Brian went to the emergency room when his headache did not respond to his normal course of aspirin and bed rest. Physically fit at 63, Brian adhered to a fitness plan that included daily five-mile runs. He was rarely ill, so he considered the Saturday evening visit to the hospital an inconvenience. In fact, Brian and his wife, Beth had plans later that evening.

Brian soon realized that he and Beth would not make either dinner or their movie. When the doctor entered the room, Brian was not prepared for what he was about to hear. He listened to the news calmly while intently watching Beth’s face. Beth sat perfectly still as the doctors delivered the news: Brian had a brain tumor.

As they talked about their medical options, the need for a second opinion and further tests, Beth drifted off. She remembered their home on the lake, and kayak paddling along the shore. As if looking through a scrapbook, she pictured their children setting the table for Brian's birthday dinner, wrapping presents, and packing for holidays at the cottage. As she listened to the doctor, Beth slumped into the chair next to her husband. The room and voices grew hazy. Her hands felt clammy and she could hear her heart beating loudly. Beth’s grieving had begun.

When your spouse is terminally ill, the first noticeable loss is the cadence of your former life. Before the impossible news sinks in that death is a possibility, you begin to grieve the life you had as two healthy people. The sense of loss becomes part of the fabric of your life with each visit to the doctor, each prescription, each sleepless night spent caring for the person that shares your life. In a way, your changing life helps prepare you for the more staggering reality of your spouse’s death.

Up to the moment that Brian took his last breath, one year after his visit to the emergency room, Beth believed and desperately hoped that he would recover. Her denial allowed her to forestall acceptance of his pending death and gave her enough hope to be an effective caregiver. Perhaps nature knows that we cannot endure the pain of complete acceptance all at once. Denial is a slow-drip acceptance of death, preventing a jarring downpour of grief.

Complete denial, on the other hand, would prevent you from experiencing the loving intimacy of your spouse’s last days. Knowing that the end is near and accepting death allows you and your spouse to have meaningful conversations, reunite with distant relatives, make peace with God and make final plans. One of the roles of hospice is to facilitate such end of life involvement with family, friends and clergy. Although painful, saying goodbye and making peace with loved ones allows for a level of intimacy that you may have never before experienced.

Beth deeply grieved the loss of her husband. She replayed their life together in her mind like an old movie. During their thirty-six years of marriage, they had idealized each other and rarely disagreed. His income provided a comfortable lifestyle. She raised four children and relied on Brian to handle their finances.

In the months following the funeral Beth walked around their big house like a lost child, looking for signs of Brian. Her heart leapt every time the phone rang, hoping to hear his voice. At 5:30 in the evening, she anticipated his arrival from work, her body aching with loss. Her best friend was gone forever. She thought she would never feel secure again without him.

To help her cope with her loss, Beth relied on grief support services offered by the hospice that had provided care to Brian in the last few months of his life. Like many hospices, her hospice offered bereavement support for thirteen months following the death of a loved one. Beth joined a grief group with others like her. At first she cried each time she told her story, but as time went on her grief diminished. Talking openly with other widows and widowers made her feel less alone. In fact, over time she found herself mentoring newly widowed group members, adding to her growing sense of balance and competence.

At first, Beth was intimidated making decisions without Brian. She had little or no experience filing tax returns, managing investments or administering an estate such as Brian’s. She felt a fresh stab of grief with each decision she faced as it reminded her of the calm, matter-of-fact way Brian had managed their affairs.

Gradually, Beth tackled her responsibilities with growing competence and strength. Through her efforts and the passage of time, she was able to accept her new life without Brian. By acknowledging the loss of her husband and openly addressing her grief she was free to take control of her life.