Thoughts, updates, and

    conversations on grief and end of life.

      Amy L. Billa, MA, LSW


Spiritual Pain and Unresolved Loss Impacts Our Vets in Life and Death

It was my honor to spend a recent Friday afternoon with veterans from all over the Buckeye State.  My colleague, Bruce Norman, PhD, (US Navy) and I presented about the spiritual pain associated with combat, Vietnam War, lost comrades, and PTSD.  After showing an excerpt of the film Soul Injury (D. Grassman, Opus Peace) Bruce and I presented information about how war experiences impact veterans' spirituality, their current experiences, and if left unresolved, will eventually affect their dying experiences.  

Some vets were quiet, a few were boisterous, some dressed conservatively, and some wore their favorite t-shirts and tattoos.  What all of these soldiers had in common, however, was their sense of brother/sisterhood as soldiers who deal with consequences of daily war memories.  Today, Vietnam Veterans fight for the rights of young soldiers and advocate for legislation on behalf of all veterans.  Their commitment to each other and our country is clear.  I am deeply grateful to live in a free country, aren't you?  When we tell a veteran "thank you for your service" you will be enriched if you allow that to be an invitation to conversation. 

See What People Are Saying

    "I would rather walk with a friend in the dark than walk alone in the light."  

- Helen Keller ​

To those who are called to vigil with the dying...

I have met some amazing servant leaders in my travels.  I had a heart connection with "K" the vigil volunteer, who picked me up from the airport in Washington and told me how she cared for her partner through terminal illness.  She explained that she was getting trained in vigiling as a way to 'give back' by serving the dying.  There was the executive of a healthcare system who leads by example, and is committed to enhancing spiritual awareness of his medical students and his staff who serve the dying.  And there is "J", a hospice and hospital volunteer for many years, who stated it took 60 years for her to finally find her calling.  "J" schedules vigils for those at risk of dying alone.  

I have had scores of other encounters, each one spurring me on in this work regarding loss and end of life.  There was the quiet gentleman, a widower, who came up to me after I spoke, and wanted to share a quote from Helen Keller: I would rather walk with a friend in the dark than walk alone in the light.   He, too, explained he feels called to sit with the dying.   The majority of people I talk with are enthralled that such people exist.  They are amazed and grateful to learn there are trained volunteers who feel called to serve at the deathbed of someone who is unresponsive and alone.  

Thank you to those who sit with the dying, expecting nothing in return: death doula volunteers who do not charge patients or families, vigil volunteers whose focus is serving the lonely and dying, and practitioners who understand the spiritual needs of the dying are as important as the medical needs.  Our world needs more servant leaders like you. 

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

Meaning Making

Whether found privately, or declared publicly, the process of discovering meaning from the death of a loved one or other tragic loss, brings healing.  For some it is volunteering to bake for an elderly neighbor or establishing a scholarship in someone's memory.  Perhaps lighting a candle on the dinner table because it acknowledges the anniversary of a loved one's death.  Donating to an alma mater.  Developing a Foundation.  Buying a cup of coffee for the next person in line in honor of someone dear.  

Going forward and finding meaning is not forgetting.  And "meaning making" does not trivialize the loss; rather, lessons learned and honoring the deceased can surprise you with strength and new facets of yourself you were previously unaware of.  I encourage you to mindfully consider how you might give meaning to the biggest loss the past year has held for you. 

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

When Grief Becomes Too Powerful 

Everyone will experience significant loss: death of a loved one, divorce, natural disaster, and so on.  After such loss, we typically go through a period of time, called bereavement.  Grief is usually felt during this period: deep distress, sorrow, and suffering.  Feeling grief is typical, but for the person grieving, it rarely feels “normal.”  Our experiences with grief are as unique as our hair color, preferences in music, and childhood experiences.  The months following a significant loss are usually marked by extreme fatigue, intrusive thoughts and memories, and intense emotions.  Life is never the same after the loss, but we eventually begin to adapt and start to experience periods of happiness, even if those times are few and far between.  For a small percentage of us, however, normal grief takes a turn, and becomes a clinical condition referred to as “Complicated Grief.”

Meredith's husband, Rick*, died suddenly over a year ago and her grief has become something more powerful than she ever imagined.    She isn't quite sure when this change took place.   Meredith always thought she would die before Rick.  One evening she said good night to him on the phone like she always did -- later on, he died suddenly in a car accident on his way home from the night shift.  Her grown children and grandchildren were supportive, but also grieving.  The closest one lived more than two hours away.  Friends did not seem to understand and she just did not want to talk about anything that didn't have to do with Rick and their previous life together.  Friends dropped away...or maybe Meredith dropped away.  She always figured she had a "touch" of depression but because of her volunteer work, raising children, activities with Rick and friends, she used to think she coped quite well.  She wasn't coping anymore.  It has been 17 months since the car accident, and she feels "stuck" and in worse condition than she was a year ago.  Thoughts of Rick and the accident keep circling in her mind, day and night, like a machine she can never shut off.

Grief can be like climbing a steep hill with unseen holes and obstacles. Complicated Grief is like climbing the very same hill but while pulling a wagon of boulders behind you. The boulders represent a few of the signs of Complicated Grief : repetitive thoughts about the loss without the ability to focus on anything else, intense longing for a deceased person more than six months after the death, feeling as if your life holds no purpose, feeling as if your grief is bigger and more powerful than you, feelings of guilt, bitterness, and struggling to trust others. This list is not comprehensive, rather a way of beginning to increase awareness of when normal grief has transitioned into an uphill journey which has become unmanageable alone.

Grief and Complicated Grief have been studied and we are gaining knowledge about its frequency, symptoms, complications, and treatment.   And Americans are not the only people to have participated in research regarding Complicated Grief.  Studies in Europe, Africa, and Asia indicate other cultures experience complications to what is considered a typical, non-clinical condition of grief.  Loss happens to us all. Grief is often a terrible experience, even for those who are productive and high-functioning throughout the bereavement period.  But what to do if six months have passed since the loss and there has been no slight improvement in functioning?   Is the griever unable to remember the past without a direct link to the deceased?  Is it torturous to consider the future, but somehow rewarding to have repetitive thoughts about the deceased person?  These can be signs that the griever is experiencing Complicated Grief and may benefit from professional support.  When someone has been previously challenged by depression and mood disorders, they are at higher risk of developing Complicated Grief.  People lacking a strong support system are also at higher risk.  Counseling provides a non-judgmental process for professional support and a way to move up the steep hill of Complicated Grief.  People often report feeling "unstuck" in their journey after talking with a professional .


The trusted relationship between counselor and griever allows the grieving person to prepare for a life not dominated by thoughts of  loss.  Developing coping skills and discovering one’s new role after the loss are common treatment goals.   The grieving person is given a supportive place designed to help with symptoms of Complicated Grief and any pre-existing conditions.   Counseling provides time set aside to remember the past and begin to imagine and build a future.   (A licensed practitioner with expertise in this area will also be skilled in working with grievers who would rather not "talk about it", preferring to process grief through physical activity, instead of expressing emotions.)   If someone you know is struggling with Complicated Grief or it feels as if their grief has become unmanageable, consider calling a local hospice to ask if they offer no-charge bereavement support.   Or perhaps share this article with the grieving person; it was intentionally written in a non-clinical style.   Consider reaching out to someone who appears to be having a particularly long and intense struggle with their grief.   You may likely be the only person to do so.

[ This article is by no means comprehensive on the subject of Complicated Grief and is not a diagnostic tool or mental health counseling; the intention is to provide general awareness and education about Complicated Grief.    *Names/identifiers have been changed. ]

Preparing Ourselves When Entering the Space Around the Dying

What do we consider when we are about to enter the space around a deathbed?  What is our responsibility to the person dying?  This video includes some thoughts and practices regarding the sacred space around the actively dying.

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

"M and T ... Flight to Chicago"

On the way to California, I had a layover to Chicago.  I sat next to an older couple and noticed they laughed easily together.  She touched his arm or patted his leg at least six times in the first hour.  I usually don't initiate conversation when I travel for business.  But I remain open to what might come my way.

About 45 minutes before landing, she leaned over and asked me if I was traveling for business or pleasure.  She introduced herself and her husband.... "M" and "T."  She volunteered that they were soon going to celebrate 50 years of marriage.  I commented that it was refreshing to see them laughing together and congratulated them on such an accomplishment.

The conversation turned to grief and loss:  they had a child who suffered a debilitating illness.  It changed their family.  Many years later it was still painful.  But they celebrate and create and travel and plan and remember.  

Had they talked in 50 years about what they hope for each other as they face dying someday? 

No.  Too difficult for "T."  

Unconstructed ideas and unspoken thoughts for "M." 

Anticipating what the grief might be like, "T" said he could not survive if "M" died first.  Yes, some spouses literally waste away, a failure to thrive, complicated by being widowed.   But together, we gently wove the beginning fabric of what this journey could look like for them.

 Eventually the cell phones came out as we shared photos of our children.  I wished them an enjoyable time wherever they were heading upon landing.   And I challenged them, when they returned home, to have the conversation: what they hope their dying will be like, the unspoken grief from years ago, and what they want for and from each other as they weave sections of their journey.  I remember their eyes.  And I remember how they smiled together despite the topic we concluded.   As the plane landed, they thanked me.  We would go our separate ways in Chicago.  As is my custom in the aisle seat, I jumped up to hunt my stowed carry-on.  My spirit was touched as "M" stopped me to thank me again for listening, for having the conversation.  It was my honor.

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

The Last Trip for 2017....
While traveling to New York in mid-October to do a presentation, I had the blessing of meeting  "M" and partner, who shared a photo of their infant shortly before the baby died.  Without malice this couple explained to me how their perinatal loss (what I in fact presented about just 24 hours earlier) was propelling them forward towards a commitment:  to honor their baby's memory by increasing awareness of healthcare practices during the birthing process.  The beautiful way they discussed their experience and goal to "rise up" was a heart connection I will not soon forget.  Their work will undoubtedly provide support to other parents experiencing the marrow-level sorrow that accompanies such a loss.   The irony was not lost on me:  a spiritual and physical connection with a couple who experienced a perinatal loss only 24-hours after I had presented on the topic.  Thank you "M."  I will follow your progress in your mission.

Lastly, my private discussion with "A" lasted less than ten minutes.  Standing about the same height, I was able to easily see into "A's" eyes as they told me about the desire to enhance skills used in a healthcare setting where people are dying.  Some patients willing to talk about death and others looking anywhere but along the path that is already paved.  "A" was searching.  Searching to know their skills were enough.  Searching to find out if they were getting in the way of what is expected or needed at the bedside of the actively dying.  And finally, searching to know how to be present for the bereaved when the paved path was no longer visible.  What struck me about "A" is after a successful career, skills and credentialing, they were still searching ...asking.  I wondered if "A" was perhaps distracted by not feeling affirmed; questioning if they were providing what was needed to patients.  I told "A" what I've been telling people for years:  "You are enough."  The sigh "A" made...the look of acceptance...and gratitude, let me know at least for that moment "A's" work was validated.  Thank you, "A" for the work you do in healthcare and with the bereaved.

On a lighter note....but just as important.... I want to give a "shout out" to Leslie Blackhall, MD.  I had the privilege of hearing her speak about her work with medical students.  Thank you Dr. B for keeping it real.  Authentic...and not necessarily PC.  And for bravely naming that our physicians need more dialogue and instruction about having the conversation with patients:  presenting all options with terminal illness, not just quantity of life, but considering wishes towards quality as well.  (These are my interpretations and take-aways from hearing Dr. B's presentation.  This blog is not a representation of her body of work nor does it contain the verbiage she used.)

New York was likely my last out-of-state presentation for 2017.  I returned to Ohio having to "hit the ground running" in preparation of two workshops within the week.   Even so, part of me returned again to my encounters with "M" and "A"...and "C" whom I did not include here.  We have so much to learn from each other about grief and loss.  I am grateful to those willing to share. 

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

I just completed my third presentation in less than a week: "Coping with Grief at the Holidays."  With admiration, I listened to a teacher who dedicates her energies to her students while grieving the recent loss of a parent.  I met a gentleman (with a stylish hat) who is missing his bride of more than 50 years.  And a gentile lady who sparkled even though she is longing for her husband of more than 60 years.   Even if family and friends do not understand, it is acceptable (and sometimes healthier) for those who are grieving to change their routine or decline invitations.  The bereaved will likely experience more-than-normal fatigue.   We all experience the isolation of grief, however, this is difficult to remember when it is your own sorrow.  Still, I encourage those who are grieving to consider creative options to celebrate your deceased loved ones. 

As the calendar turns to November, this Thanksgiving I will remember those I have met during my Grief Loss Education travels, my deceased loved ones, my family and friends who are living, and say a prayer of gratitude.

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

Valued Tradition or Stressful Obligation?

A technique to assist the bereaved in surviving the social part of the holiday season....

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)

Thoughts...mysteries...updates...and conversations on grief, loss, and end of life.

"Why Meditation"

Many of my extended family members keep in touch with me through texts and emails.  A few months ago we did a conference call with five of us... it was, well, interesting.  But fun.  From New Mexico to the Midwest to Florida, we manage to keep in touch.  It seems for the past year the topic of meditation keeps coming up.  And gratitude.  And meditating on gratitude.  You get the idea. 

When people are grieving, they are usually struggling with being in the moment; the here-and-now is filled with pain. Or they can't get out of the past; being consumed with thinking of their loved one's dying moments, or things left unsaid. Having a few minutes of meditation each day with a focus on the present breath can help. And it's easy to learn. Not easy to do initially, but many report feeling the benefits quickly.

Meditating for even a few minutes a day can be beneficial.  Being mindful of your breathing or your surroundings while giving yourself permission to forget the lists, the budget, the doctor's report, the job, oh, and that phone call you didn't make...is a gift to yourself and your loved ones.  It certainly does not mean your lists and concerns vanish.  But it is a way to be present, even very briefly, while allowing your mind to quiet for a moment. 

Research shows meditation can improve depression and health, such as high blood pressure.  It is practiced by people from many different faiths. It's free.  It can be done in a variety of methods and locations.  Sometimes I would describe it as relaxing.  Other times I would describe it like a mini re-boot for my brain.  For those dealing with significant sorrow, short periods of meditation is believed by some researchers to help with perspective and emotions.   

During a recent phone call with one of those awesome family members I mentioned, I told her I was feeling a bit scattered with preparing for a training in California and one in Ohio.  She asked me if I'd been meditating much recently.  I hadn't.  I meditated that night and it was helpful!  Another family member told me about an "app" for your smart phone called HeadSpace...it's free and has short and long, guided and unguided meditations.  In my opinion the format they use is great for beginners.

There is so much written, posted, and televised about meditation and mindfulness.  Where to begin?  For me, if I'm new to something, I like to start with simple definitions and information.  I can be a skeptic sometimes.  So I begin by searching for reliable information which is based in research or experience.   And a good place to get some basic, easy-to-understand info about meditation is on the Mayo Clinic's website.  Trust me, it's written in a way that is easy to understand.  If you are feeling adventuresome, or curious, check out publications and YouTube videos by Jon Kabat-Zinn, a pioneer of scientific research on meditation.  

If you are considering meditation for the first time:

1. Look into the different types of meditation and do your own research.

2. Talk with your primary healthcare provider about your plan to start meditating.

3. If it's appropriate for you, try different lengths and types of meditation.

4. Talk with others about their experiences with meditation.

(Videos and written materials are not designed to be mental health treatment or specific advice for someone's unique situation.)