, or any combination of things from anywhere on the list.
This type of stress seriously affected my health many years ago. Just one week after my mother died, my father and I both visited his doctor to treat our severe bronchitis. Grief and bronchitis do not go well together! During the year that followed, I was naturally still grieving deeply, and that normal process had its impacts on my body and my lupus. Within a few weeks after losing my mother, I was hospitalized with a ruptured abdominal artery, infected appendix and ruptured ovary (a very close call!) and within six more months my spine destabilized around an old trauma (and required neck braces and neuro rehab) while my lupus escalated to organ (CNS) involvement. Within just one year of mom’s death I had graduated from treatment with only plaquenil to requiring adding weekly methotrexate, daily high dose prednisone and Imuran (azathioprine). For ten more years, my medications never could be rolled back to the earlier levels, and eventually even those would no longer control my lupus.
Four resolves in grief
So, it is time to follow my advice. My hope is that as I now grieve my father’s death in the coming weeks and months, the advice repeatedly shared with others will ring in my own ears and hopefully may help me remember to grieve healthfully. These are my four resolves…
First, I will breathe! Taking long draughts of air, in and out, deep and full, inhaling, cleansing, body-calming breaths. I will take my asthma sprays on schedule, and listen for my body telling me when it is having trouble, and I will make a point to intentionally breathe.
Then, I will hydrate, hydrate, hydrate. Easy to say and harder to do. But now, there is no fluid better for me than the cleansing goodness of pure, refreshing water. I will carry it with me in the Arizona heat as I drive around, at home or work pour another glass often, and even set a timer if necessary to remember to drink water. Eight ounces every hour, would not be too much water!
Next, sleep is the hardest resolve to carry out right now, but I will keep working at getting the sleep I need. Since lupus robs me of so much sleep when I wake up in the middle of the night with pain, this takes some extra effort. Yet, I am promising myself to make the most of my opportunities to sleep. This means I need to replace my broken c-pap machine as soon as possible, since I fall asleep faster, rest better and wake up less often at night when I am using it. Using my c-pap for my sleep apnea helps reduce fatigue, and that’s a good idea, especially now.
Last, I know that prayer, Bible reading, singing hymns and playing them at the piano are forms of worship that can become a bridge to real rest. When I simply cannot sleep, I will turn to these until I get exhausted enough to fall back asleep, and in the process find a different kind of peace and rest.
When emotional or physical pain robs me of sleep, there is no place like the shelter of the Most High to calm and comfort my weary soul! In the shadow of His wings, I sing for joy! Even in my grief, even in the valley of the shadow of death, I will fear no evil, for thy rod and thy staff, they comfort me. These were some of the last words I read to my father from the Bible a few hours before he left us.
Now, they speak peace and health to my heart as I grieve and remember.