Grief is Complicated

“I will not say: do not weep; for not all tears are an evil.” – J.R.R. Tolkien, The Return of the King

I first want to say that this is not a cry for help, nor is it me saying that those around me have failed me. It has been weighing on my mind as something that needs to be discussed because those facing grief, and the complicated emotions surrounding it, need to know that it’s valid. Everyone experiences grief and loss differently, and the range of emotions can be different – and it’s all valid, but it’s important to seek support. For those reading this because you know someone who has lost a baby: reach out, acknowledge them, listen, say their baby’s name. And not just once or a few times initially; continue to reach out and support them in any way they indicate is helpful because they are in it for a lifetime. Second, I want to be clear that this is my experience and my thoughts on deciding things for myself, but to each their own – I mean no negative judgement. I spent over four years in the mental health field, and I know that there is stigma around depression and anxiety, as well as stigma around pregnancy loss. We shouldn’t have to suffer in silence for any of these things, and certainly not when they combine.

I was holding Ava while tears streamed down my face when my OB came in to speak with us. Honestly, I don’t remember much of what he said other than he thought from my labs that I might have an infection brewing from labor so I would have to stay for observation, and he wanted me to schedule a follow up with him. I told him I had scheduled an appointment to transfer to him which happened to be next week and he told me to keep it.

Sitting in his office less than a week after holding my Ava for the first and last time, he asked me how I was doing. I didn’t know what to say, so I shrugged and said something along the lines of “fine.” In a dense fog and fighting back tears, only knowing that I had yet to collect my daughter’s ashes, how could I possibly know how I was doing? I knew I was deeply sad, mourning, grieving for my daughter, but were my feelings, thoughts, and actions in line with “normal” reactions? What is normal anyway? Nothing. Nothing is normal. If there was a normal before, there wasn’t a normal anymore. My OB turned to my husband, surely struggling himself, and asked if he thought I was doing fine. My OB told me he could prescribe meds if I thought that would be helpful. At the time, I said no because I was still in the state of mind that I deserved to feel awful. I was struggling, but shouldn’t I be? He offered support groups and counseling information, but I also refused those because I wasn’t ready to speak to strangers about my feelings. I didn’t want to hear their sad stories about their dead babies. I couldn’t take on anyone else’s pain while I was dealing with my own.

I came in for another check up with my OB five weeks later and again he asked how I was doing. This time, the fog had lifted some, and I was able to say with some truth that I was doing “better.” After all, I was no longer crying multiple times a day, so that had to mean I was doing better, right? He again asked if I felt like I needed medication and I said no. This time, it wasn’t because I was trying to punish myself. I only said no because I knew the meds I wanted couldn’t be continued in pregnancy, so starting just to stop them didn’t make sense for me.

So, here it is – the point of this post. Grief is complicated. You can have grief by itself which obviously includes sadness. You can have depression by itself. You can have both. You can even throw anxiety into the mix: depression and anxiety, grief and anxiety – or all three in a big messy tangle. I would be lying if I said I didn’t think about death a lot in that first month or so. Death… how many ways death can come and steal happiness. How many ways there are to die, but all seemed too messy and, alas, would only lead to more people feeling how I felt right then and that’s not fair, is it? I’ve faced depression and suicidal thoughts before, albeit years and years ago, but it wasn’t new. I’ve struggled with anxiety basically every day of my existence, so that wasn’t new, either.

What has been weighing on my mind lately is that how dealing with depression can be so different and complicated when dealing with grief. I was a children’s mental health case manager for years, working with children who struggled with various disorders. I’m not able to clinically diagnose, but it was my job to teach coping skills, practice those coping skills, and figure out ways these children can be successful in daily living tasks that may be affected. For example, with a child who has ADHD, I would spend time with them creating a step-by-step list for cleaning their room: 1. Pick up dirty clothes from the floor and place in the hamper. 2. Collect any dirty dishes in the room and take to the kitchen. You get the point. For clients struggling with depression, we spent a lot of time doing activities that highlighted positives and the future.

When I was discharged from the hospital following Ava’s stillbirth, I was given a screener questionnaire with questions I was supposed to rate from “Never” to “Always.” “In the last 7 days, I felt happy more than anything.” Big fat tear drops sprang from my eyes. “I look forward to the future.” I began to sob. “I blame myself for things unnecessarily.” My husband had to come sit next to me while a nurse told me to take my time. This questionnaire was standard for screening for depression – I had seen these questions being asked countless times during my tenure as a case manager. Yet, in my situation, even with the in-depth understanding of why I was being screened and how, it didn’t feel right. I was grieving the loss of my baby, my future. How could I have been happy in the last week when I spent that week waiting for my baby to die, then giving birth to my first child who was already dead? My baby died inside of me. How could I not blame myself? I’m certain I answered those questions accurately, yet no one stopped me from walking out of the hospital. No additional support was given or even offered as a result of the screener which without a doubt indicated I was at least at risk of being suicidal. So, what was the point?

I know the signs. I kept myself from going over the edge because I knew the signs and treated myself like one of my clients. I created a treatment plan for myself. I needed to “feel better” – whatever that meant – so action steps I put in place included Omega-3 supplement daily, exercise, and writing to Ava in a journal. But a few key pieces of how I would have treated a client, how I dug my way out from depression before, included looking for positives and focusing on the future. Those were impossible and, honestly, still can be. What positives can there be in baby loss? In life after baby loss? Thinking about the future – that only leads to thinking about how Ava isn’t going to be in my future. The future I had spent 6 months daydreaming about was ripped from me, and I had no interest in daydreaming up a future without Ava. I will go forward with time because I must. Now I can see that the future may not be what I wanted, but I can hope for a future with Ava’s sibling, my rainbow, earthside.

All of this to say, grief is complicated. But, sometimes, it isn’t just grief and getting help is important. I know how hard it is to speak up, reach out, and do what you have to in order to survive. If you feel like your grief is complicated, speak with your doctor or seek out a therapist – and don’t feel like you have to wait for a year or any certain amount of time. It’s widely recognized that loss can trigger depression and anxiety to coexist with grief, and not just after a given time frame of mourning. Please, please know that you are loved. It’s not your fault. You don’t deserve to suffer in silence.

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