Relief and Guilt After a Loved One's Death

The relief comes first, sometimes within minutes of the death. Then, close behind it, the thought: what kind of person feels relieved?

That pairing is so common it is close to the standard experience of a caregiver's bereavement. The American Cancer Society lists guilt and relief side by side among normal responses to a death, along with shock, numbness, anger and helplessness. Most people get several at once.

The relief itself is covered more fully in the companion piece on relief as a normal response to a death. What follows here is the other half: the guilt.

Relief feels like a verdict. It seems to say something about how much you loved them, or how willing you were to keep going. It is not a verdict. It is a nervous system registering that a long emergency has ended.

Guilt is doing something else. It tries to hand you back control over an event you never controlled: if the death was your fault, then it was preventable, and a world where deaths are preventable is less frightening than the real one. Guilt is often grief looking for somewhere to stand.

They tend to be the same few scenes, and they tend to start around three in the morning.

• Hospice. We should have called weeks earlier. Or: we called, and it felt like giving up on him.
• Stopping treatment. Maybe one more line of chemotherapy. Maybe the trial in the next state.
• The hospital. We should have taken her in. Or: we should never have taken her in.
• The last conversation. What you said, or did not say, or snapped.
• Not being there. You went home to sleep, and it happened while you were gone.

Each replay presents itself as new evidence. It is the same evidence, run again.

One test is worth applying to every replay: did you know then what you know now?

You decided under uncertainty, with an incomplete picture, exhausted, usually inside a deadline somebody else set. Hindsight supplies the ending, then judges the decision as though the ending had been visible. It was not.

Hospice timing deserves a mention, because it is the most common regret and the least personal. NCI's guidance for clinicians notes that even as more patients are referred to hospice, lengths of stay stay short — late referral is a documented, system-wide pattern. When families all over the country reach the same regret, the cause is not all those families.

The research summarized in NCI's professional bereavement guidance suggests that what carries families through afterwards is meaningful engagement across the end of someone's life — the conversations, the care, the preparation — rather than being physically present at the moment of death.

If you are punishing yourself over the ten minutes you were out of the room, weigh them against the months you were in it.

Ordinary grief is savage, and it moves. It comes in waves, ambushes you on anniversaries, and slowly loosens its grip. NCI describes most people finding that symptoms come less often and feel less severe as time passes.

Complicated or prolonged grief is different: it does not loosen. NCI describes symptoms that do not improve, last a long time, cause extreme distress and interfere with several areas of life. ACS lists warning signs including sadness that never lifts, bitterness or anger, self-blame for the death, constant preoccupation with it, an inability to make any plans for the future, alcohol or drug use to cope, and wishing you had died too.

Somewhere between six months and a year after the death with no movement at all is the point at which most guidance says to get an assessment rather than wait longer.

One more thing worth naming. Grief that the people around you do not treat as a real loss — because the relationship was difficult, because you were an in-law or an ex, or because everyone assumes a long illness gave you time to prepare — is called disenfranchised grief. It is harder to carry mostly because it goes unspoken.

• Hospice bereavement services, usually available for around a year after the death, whether or not you were the main carer
• A grief counselor or therapist — grief-focused talking therapies have evidence behind them, and are sometimes combined with medication
• A bereavement support group, in person or online, through a hospice, hospital or community organization
• Your own doctor, if you are not sleeping or eating

If you are thinking about harming yourself, do not wait for an appointment. ACS advises staying with the person, calling their doctor, going to the nearest emergency room, or calling 911.

For the specific decisions that get replayed most — hospice timing, stopping treatment, whether to admit someone to hospital — there is a separate piece on why caregivers second-guess end-of-life decisions.