Australian Doctor 11th Oct Issue | Page 41

CF

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Disability Insurance Scheme ), and to guide the GP through management of Cassie ’ s ongoing deterioration and ACP .

Case study three

Brian , seven , has incurable leukaemia , despite undergoing chemotherapy and stem cell transplantation . He has disease progression into his bone marrow and leukaemia cells in his CSF .

His parents have always wanted to take him on an interstate holiday with his grandparents . Brian is asymptomatic , and his parents book the trip . They take a support letter from his GP in case Brian needs medical attention while on holidays . The holiday is wonderful , however in the days before they are due to come home , Brian starts to lose his vision . Brian has always known he has a sickness , and that the doctors are helping him to get better with medicine . His parents have not yet told him that the doctors cannot ‘ fix ’ his leukaemia . On the plane ride back home , Brian is quiet and withdrawn , and shares with his mother that he is very worried , but the conversation does not progress further . On their return , Brian ’ s mother books an appointment with their GP . The GP welcomes Brian into his consulting room and invites him to share what has been on his mind . Brian is hesitant and tells him that he does not want to upset his family with his own worries . After some time

Table 3 . Contemporary models of grief and loss Model Continuing bonds 40

The dual process model 41

42 , 43

Styles of grieving Intuitive

Meaning reconstruction 44

Shattered assumptions theory 45

Detail

The bereaved finds ways to redefine the relationship with the deceased , allowing for a continued bond

An oscillatory type of processing where the bereaved moves between loss- and restoration-oriented processing , highlighting that dynamic ‘ doses ’ of grieving is important for adaptive coping

( focus on feelings ) and instrumental ( focus on cognition ) styles have been identified

A process of reconstructing a meaning from a loss

Based on three inherent assumptions :

• The world is benevolent

• The world is meaningful

• I am worthy Recovery requires rebuilding an individual ’ s world view through assimilation , accommodation , meaning-making and benefit-finding . Challenges to an individual ’ s ability to rebuild their world view include an inability to integrate loss into a larger story , and when loss cannot be told to oneself or others

Growing

• Expectation • Reality around grief 46 Before loss

Loss

Eventually

Image supplied by Very Special Kids .