One month ago, a 7.0 earthquake hit the country of Haiti. In the weeks that followed, horrific images captured bodies of people of all ages being discovered in grotesque positions; survivors being pulled out from under rubble, barely alive—after several days and sometimes weeks without food and water; and hundreds of thousands of citizens weeping and wailing at the realization that their relative or friend would never be seen again.   

Around the world, people safely watched the events unfold on their television or computer monitors, shaking their heads in disbelief and thanking God or whatever their higher power might be that they are not the ones to have to deal with such tragedy. And no matter how it comes about—expectantly or unexpectedly, publicly or quietly—the grieving process does not stop with the benediction given at graveside services.

And the grief process is compounded when death happens near the holidays, birthdays, anniversaries or other special days like the Valentine’s Day. Yet, the reality is, death is death. Watching starcrossed lovers exchange gifts, candy and cards can cause feelings of loneliness and all that it encompasses to rise to the surface, even when they have been thought to be sufficiently suppressed.

According to J. William Worden of the Rosemead School of Psychology, there are four tasks in mourning: 1. accept reality of loss 2. experience and bear the pain or grief 3. adjust to a world in which the dead person is missing and 4). withdraw and reinvest emotional energy.

Most people try to avoid grief altogether, which is why major decisions made during this time often turn out to not be beneficial. People often quickly seek a surrogate for their deceased loved one by re-marrying right away to replace a deceased spouse, adopting a child to replace the lost one that died, or even buying expensive pets or toys to take their mind off of the death for even a little while.

When well-meaning friends and family members tell a survivor to “get on with their life,” they are generally expressing the need to make adjustments. Daily life changes. Either things that used to include the deceased person are no longer enjoyable without him or her, or many of the functions the deceased had responsibility for are taken over by someone else.

Although losing someone “without notice” is difficult enough, the process can be severely painful when the one who dies has lingered for days, weeks, months or even years at death’s door. And as hard as it can be to care for a dying loved one at home, putting Mama in a facility of any type often has its own challenges. The biggest stem from the way different cultures make end-of-life decisions and prepare for the inevitable.

Authors Kerstin Gerst and Jeffrey A. Burr of the University of Massachusetts, Boston, in the report “Black-White Differences in the Completion of Advance Directives,” examined the likelihood of completing written advance directives for end-of-life health care and engaging in informal verbal communication about advanced wishes. They concluded that Whites were more likely than Blacks to grant durable power of attorney for health care, to complete a written will, and to informally communicate their wishes. Also, Blacks were less likely than Whites to engage in more than one form of end-of-life planning. The authors speculate that sociocultural differences in trust in the medical system and knowledge about advance directives may partially account for these findings.

Mistrust might be an understatement. One might think facing racism would be the last thing someone would face at the end of their journey, however Paul C. Rosenblatt, writes in “Racism and Black-White Relationships in End-of-Life Care in the United States: A Speculative Analysis,” states that despite the almost sacred nature of end-of-life care in hospitals, hospice programs, and nursing homes, there is every reason to think that racism and the racial system are often present in Black-White relationships in end-of-life care in the United States.

Marilyn Hardy Bougere, MSN, RN, CNS states, “As the racial, ethnic and cultural diversity of the U.S. population continues to increase, there is an ever-growing need for the health care profession to become culturally competent in all aspects of care delivery--and this includes the care we provide to grieving patients and their families.” She continues, “research has made it clear that cultural traditions, beliefs and values do make a difference in how people outwardly express their grief and how they try to cope with it. To provide culturally sensitive care, health care professionals must possess an understanding of cultural practices and how they impact the overall grief experience of the patient.”

That message is not lost on Keath Savage, a medical professional with Evercare, part of the UnitedHealth Group family of businesses. Evercare provides hospice and palliative care services in 11 states. The Medicare-certified organization’s services are covered by Medicare, Medicaid, military health plans and most private insurance. Savage, RN,  says the most important thing, which cuts across all cultural lines, is to remember to have balance.

“People need to make sure they take care of themselves. Sometimes, people think certain things are expected of them and they feel guilty if they don’t have those emotions come forth. For example, when someone lives with someone and they die, everyone expects them to be strickened with grief so they can’t function. Sometimes it’s such a release, a freeing if you will, because the loved one ... is no longer suffering. Especially if they have a strong based faith, they can look at death and know that the person is in a better place, whatever belief system they may have.”

To the survivors she says, “Get enough rest, plan your days. You don’t have to do everything that’s expected of you, so choose what you want to do. Make sure that you eat right ... that you exercise. Try not to be alone all the time and think nobody knows how you feel. Nobody will know exactly how you feel because nobody is you, but you. Other people have gone through similar experiences and there are a lot of support groups … setup to provide different types of services. Sometimes it’s for children. Don’t think that because they are kids ... they are young, death doesn’t have a profound effect. Go see a local counselor or your local church. There are groups all over the place. You can go on the web now. It’s just amazing the number of support groups you can find. They may be right around the corner from you and you never knew they existed. Sometimes they have online chat rooms that are helpful.”

Keath also said that people often think that they are keeping their loved one’s memory alive by keeping their things around or that they are paying tribute to them by keeping the schedule they had with that person. “You have to start building your own life. You can still honor your loved one. Be guilt free by not accepting anyone’s else way of dealing with things. Don’t rely on anyone else to deal with it the way you do. There’s unhealthy ways of coping, but there is no wrong way. Just talking to someone is very important.”