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The story of life … and lemons

We all know the phrase “when life throws you lemons, make lemonade”. But what if we don’t feel like making that lemonade?

What if all we want to do is take that bag of lemons and beat the living daylights out of “life”, or better still, take that bag and barter it for that one extra moment, that one unsaid word, that one unspoken conversation? That, dear readers, is all part of the cycle of life alongside our responses to the challenges, trials and losses it throws at us.

The concept of the “Grieving Process” was first penned in 1969 by an American psychiatrist, Dr Elisabeth Kulber-Ross, who based her book On Death and Dying on her work with terminally ill patients. Initially, only five stages were described, namely Denial, Anger, Bargaining, Depression and Acceptance, but this model has subsequently evolved into the following seven-step process:

1) Shock and denial

2) Pain and guilt

3) Anger and bargaining

4) Depression, reflection and loneliness

5) The upward turn

6) Reconstruction and working through

7) Acceptance and hope

Experts believe that not every stage has to be experienced or worked through and neither do these stages have to happen in this particular order, as long as the ultimate goal of acceptance and peace is achieved.

Loss and the grieving process can be experienced equally following the physical death of a loved one, as by the loss of their presence in one’s life. For example, after a divorce or a long-distance separation (which we all experienced in one way or another after the covid-related prolonged travel bans).

It can come on within minutes, days, weeks or even months following the loss and can last for years. The process is an individual journey and cannot be rushed or depreciated … what works for the goose may not necessarily work for the gander!

The initial shock will always create some form of a stressful situation, but if that stress-fuelled fight-or-flight response continues long-term, the subsequent over-exposure to cortisol and other stress-related hormones our bodies produce can unsettle just about every other normal physiological process in our body. This can result in an increased risk for:

➔ Anxiety and/or depression

➔ Muscle tension and chronic pains

➔ Headaches

➔ Digestive problems such as colics, cramps and recurrent diarrhoea

➔ Sleep problems

➔ Immune problems

➔ High blood pressure, heart disease, heart attacks and strokes

➔ Blood sugar imbalances and weight gain

➔ Memory and concentration impairments

This is why we will often experience emotional pain as an actual physical punch to the gut, or a constricting sensation in the chest with breathlessness and pain. It is not all a “just in your head” psychosomatic episode, it can be an actual physiological process with actual tangible symptoms.

The way we deal with stress can partly be attributed to our genetics, however, our overall life experiences, our previous traumas and how they were dealt with in the past will ultimately define our survival and coping mechanisms. Realising when to ask for and understanding when and how to offer help is key.

Therapy can come in the guise of long walks or daily exercise or caring for a new pet (hence the evolution of “therapy pets”), as much as it can through specific grief management or group counselling sessions.

For some, reaching out to a new or existing faith or spiritual entity is the answer, for others it is simply being able to pick up the phone and call an old or new friend. Either way, the object is to be able to listen with understanding, validating their pain without appearing patronising and a know-it-all, and offer productive help, such as doing specific errands or cooking meals etc.

Sometimes medical help needs to be sought, especially if the anxiety or depression is starting to seriously affect and interfere with the individual’s activities of daily living. In such cases, regular follow-up is essential to assess progress and to monitor for any adverse effects that medication may be having.

So, as many of you will already know, I have also experienced a recent loss, personal and professional. It will not be easy filling those “little big” shoes of my esteemed predecessor, but this article is one of the first steps … this is me taking over the Resident Prescription … this is me taking that bag of lemons and making lemonade.

Best health wishes,

By Dr Jo

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Dr Joanna Karamon is a General Practitioner with over 20 years’ experience. She is Clinical Director of Medilagos, part of the Luzdoc International Medical Services Network