In these COVID days I rarely see a patient face to face. Even video appointments are limited as many of my older patients don’t have the skills to do Zoom—or at least they say they don’t. Appointments with many are a phone call and I try to imagine what the person on the call looks like. Body language is now a thing of the past in counseling and I miss it.
The man on the phone sounded older and as he talked, I glanced at the demographic information in his electronic medical record. He was 69, not an age I regard as old anymore as I negotiate this decade myself. I had never met him before but one of the nurses told him to call me. Like many of my patients, this man had been treated for prostate cancer with surgery and now he had profound erectile dysfunction. But there was a twist—and this is when he started to cry. This was not a gentle, tears running down the face kind of cry. No, this was what Oprah would call the “ugly cry.” I heard him gulping as he tried to get the words out, and I missed some of them. I did not dare to ask him to repeat himself as I did not want to prolong his obvious pain. Eventually with a couple of hiccups and some nose blowing, he had calmed down enough for me to paraphrase what I thought he had said.
His wife of 35 years had died suddenly 3 months before. They had no children and were everything to each other. She was being treated for breast cancer and everything had gone well, until she developed a DVT, and just like that, she was gone. He was still recovering from his surgery when she was diagnosed and he felt an enormous amount of guilt because he believed that he had not paid her enough attention when she was diagnosed; he was dealing with severe incontinence and was reluctant to leave the house, even to go with her to her chemotherapy appointments.
Now he wanted to start another relationship and was convinced he had to do something about his lack of erections. Like many single or widowed men his age that I have seen, he felt sure that without erections, he would never find another partner. I usually ask men to consider the age of women they would be most likely to date, and the common response is someone close to their age, late 50s or early 60s. I then explain that from my experience with post-menopausal women, many want companionship and not sexual gymnastics. This often gets a laugh and acknowledgement that he too really wants company and perhaps his lack of erections is not a dealbreaker. But with this man, there was something more important. He was in the midst of profound grief and this influenced everything in his life.
One of the tasks that couples dealing with the sexual side effects of prostate cancer treatment must attend to is the loss of what was their sexual relationship. This is an active process where the couple needs to mourn the loss of what was once easy and pleasurable so that they can move to a realistic new way of being sexual. For a single man, the loss and mourning process is more complex. My patient was in the throes of complicated grief; his wife’s death was sudden, he felt guilty about his perceived lack of attention to her, and he was dealing with his own loss of sexual ability. Any attempts to start a new relationship could be a recipe for disaster that would compound his grief and likely affect his self-esteem. And of course, there is the COVID-19 pandemic where he would have to meet someone online as the usual social opportunities are not available; this can be a significant barrier for an older person who may not trust technology and perhaps does not understand this “new” way of meeting others.
He finally admitted what I knew all along: he was lonely, so lonely; the pandemic has increased the isolation that so many people, especially those who are living alone, experience. I empathized with him about his situation and suggested that perhaps now was not the time to be looking for another relationship when he had recently lost his partner. He agreed and asked me when I thought he would be “over” her death. I explained that there is no timeline on grief, and the emotional pain he was feeling was testament to his love for her. “Ah,” he said, “I never thought about it that way, Doc. Can I call you again when I need to?” My answer was yes, of course.
Holly Gwen Prigerson, PhD
May, 06 2021 6:23 PM
Great article offering important new insights that will normalize grief to older adults. Data do, however, show that grief, except in the significant minority of cases in which a mourner meets criteria for a diagnosis of Prolonged Grief Disorder, does have a timeline. It is hard to argue that the initial reaction to the loss of a significant other is not shock, and that most mourners gradually come to acknowledge if not accept, the loved one's death over time. I think what may be more apt is to say that grief has no expiration date. That, indeed, appears to be true and important to acknowledge.