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The exhaustion of grief

6/4/2022

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After Tim died, I became so tired. The kind of tired that squashes you flat. The kind of tired that it felt like even my bones hurt. Feeling this exhausted can be scary. But it is a normal part of grief.

​Why does grief make you tired?

You're in shock
A psychological shock triggers the fight, flight or freeze response. Our bodies fill with the stress hormone cortisol, desensitising us and putting us on alert. After a bereavement, particularly a sudden and unexpected one, our cortisol levels remain high for a prolonged period of time, leaving us exhausted.

Your brain has so much to process
Our brains get tired when they are being asked to process information all the time – every decision requires energy. So grief exhaustion is both physical and mental.

You can't sleep
Grieving often means your head just won't stop – it's full of spinning thoughts and tough memories. You may also be having nightmares, flashbacks or intrusive memories. All of these will affect your sleep.

There's so much to do
Bereavement leaves us with a lot of admin, from bank accounts to businesses, and from phone contracts to funeral arrangements. There is so much that needs to be completed, and some things must be done in specific timelines.

Losing someone also means losing their help at home. This can include routine jobs around the house and caring responsibilities. For some people, bereavement means having to find somewhere else to live, sometimes at short notice.

You are hypervigilant
Hypervigilance is a state of extreme alertness where you are constantly assessing the environment for threats, both real and perceived. You may feel that since you have been through a traumatic event, what's to stop another? Hypervigilance can be a symptom of post-traumatic stress disorder (PTSD). It is exhausting in itself, as well as making it hard to relax or sleep.

You aren't eating properly
It can be hard to eat well when you are grieving – it may not seem worth it to cook for one, or your appetite may not be what it was. Not having enough of the right kind of nutrients leaves you without energy. Both your diet and your alcohol intake can also affect the depth of your sleep.
​
What to do?
  • Be kind to yourself. I really mean this. You've been through a lot
  • Rest when you need to. Naps can be wonderful things
  • Try to get the sleep you need
  • Learn to manage the energy that you have
  • Eat as well as you can
 

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Using writing to cope with grief

1/4/2022

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I'm a writer by trade. Science writing pays the bills and fiction provides the creativity. After Tim died, I used my blog as part of my grieving, sometimes writing to Tim, sometimes documenting the steps I took, other times just setting down in words how I was feeling. There were bees in there too.
 
Writing The Widow's Handbook is helping me work through parts of my grief, and understand why I feel how I feel.
 
Writing your grief
Writing can be a way of making sense of the world, of getting feelings out of our heads and putting them in order, of processing our grief. It can help us to manage the chaos in our heads. Writing can trigger emotions, so be prepared for what I call grief attacks, those moments that feel like waves of the sea catching you behind the knees and sweeping you off your feet.
 
Writing can actually help our health – it can boost our immune systems. It can also improve our mood. While depression isn't the same as grief, a study of people with depression showed that writing every day lifted their mood.
 
Getting writing
Just sit down and do it, with paper and pen or pencil, or on a computer or tablet. Whatever works for you. Don't worry about whether what you are writing is any good. Later you can edit it if you want others to read it, or if you want to keep it as a record, but for now, just pour it out on the page.
 
Writing for yourself means that you can be more open and honest than you perhaps can be with other people. You can just let out exactly how you feel, whether that's anger, relief, hope or heartbreak.
 
How to start
  • Keep a notebook and pen in your bag, on your bedside table, in the car, on your desk
  • Write regularly, perhaps for 15 to 20 minutes a day or a week
    • If that seems a lot, begin by setting a timer for just 5 minutes
  • Write whatever you want to, because it's for you:
    • a diary
    • letters to yourself or to the person who has died
    • a blog to share how you feel and explain grief to people who haven't experienced it
    • a memoir
    • fiction or poetry based on your feelings

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The spoon theory and grief

23/3/2022

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​The spoon theory was created by Christine Miserandino to explain to a friend about what it felt like to have the chronic illness lupus. She used it to describe how every task in a day requires a block of energy, be it physical or mental, and that she had to budget out those blocks across the day. She wrote it up as an essay for her blog.
 
"I quickly grabbed every spoon on the table; hell I grabbed spoons off of the other tables. I looked at her in the eyes and said 'Here you go, you have Lupus'… I asked her to count her spoons. She asked why, and I explained that when you are healthy you expect to have a never-ending supply of spoons. But when you have to now plan your day, you need to know exactly how many spoons you are starting with. It doesn’t guarantee that you might not lose some along the way, but at least it helps to know where you are starting. She counted out 12 spoons…. I asked her to list off the tasks of her day, including the most simple. As she rattled off daily chores, or just fun things to do; I explained how each one would cost her a spoon… I think she was starting to understand when she theoretically didn’t even get to work, and she was left with 6 spoons. I then explained to her that she needed to choose the rest of her day wisely, since when your spoons are gone, they are gone."
 
Spoons and grief
The spoon theory was created for chronic illness, but it can also be used for the impact that grief has on your physical and mental spoon numbers. Early on in grief I was so tired that my bones hurt, which took away some of my physical spoons. I also had widow brain, which took away some of my mental spoons too. Creating a spoons graphic based on your own needs can be a useful exercise to help you understand what you need, and what you can do to look after yourself.
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What you can do
  • Be kind to yourself
  • Some days you might wake up with very few spoons – those are the days that you need to rest, both physically and mentally
  • Get to know your limitations
  • Prioritise the things that have to be done, the things that it would be useful to do, and the things that can be put off to another day
  • Schedule your day to meet the spoons you have – you may have more energy at different times of day
  • Accept that you may need to ask for help, and accept help when it's offered (I know it's hard)
  • Understand that, when you are low on mental spoons, physical spoons, or both, it's hard to make plans. And that you might need to change your plans at the last minute, too.
  • Pace yourself – if you have a busy day ahead, have a quiet day the day before if you can, and be prepared that you might need to rest the day after
  • Take breaks when you need them
  • Explain to people what you are going through – the spoon theory can help
  • Try to eat and sleep as well as you can, and consider adding in a basic multivitamin and multimineral if you're not eating well
  • Exercise when you can
 
Notes about spoons
  • Your numbers of spoons can change from day to day
  • Physical and mental spoon numbers can differ – gardening may be a high physical spoons activity but if you enjoy it, it might be low on mental spoons, or even help you to replenish your spoons
  • The number of spoons any activity takes will vary from person to person
  • Replenishing mental spoons differs for different people – for extroverts, spending time with people helps, and for introverts, spending time alone might be the right thing to do. I'm an ambivert with introvert leanings, and so I love being with people right up to the point that I suddenly need to be alone
  • The spoons lost in grief do come back, but your spoon numbers might drop on milestone dates or days when grief hits hard 
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Hints and tips for sleep

21/3/2022

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Lack of sleep can have an effect on our health – it's been linked to obesity, heart disease, memory loss, high blood pressure, diabetes and a less effective immune system. Not having enough sleep can leave you craving sugary, salty or carbohydrate-heavy food.

Lack of sleep has connections between depression and anxiety. It can even affect your balance.

Sleep can be so hard when you are grieving - your head is full of spinning thoughts and tough memories, and you may have nightmares. ​​Here are some hints and tips for improving sleep.
 
During the day
  • Get sunlight, or use bright daylight bulbs during the day to reinforce your circadian rhythm
  • Use the bed to sleep, not to work
  • Exercise during the day can help you sleep at night, by increasing sleep duration, deep sleep duration and fewer times waking up. Avoid strenuous exercise or competitive sport in the few hours before bed
  • People who eat a Mediterranean-style diet have a lower risk of insomnia, and are more likely to have a good night's sleep.
  • Avoid napping if possible
  • Try stopping smoking, as nicotine affects sleep
  • If you drink alcohol, try cutting it down, especially late at night – while it makes you feel sleepy, it disrupts later sleep
  • Try cutting down caffeine, especially later in the day
 
In the evening
  • Don't eat a heavy meal too close to bedtime
  • Avoid devices for half an hour to an hour before bedtime, and don't have TVs, computers or smartphones in the bedroom
  • Don't drink too many fluids before bedtime
  • Have a warm bath or shower, with lavender-based bubble baths, soaps, body washes and body lotion – there is some evidence that the scent of lavender does have an effect on sleep
 
Bedtime
  • Think about your sleep hygiene – have a target bedtime, and a fixed wake up time, even at the weekends
    • But if you really aren't sleepy, don't force yourself to go to bed
  • Dim the lights
  • Take half an hour to wind down – music, reading, stretches, yoga
  • Have a consistent pre-bed routine, such as cleaning teeth, putting on pyjamas
  • Make sure your mattress, pillow, duvet and bedding are comfortable
    • Mattress toppers add extra snuggliness
    • Wool mattresses, mattress toppers and duvets can help you regulate your temperature 
  • Weighted blankets may help with stress and anxiety
  • Keep your bedroom cooler than other rooms
  • Have blackout curtains or blinds
  • Block sounds with ear plugs, or drown them with white noise
  • Listen to low volume audio or music on a player that switches off automatically – Radio 4, radio 4 Extra, podcasts and Audible are all good options for audio, but make sure it's not too interesting or it will keep you awake!
    • The Calm app has meditation, music and stories designed to lull you to sleep
  • Use lavender oil or lavender-based pillow sprays,
  • Have a glass of warm milk – tryptophan can improve sleep and mood, and warm milk reminds me of being a little kid tucked up in bed
 
If you can't sleep
  • Try counting sequences
    • Count sheep
    • Count backwards from a hundred, starting again every time you make a mistake
    • Count the Fibonacci sequence
  • Try the cognitive shuffle
  • Try the 'military method' – relaxing each part of your body, and then making your mind blank
  • Try progressive muscle relaxation, where you tense each part of your body and then release the tension
  • Try slow breathing – it can help in sleeping as well as grounding
    • 7/11 breathing – breathe in for a count of seven, and breath out more slowly, to a count of eleven
    • Box or four-square breathing – breathe in for a count of four, hold for a count of four, breathe out for a count of four and hold for a count of four
    • Alternate nostril breathing – block your left nostril, and inhale and exhale through your right nostril, then block your right nostril, and inhale and exhale through your left nostril
    • 4-7-8 breathing – breathe in through your nose for a count of four, hold your breath for a count of seven, and then breathe out through your mouth for a count of eight
  • Try mindfulness or meditation
  • Distract yourself with imagery – visualise the route of a favourite walk, a childhood room, a wonderful beach or an amazing view. Bring in as many details as you can, including sounds, sights, views, textures, colours
  • Try sleep hypnosis – there are lots of sleep hypnosis audio tracks on YouTube
  • Tell yourself to stay awake…
  • If you can't sleep after 20 minutes, get up and do something calming in dim light, and then try again
 
If insomnia is making you so tired during the day that you can't work, care for yourself or others, or means that driving feels dangerous, talk to your doctor. There may be medications or therapy techniques that could help.

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Cooking and eating after loss

18/3/2022

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Cooking can feel like the last thing you want to do when you are grieving. Your appetite might be gone, and shopping and cooking for one, setting the table for one, and sitting down to eat alone just reminds you of what you have lost. You might simply not have enough energy to cook (spoon theory isn't just about chronic illness). In a world where everything is packed in two, or four, or huge multipacks, cooking for one can feel very wasteful, or make you feel trapped into eating the same thing every day for a week.
 
When you just can't face cooking
In the early days I didn't really want to eat much, and then if I did want to eat I certainly didn't want to cook. Remember at this time, eating anything is better than eating nothing, and now is not the time to be counting calories or stressing about dieting.

​There are quick and easy alternatives that get you through the bad days.
  • Smoothies are a good way to get protein, vitamins, fibre and your five a day. Plain yogurt provides protein and calcium, oats, coconut flour, nuts and seed add fibre, and fruit and veg add flavour and nutrients
  • Meal replacements, such as shakes, soups and bars are nutritionally complete
  • Tinned soup
  • Anything on toast – butter, marmite, beans, an egg, peanut butter
 
Recipe boxes and ready meals
Recipe boxes provide you with all the fresh ingredients you need, which takes the pressure of shopping away, and reduces waste. Hello Fresh appears to be the only one that provides one portion meals. Mindful Chef and Gousto recipe boxes serve two, but you can split what you make and have it the next day.

Potage, Cook and Wiltshire Farm Foods deliver single portion ready meals for the freezer (Wiltshire Farm Foods also does meals for special dietary needs) and Mindful Chef has a range of ready meals, soups and broths. Allplants and Planty deliver single portion vegan ready meals for the freezer.
Many of the plans have introductory offers, with reduced prices for the first few deliveries.
 
Keeping it simple
When you start to cook for yourself, keep it simple. That doesn't mean dull food, just food that can be made in single portions, prepared quickly and don't involve waste.
  • Jack Monroe's Tin Can Cook is a book of recipes that you can make straight from the cans on your shelf
  • One Dish Kitchen is a website of single serving recipes, and has a section of easy things to cook
  • Quick and easy meals for one, practical one person meals, and one-person cooking ideas that won't waste food
 
Learning to cook
Some people face living alone being unable to cook, or lacking confidence in their own abilities. And while all the television shows on cooking are great, they can make the whole process look really daunting. These resources are also useful for people looking for inspiration.
  • There are cookery schools in many towns and cities, and cookery classes at local colleges, which teach cooking from basic techniques to producing something amazing
  • Delia Smith's website has a whole section on learning to cook, with videos, guides and a glossary
  • Jack Monroe's website Cooking on a Bootstrap is packed full of simple and low-cost cooking ideas
  • GoodtoKnow has the 57 basic recipes that the site reckons 'everyone should know how to cook'
  • Felicity Cloake's Masterclass has a series of 'How to make' recipes that are broken down into steps
  • YouTube has a lot of cooking videos for beginners, including cook-along videos
  • Miranda Gardiner wrote Teaching Dad to Cook Flapjack, a collection of family recipes, when her mother died and her father didn't know how to cook
 
Gadgets
The two best things I bought for the kitchen were a soup maker and an air frier. My soup maker means that I can load it up with veg and stock and half an hour later I've got my five a day in a mug, with another portion for later. Some will also make smoothies, sauces and even jam.
My air frier is effectively a tiny fan oven, and means that I don't need to put the oven on when I'm cooking for one. As well as making awesome roasted vegetables, great baked potatoes (microwave them first and then finish them in the air fryer, nice crispy bacon and rather good chips, it's great for warming through bread rolls and yesterday's left-over slice of quiche.
 
Batch cooking
When you have the energy, and feel like a day in the kitchen, batch cooking means you can cook in larger batches but not be stuck eating the same thing every day. You'll also have a freezer full of ready meals.

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Bereavement support payment

14/3/2022

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You can get Bereavement Support Payments from the government. This is not a means tested payment, and is open to people whose husband, wife or civil partner died in the last 21 months, provided that the late partner paid National Insurance contributions for at least 25 weeks in one tax year, or if they died because of a work-related disease or accident. You will get £2,500 as an initial payment, and £100 a month.

Claiming within 3 months of the death means that you will get the full amount, but you can claim up to 21 months after their death. You can apply online, by phone or by post.
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Models of grief: Four phases of grief

9/3/2022

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Psychiatrist Colin Murray Parkes and psychologist John Bowlby came up with the four phases of grief model in the 1970s. This is a linear model of grief, like the four tasks of grief and the six R processes of mourning. The real experience of grief generally isn't linear though, and people as they grieve can cycle through different phases, or ping between them like a pinball machine.

Shock and numbness
After someone dies, whether it's sudden or expected, there is a period of numbness that perhaps helps us to survive the first few days, weeks or months. It's hard to accept the reality of the loss.

Yearning and searching
In the second phase, we long for our person to return. Our life is full of sadness, anger, anxiety and confusion. We can seem preoccupied.

Disorganisation and despair
Accepting our loss can leave us without energy, despairing and feeling hopeless, and can make us withdraw. Life feels like it will never get any better.
​
Reorganisation and recovery
In the recovery phase, intense sadness starts to withdraw and we may be able to remember the person we lost with more positive feelings. Energy begins to return.

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Flashbacks and intrusive memories

3/3/2022

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 Just over four years ago, Tim died suddenly and unexpectedly next to me. I had to call 999, for only the second time in my life. The call handler dispatched the ambulance, and I pulled Tim onto the floor. The call handler talked me through CPR – I shouted 1-2-3-4 as I pressed down on his chest, and I can still feel in my bones the moments his ribs cracked.
​
The paramedics arrived, and for a moment they thought they had restarted his heart – but no, he was gone. Tim's sudden death left me with dissociation, flashbacks, intrusive memories and nightmares, all symptoms of post-traumatic stress disorder (PTSD).

Flashbacks and intrusive memories
Flashbacks are moments where you feel that the trauma is actually taking place again, right here and right now. Intrusive memories are unwelcome thoughts and memories that push themselves into our mind.

Flashbacks and intrusive memories can be triggered by lots of things – a smell, a sound, something you see. I had a flashback in the middle of a conference when someone coughed, and it sounded just like Tim's last breath. I wanted to run but couldn't get out. I repeated under my breath 'that was then, and this is now'.

There is a brilliant video about intrusive memories from The Loss Foundation that explains more about why these happen.

Dreams and nightmares
There is a theory that dreams and nightmares are a way of our brains processing the events that we have been through, and storing our memories. If this is correct, it's not surprising that we have grief dreams. They're not always about our partners dying – I've had dreams about Tim coming back temporarily, about his death being a mistake, about him not dying at all but leaving me or me leaving him. Over time, the bad dreams do diminish, though they can pop back up after emotional moments or times of conflict. I do now have nice dreams about my parents, and about Tim. While I wake up sad, I think 'It was nice to see you again'.
​
Dissasociation
When you disassociate, you can feel unreal, and disconnected from yourself or the world. You might feel that the world around you is a film that you are watching, or that you are watching your life as an outsider. You might blank out, not remember what you are doing, or feel like you are daydreaming. It can come with a feeling of numbness. While dissociation in PTSD is similar to depersonalisation-derealisation disorder, a dissociative disorder that I have had in a mild form since my mid-teens, it is linked to a specific traumatic event.

What to do
For flashbacks and intrusive memories, or after nightmares, telling yourself that it isn't real, and that the event is over, can help. Grounding techniques can also be useful.

If flashbacks, intrusive memories and nightmares become disabling, talking to someone can help. I saw an integrative psychotherapist who used techniques based on CRM (comprehensive resource model), and this made a huge difference for me. EMDR (eye movement desensitization and reprocessing) and CPT (cognitive processing therapy) are also used in PTSD. 

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​Widow's brain is real

25/2/2022

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Straight after Tim died, my head was full of fog. I felt disconnected from the world. And I think this was my brain protecting me from the awfulness of what had just happened. While the disconnection went away, the brain fog – known as widow brain or grief brain – stayed.

​It's a feeling that you can't think straight, and with it comes short term memory loss, numbness, lack of ability to process information or instructions, tiredness and lack of focus. But be reassured – it's normal. Our brains are acting to protect us from the trauma.

Widow brain, for many people, lifts in the first year to 18 months, but it lasts for different lengths of time for different people, and stress or milestones can make it worse. For people who have been caring for someone for a long time, part of widow brain may be a loss of purpose. Greif can also mean not eating properly, not exercising, or not sleeping well, and this all feeds into widow brain.

The science bit
Emotional traumas affect how our brains work. Imaging the brain shows that mental and physical pain trigger the same areas of the brain. While it's nothing like the same level of trauma, a brain imaging study in people who have recently split up with their partners shows that it affects their executive function, the system in the brain that sits in the prefrontal cortex and supports your ability to understand, decide, recall, memorise and have self-control. Your prefrontal cortex gets overloaded by grief and makes it harder to function well.

The practical bit
Rest
Grief has made me the most tired I have ever been. So tired my bones hurt. Rest your mind and your body when you can.

Tell people
Explain to people what's going on in your head, and send them this blog post if they don't get it.

Decisions
A really useful piece of advice for me was not to make any major decisions for the first year.

To do lists and notes
Write things down. To do lists are useful, and have stopped me forgetting to do many, many things (the combination of widow brain and ADHD really doesn't help my memory!) Break tasks down into the smallest bits possible – rather than having a to do for 'put everything into my name', break it into house insurance, deeds, rent' etc. That way tasks are less daunting, and crossing off each small thing make it feel like an achievement.
  • Whiteboards and marker pens
  • Paper and pen
  • Sticky notes – virtual or physical
  • Bullet journals – some people swear by these, but I would have found them far too complicated in the early days of grief

Reminders
Digital reminders rule my life. I use smartphone alarms to remind me to do things that are daily or weekly. I put appointments with reminders on my digital calendar for everything from whether it's bin day or recycling day, through birthdays, to work deadlines and days out, and I can access this on both my phone and my computer.
Physical reminders can also be helpful. If you need to remember to take something with you when you go out, put it on the doormat, or leave a sticky note on the front door (I get through a lot of sticky notes).

Out-sourcing
Have a pad of sticky notes and a pen somewhere convenient. When you think of something that needs doing, write it on the sticky note and put it on the wall. When someone says 'what can I do', give them a sticky note.

Stilling the whirling thoughts
Grounding can help to still your brain when everything is churning around and destroying your ability to focus.
​
Self-care
Be kind to yourself and forgive yourself. Remember – you are only human. You've been through a lot. And you are grieving. It's not your fault your head is like this. In the end, things getting missed or forgotten are very rarely the end of the world. 

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That day

24/2/2022

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You walk out of the house/hospice/hospital, and close the door behind you. You know that your life is never going to be the same again. Your brain is full and spinning. Part of you doesn't believe that it's real, and part knows that you will carry this loss for ever. People are around you loving you, caring for you, but you feel numb, distant, separate. You want to be alone with your thoughts but you need to be surrounded by people. The world carries on as if nothing has happened but for you it has stopped. ​

Tim Dudley 1 December 1967 to 24 February 2018
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    My name is Suzanne Elvidge, and I was widowed at 50 in 2018

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