The Dying Therapist— An Interview with Lisa Greig
Interview with Lisa Greig. How do you help a friend through the death of a loved one? How do you avoid being put on a ventilator at a long term care facility while you’re still young? How do you respect your Grandma’s end of life wishes?
Lisa Greig opens her TEDx talk by saying, “I’m dying, but then again so are you.” She is a social worker who believes focusing on having a happy death will result in a fulfilling life. In this interview she shares insights from working in trauma centers and with bereavement clients. She answers the questions: How do you help a friend who’s loved one has just died— and what shouldn’t you do? What will help when you lose someone? How do you prepare for a tragic accident? How do you talk to an aging grandparent or parent about their end of life wishes? And so much more. Enjoy this edited interview with Lisa Greig.
HS: In your talk, you mention that your family is very open about death, which is amazing. When did you realize that death was more than something your family talked about, but a subject you actually wanted to focus on?
LG: It wasn’t until I was in my undergrad. I played on my university basketball team which is what drew me towards the university that I chose. I actually started off as business, which I did a year of and I quickly went, “Whoa, this is not for me.” There was no passion for me. It was a great program, just not for me. So I thought about what I wanted to do, and social work really stood out. I wasn’t drawn to social work just for helping and caregiving, which is why a lot of social workers are drawn to the profession. For me, it because I love puzzles and patterns, and I think that’s what humans are. To help put those together, to figure them out in detail, and deconstruct issues — these were the things I loved about being a social worker. In that moment I was thinking, “If I do social work, what am I going to do with it?” It was a very practical, logical side of my brain. I can’t just be a social worker and not know what I’m going to use it for. It was that moment when I realized it was grief, bereavement, end of life. That’s what captured my curiosity more than anything.
HS: Do you feel like you want to help people explore death because it’s something that you also need to explore?
LG: There’s definitely what I would call the rabbit hole of mortality. Even though I’m death-obsessed and I’ve embraced it, there’s still an unknown piece of death. I never want to shy away from that. I don’t ever want people to be like, “Oh, don’t worry about it, it’s not scary at all.” No, it is. I want to validate that, because there’s nothing worse than someone being like, “This is my experience,” and then being silenced, right? So more than anything, acknowledge it. Then talk about the whole other side to it. Which is life. I think the barrier we have to get through is realizing that we’re all on a timeline, but we don’t know what our timeline is. So let’s acknowledge it, let’s not pretend like it’s not there. Then we can just set it off to the side a little bit, so we can focus on what we want to do with our time here. That’s more of my driving force than anything.
Death can be a rabbit hole that you go down. You don’t ever get answers. Talking about your death doesn’t mean that you’re going to come to this be-all, end-all conclusion. That doesn’t invalidate people with their own cultural, religious and spiritual values. Depending on what your religious belief is, some people do have an end game to death. I think it still has uncertainties — people don’t know what it looks like to get there. For me, of course there is fear of the unknown, but there is also the choice to not get hung-up on fear. This’ll be the type A in me, how do I get control of it? And so you talk about it, right? I think it’s the simple things like, here are my advance care directives or let’s talk about end of life planning. What do I want for myself? Is it cremation? Is it a burial? I think that just by taking some control back, I think there’s comfort in that.
HS: I play with this balance a lot because I also find a need to take control, but it also seems like death is the ultimate loss of control. How do you reconcile those two things? Or do you just accept it and move on?
LG: I think it’s accepting, to be honest. Life throws at you two choices: fear or love. Right? If we allow ourselves to constantly live in fear, then suddenly, we’d just become paralyzed by our mortality. And I hope that’s the choice to live in love is what I can help people with more than anything. That reconciliation that it is true, I really am out of control, but I can choose to live a healthy lifestyle. I can take care of myself, my whole self. Not just my physical self, but my mental and emotional self as well. I take that holistic approach, which I think is so healthy. Those cases still turn up every day though — the forty-year-old mother diagnosed with breast cancer, or the fifty-two-year-old non-smoker who’s never been healthier and has lung cancer. That’s horrible, and shows we don’t have control. But do we always want to live in fear, and my answer is always no.
HS: Agreed. Are you regularly working with people who’ve had a loved one die?
LG: More often than not. I have a lot of different practices, but a large portion of the people I work with are grieving individuals. And that’s where my passion is, whether it’s anticipatory grief or people in the throws of grief.
HS: A lot of people in my life have had really close loved ones die. As someone who’s not a counselor, how should we show support for the living people who’ve lost someone?
LG: I think the best thing that we can do as humans is listen and offer empathy. Empathy isn’t trying to make things better. I think we project our own discomfort with death. You see this in comments like, “At least you still had good times with them,” or, “They’re in a better place now.” That’s not listening, because they’re grieving that loss. I think the best thing we can do is validate, “I’m so sorry, this must be so hard.”
Something I’ve heard from grievers too, is that our human instinct is to say, “Let us know if there’s anything we can do for you.” That’s so kind, but I’m yet to meet someone in the throws of grief who can say what they need done for them. Sometimes the best thing is just, “I would like to bring you a meal. Can I do that any time, or is there a day that’s better for you?” Or, “We’ve arranged for this for you.” Or, “Here’s a gift card for a restaurant that does delivery, or you can go out because you need a break.” Or, “You probably haven’t gone to Walmart to get your toilet paper. Let me go and pick up some things for you.”
Those are prime examples of things that can go a long way for people who like tangible things, who want to know, “How exactly can I help?” But I think the simplest and easiest thing we can do is just listen, and hold space. Just sit with these people so they get to go outwards with their grief. If you can hold space for them and just be with them them, that’s one of the greatest gifts you can give.
HS: On the other side, are there any major NO-NOs that you shouldn’t do when your friend has lost someone?
LG: I think, “I know exactly how you feel.” That one is a huge red flag for people. I’ve heard that over and over. If I tell one person, “I know exactly what that’s like.” They’ll respond, “No, no you don’t, because you didn’t lose this person,” or “your relationship to them is different.”
It’s downplaying their emotions. People with depression share the sentiment, people ask, “When are you going to get over it? Can’t you just get over it? Are you still grieving? When are you going to be yourself again?” Those shaming comments strike right to the heart of people who are grieving. We live in a world where I hope that everyone is doing the best that they can. Grief isn’t fun to be in, it’s like a dark cloud. Everyday is hard. I tell people I work with, “You’re redefining your new normal.”
Death changes us. The new version of us isn’t good or bad, it’s just different. It’s a growth and transformation, and some people aren’t comfortable with that process. There are also the secondary losses that we experience after we’ve gone through death. Sometimes their friend groups change — some of their relationships will get stronger, and some of them will completely dissipate. And that’s normal.
HS: It’s got to be pretty shocking though.
LG: Oh, it is. It absolutely is. And I think that’s when people say, “I just don’t feel like myself.” Because part of them is not themselves anymore. And it’s ok, but it’s another loss for them to grieve when they’re already grieving one.
HS: What major lessens have you learned from working with people who are in bereavement?
LG: They all sound so cliché, but they’re so true. Life is short. Even for people who lose a partner after sixty years of being married. They’ve had sixty years together, but life can change in a complete instant. That’s true, and it’s true over and over and over. Relationships are so important. I know that grieving is a consequence of strong relationships, or can be, but at the same time they’re what get you through it. And if you’ve read those five quotes by that hospice worker — they’re bang on.
The people who move through their grief quickly are strongly rooted in themselves and their relationships. They have fewer regrets, and are actually living a life they choose for themselves. The same goes for the people who get the palliative diagnosis or the terminal diagnosis — they’re in the doctor’s office given x-amount of time to live. If they reflect on their lives and think, “No, I’ve done what I wanted to do.” It will still be hard and painful and difficult, but there will be some closure too.
Back to those five quotes by that hospice worker — time and time again when I’m sitting with people in their grief, those show me whether they’re on a healing path or whether they’ve got some hurdles to get through. How many woulda-coulda-shouldas are they left with?
HS: Just seeing those quotes makes me want to get that information in front of everybody, so many people don’t have it on their radar at all.
LG: I haven’t found the magic equation that helps people identify with them, because some people read them and they don’t resonate as much, you know? I think anyone who’s experienced any kind of loss (and loss doesn’t have to be death, loss can be in marriages or friendships) are more likely to connect with the quotes. Some of them can be like, “Yep, I need to make those changes now.” People who’ve experienced an accident, or maybe an temporary illness, will feel like they’ve got a wakeup call.
HS: You also mentioned that you had a really close friend and mentor, I think it was your basketball coach, who died.
HS: How did you navigate that grief?
LG: I went and saw her probably nine months before she would have died, and I had a wonderful visit with her. There was still a lot of hope at that time. I’m glad that I didn’t know that was the last time I’d see her, but a part of me treated it like it was. So there wasn’t like this moment of, “We’re saying everything we need to say,” but there was that gift of being present. Talking and laughing and having such a wonderful time. The phone call that I had with her, we just talked for an hour. I knew that would be the last time I talked with her. Again, I didn’t tell myself, “I’m saying goodbye forever,” even though I knew that — I knew that’s where the raw emotion was. It was having that time with her that was invaluable. I think that that navigated my grief more than anything. And knowing, after she had died, that I was going to go to her funeral. I wanted to be around the people who loved her most. I knew for me that is what was needed and that what would be healing. There was a personal family funeral that we attended and we also held a celebration of her life. Just being there and doing those things and being around my closest teammates — it’s just so powerful to talk about it.
She was a coach, so let’s not kid ourselves, not everybody had a great relationship with her. There was competitiveness. People were benched who didn’t feel that they should have been. But just to share and laugh and cry, that was the most healing thing for me. Once I left the funeral, I had to leave that piece of me behind. She was a huge reason I went back to Toronto once or twice a year. When I go back now to see everyone, there’s a loss of what that city was to me. Celebrating her life is what helped us grieve, allowing ourselves to feel the sadness, but also the joy. The fun stories. She said ridiculous things. We always joked that she had no filter. She never did. We had a lot of those things to laugh over. There’s something about healing in a group that really works, and I think grief groups are powerful for that reason.
HS: What advice do you have for someone who has just lost someone?
LG: Talk to someone. Go see a counselor, even if it’s just one time. Just share your story. I think there’s something about sharing with those closest that isgood, but there’s also a protective instinct that prevents us from going as deep into our grief as we want to. We’re being delicate. We’re trying to protect others from their own grief by not sharing too much about ours. So go talk to someone, and when you’re ready, find a grief group in your community. I facilitate them. I see how powerful they are. It’s so nice to be sitting in a circle with someone who can say, “Me too,” and actually relate to you— where you don’t have to explain how you’re feeling, because people there just get it.
HS: People who can offer understanding are so powerful.
L: It’s so powerful. As much as our grief is very unique, there are so many commonalities. We know our experience, our feelings, and the struggle of our days, but when you get in a group of people and hear that other people are going through it too, you feel normal. It’s a powerful thing to have, not just our grief, but many aspects of ourselves normalized.
HS: Something I struggle with a lot as a death-focused individual, is this balance between being really curious about death, thinking it’s good to think about, but also not wanting to downplay the tragedy of death. How do you deal with that?
LG: The big thing is normalizing the fear. It’s about saying, “This is hard. This is scary, but it’s also this universal and we all feel it.” I’m not up here telling you that I’ve come to terms with it and everyone else should, because I haven’t come to terms with death either. I don’t know what it all means. What I do know is that talking about it in group forums, addressing the elephant in the room, does help. I think it’s essential that we validate the fear.
Sometimes, I think we downplay things too much in our culture. It’s like any diagnosis, right? For example, we can essentially live with diabetes now, type one or type two, but we don’t want people to say, “Oh yeah, but don’t worry. You can just take an insulin injection. It’s all good.” No, no, no. It’s still life changing. It’s still a huge inconvenience. It’s still painful. It still requires a lot of management. So let’s educate ourselves on it so we can be aware of the struggles. The struggle won’t go away, but we can acknowledge what’s going on. I tell all my clients, not just my grief clients, you’re allowed to throw yourself little pity parties, you just can’t stay in them. When we look at the state of the world right now, it is so easy to say, “I shouldn’t complain, there are so many people worse-off than me.” I say to my clients, “You’re right. There are so many people worse off than you, but there are so many people better off. We just need to talk about you, because that’s all that matters.” Let’s not downplay our own struggles, because somebody’s worse off than us.
I think gratitude gets us through everything.
It goes back to mortality and our own fear of death and dying. You’re right, it’s totally scary. But not talking about death and not thinking about it — how has that worked out? It hasn’t. We need a different approach.
HS: Oftentimes, people don’t want to acknowledge death, so I hesitate before talking to others about mortality. For example, my Oma has just turned 80… Well, first of all, I should probably ask my dad if he’s talked to her about advance healthcare directives. I’ve thought about talking to her, and it almost seems more intense now that she’s old, and in that time when we expect her to die, to bring up, “You’re going to die. How do you want me to deal with this?” Do you have any advice on that?
LG: I think we can only ever approach things from ourselves. A lot of people would say, “You’re 80, you need to talk about this.” But then Oma, or like my own grandma who just turned 80, says, “No, I don’t need to talk about this.” Especially with grandmothers (both of my grandfathers have died, and I never had any of these conversations so I can’t speak to what they would be like), they’re the matriarchs of families. They’re kind of like police officers who serve and protect. I think when a granddaughter or child goes to them and says, “I think about this because I want to do the right thing. I know that this is an awkward and hard conversation, but I want to have it. I want to know what you want because I don’t want to fight about this after. It’s going to be hard enough when you die, Oma, but I want us to able to get together and celebrate and cry and not be talking about flowers or details. I want us to all be on the same page, and this conversation is the only way we can get there.”
HS: What about family reactions? When you went and talked to your grandma, I know you said your family is super death-supportive…
LG: My dad is the eldest of three siblings. I talked to Dad after talking about this with Grandma and was like, “FYI, this is what we talked about, and this is the information I got.” He wasn’t surprised by any of it.
I was like, “You should have a conversation with your siblings about who’s going to have the conversation with her next because a conversation you had with your daughter in passing won’t stand up with relatives who are her health proxy. I will absolutely be there to say, “No, this is what grandma would want,” because I know, but I’m not her health proxy. So I’m passing information onto you three who have the joint power of attorney. This is a great opening for you guys to sit down and one of you to call up your mom up and say, “So I heard Lisa had a conversation with you.” She might just say, “Yep she’ll fill you in on it,” and there’s your cue.”
Sit down with your dad too and say this needs to happen. Record it, if you want. Say, “Oma, I don’t know if you know this or not, but I have a publication on death. I’ve done interviews on it, and I want to practice on you. I want to ask you these questions. Are you ok if I record them?” How amazing is that not even to have for your family but to have after.
HS: It’s funny because I have actually told her, at least in little bits, and she’s one of the only people who hasn’t immediately come back with, “That’s kind of morbid, are you sure you’re ok?” She was like, “That’s awesome. People need to know about this.”
LG: Then you have an easy candidate. I’m willing to wager that most eighty-year-olds are probably ok to talk about death because they’re 80. Because not only are they hyper-aware of their own mortality, they have also experienced so much loss at that point. Everybody around them has likely been dying. The other thing that I’ve learned is that it’s usually everybody else’s discomfort that gets in the way. I’ve always known that my grandma is superstitious, and so I think her fear is that by talking about it, it would happen. It hasn’t yet, so you know that’s good [laughs]. I think it was so healing and so healthy to talk with her.
HS: Yeah, it makes a lot of sense. Someone with more life experience has had to confront mortality more than I have at the beginning of my life. So, of course, I’m the one thinking, “Oh, it’s a touchy subject.”
HS: This is kind of funny to admit, but I haven’t done any of the practical stuff around death. That’s one of the things hospice training tells you to do. At any point in your life something can happen to you, so you should have your living will and your healthcare directives completed. Where do I go to do that?
LG: You know, there are so many places. There are websites that walk you through it — The Conversation Project, or Death over Dinner. Everywhere has different requirements about what you have to do to put your documents into effect. I know up here all that it needs is to be signed, dated and witnessed. But having a document, while very good, is useless without a conversation.
Having been a social worker with ICU, I’ve had so many families bringing me power of attorney documents that talk about some advance healthcare directives. They don’t realize that now I need them to explain it to me. I need a voice in there because this is all now interpretation. We don’t interpret this document. You do. We’re not gonna take this and say, “Oh, Mrs. Smith meant this.” We’re still coming to you to say, “What does she want for life-saving measures? What is her code status? When she says, “Do not resuscitate,” does that mean no antibiotics and chest compressions, what about intubation?” The looks on the families faces are like, “No, but we have this document for you.” And we’re like, “Uh huh, but there’s no voice.” That’s one thing I tell people, do the documents, but then you gotta talk about them. Because if you have the conversation you can say, “We did talk about it. No she wouldn’t want this.”
A great place to start with friends and family is, “Right now in your life, what does quality of life mean to you?” For some people, living as a quadriplegic or paraplegic is great because there are so many advances now, it’s a no-brainer. But for some, that’s not ok. For some people, living on a ventilator in a long-term care facility at a young age is not ok with them. These are some of the options that it comes down to. The frustrating part is that there is a lot medical jargon. That’s why it helps to just kind of talk about what is quality of life, beyond just, “I don’t want to be a burden on my family.” That’s not fair because that’s putting it on your family. What does that mean? Are you ok as long as you can sit outside? Whether that’s you walking yourself or wheeling yourself. As long as your mental faculties are there, that’s ok with you? Beyond a certain age, there are statistics on how chest compressions can affect someone. A lot of good doctors will have those conversations: “What kind of life would she live? What would be important for her? What would she like to go back and do?” When you’ve talked about it, you can say, “I’ll never forget the time that she said this.” That provides a lot of insight.
HS: I’ve learned more and more the different types of DNR, just like you were saying, antibiotics, chest compressions, intubations — they are all different levels of invasive. We think of a DNR as a one stop shop even though it isn’t.
LG: And that’s our, no pun intended, but that’s also our fatal flaw. I’ve worked long-term care. I’ve seen the impact when our frail elderly receive chest compressions and also the impact on the paramedic who had to administer them. There’s trauma. Again, if that’s what the person wants, that’s ok. We have autonomy. We have the right to make that decision. I just want people to make an informed decision.
HS: Was there a moment when you realized your own mortality?
LG: Fortunately, I can honestly say, “No,” in the sense that I’ve never had any of those moments where I had my life flash before my eyes. When I worked as a social worker in the ICU and had a lot of young traumas come in was when I had that moment of, “I could actually put myself in their shoes. That could happen to me. That could happen to anyone.” You could be in a freak car accident, or fall off a horse, or another trauma. Those are a compilation of examples from working in that environment. Every day I was faced with my mortality. Working in a trauma center you see it’s just wrong-place-at-the-wrong-time for some people. You’re not safe from accidents unless you want to live in your house in a bubble. I don’t want to do that because that’s not living.
HS: Did you choose to work in the trauma center?
LG: Yes I did. I applied to work in the ER and ICU as a social worker.
HS: Were there any major lessons learned from being in that environment?
LG: Oh my gosh, so many. I wrote a paper for my masters when I was working there called “Patient Death, Professional Grief” and I did an interview with a bunch of my colleagues, and it was a qualitative research paper. Again and again what came up was how trauma work is a reminder of how life is so short and how quickly things can change. I learned how important it is to talk about it.
It’s so cliché, but do not take relationships for granted. It became harder and harder to hang up the phone or end things on a bad note. I made a conscious decision to never end things on a bad note because I didn’t want to ever have that be the last conversation I had. I hear that from so many people who said about the last conversation they had, “If I’d known, that’s not what would have been.” We’re in control. When we’re with people, we can be present with people. We need to say what we need to say. We can’t say “Oh, I’ll have that conversation later. I can say that another day.” We can’t miss that boat for love over fear. It’s about embracing love.
Also, self-care is so important, Hannah, it’s so important. Whether you’re talking to people, going out with friends, going on a run. I don’t care who you are, working in those environments affects you. I pride myself on doing a good job of not taking everything home with me, but there are some cases that I hold very near and dear to me. They have changed me. I know when I see certain families affected, or see loss that has happened, is when I need to self-care.
You have to respect privacy and protection — you never talk about specifics that identify people, but you need to talk, and you need to share. If you’re in a workplace where that’s absolutely a no-no, you need to get together with a group of colleagues.
If you’re in a profession that interacts with people, you get impacted. We’re humans, we can’t turn it off.
HS: How do you deal with HIPPA and confidentiality? Not only do you have it in the death environment (which I’ll have to deal with when I start doing hospice volunteer work) but as a therapist you, rightfully, can’t talk about any of your patients.
LG: We talk about how we feel. I don’t think that we need to say, “Patient N came in and presented these things, and this happened and the family came in.” We need to start doing a better job of being in touch with how we’re feeling. It’s about coming home and saying, “My whole world blew up today at work.” Or, “When I was sitting with my patient (or my client) today, they were talking about these things and I felt this. It made me think about my own life and this, this, and this are the reasons why.” We can share with people because it’s not the patient’s story specifically that impacts us, as much as how we feel.
If it’s something we’ve physically seen, then we need to go to our boss and say, “I need to talk about this, can you recommend the best way that I can?” In Canada we have a lot of places that will place you in programs where you can talk with a counselor, but you can even talk with a colleague, as colleagues are all bound by the same code of ethics. I know a lot of hospice groups that have volunteer support groups for that reason. You’re not trading stories like, “You wouldn’t believe what Edna did today!” That’s not it at all. It’s like, “I had a really hard time today with my client.” There’s a way we can talk about things and not identify people — we have to be cognizant of that.
For me, I’m in a small city. I’m not going to go home to my partner and say, “A major trauma came in today and four people were killed and I had the one living person, etc. etc.” Because guess what, that’s all over the news. They’ll know exactly who that is. But if I say, “I had a pretty severe trauma today, and this is how it impacted me,” then I’m fine because I’m talking about myself.
HS: We’re at the end of our hour and I have a question that I’m asking everyone. Answer at whatever level of detail you’d like. What do you want your funeral to be like?
LG: I’m torn because I’m a brunch lover. Part of me wants it to be a big brunch — everyone wakes up, has mimosas and really great food, then it can go all day. I don’t want people to dread it all day. It’s not like a wedding where you wake up excited to get there. You wake up and it’s like, “I’ve got to get the egg salad sandwiches made. I’ve gotta get to the funeral.” So I think it will either be a brunch that continues all day long or a party in the evening. A big ol’ potluck. I love community, family, friends, and relationships, which is why I’d want it to be a potluck.
Photo by Ross Dance Photography. Lisa is a social worker based in Saskatoon, Saskatchewan, Canada. Besides her private practice she also facilitates Death Cafés and has just started a death themed book club, calledEnd of Life Book Club YXE. If, like me, you want to follow along with what the book club is reading but don’t live in Saskatoon, you can follow Lisa on Instagram where she posts the book selections. Make sure to checkout Lisa’s website and TEDx talk.