Grief Anniversaries and Returning to Work

Two things tend to collide a few months after a cancer death. Everyone else has moved on, and you have to go back to work. Then the calendar starts producing dates that flatten you without warning.

Both of these are documented. Neither means you are grieving wrongly.

The National Cancer Institute's bereavement summary reports that "Most bereaved persons experiencing normal grief will note a lessening of symptoms after about 6 months." It adds that expressions of grief begin soon after a loss and "largely resolve within 1 or 2 years."

One study NCI cites found that "primary grief indicators peak at approximately 6 months postloss, after which the negative grief indicators begin to decline." Read that again. Grief often peaks around six months, not in week one.

That is roughly when casseroles stop, sympathy cards stop, and colleagues assume you are through the worst. The gap between what other people expect and what is actually happening is the hardest part of month six.

NCI describes them precisely. "Many bereaved persons will experience highly intense, time-limited periods (e.g., 20-30 minutes) of distress, variously called grief bursts, pangs, or waves."

Twenty to thirty minutes. That number is worth carrying around. A wave in the supermarket car park is not a breakdown and not a relapse. It has an end.

NCI also names what sets them off: "reminders of the deceased, such as major cultural or social holidays, the anniversary of the patient's death, or giving away items that belonged to the individual."

So three of the biggest triggers are predictable. You can put them on a calendar.

Write down the dates that are likely to be hard this year. Most people find more than they expected.

• The date of death, and the date of the diagnosis.
• Their birthday, and your shared anniversary.
• Major holidays, which NCI names directly as triggers.
• The day you clear the wardrobe or give things away, which NCI also names.
• Work dates that only you know are loaded: a client they met, the annual review they always helped you prepare for, the conference you always called them from.

Then decide, in advance, what each date will look like. Book the day off. Or work through it deliberately. Or move a meeting. Deciding in February about a date in July is far easier than deciding at 8am on the day.

NCI describes mourning using Worden's four tasks: "Accepting the reality of the loss. Processing the pain of grief. Adjusting to the world without the deceased. Finding an enduring connection with the deceased while continuing to engage in new relationships."

Going back to work sits inside task three. It is not a sign that the grief is finished. It is one of the ways you find out what the world is like now.

That reframing helps when work feels like a betrayal, or when you feel numb at a desk you used to like.

This is where a lot of bereaved people are surprised, so here are the facts from the US Department of Labor.

FMLA does not cover bereavement leave. The qualifying reasons are birth and bonding, adoption or foster placement, caring for a family member with a serious health condition, your own serious health condition, and military family and caregiver leave. The death of a family member is not on that list.

Any bereavement leave you receive comes from your employer's own policy, or from state or local law. Check your handbook rather than assuming.

FMLA does cover your own serious health condition, including mental health. DOL states that "A chronic condition whether physical or mental (e.g., rheumatoid arthritis, anxiety, dissociative disorders) that may cause occasional periods when an individual is unable to work is a qualifying serious health condition if it requires treatment by a health care provider at least twice a year and recurs over an extended period of time."

DOL's guidance names anxiety among chronic conditions, and major depressive disorder among serious mental health conditions that can qualify.

Eligibility has hard numbers. You must have worked for the employer for 12 months, worked "1,250 hours during the 12 months prior to the start of leave," and work at a location where the employer has "50 or more employees within 75 miles."

The leave is unpaid, and capped. FMLA gives "up to 12 workweeks of unpaid, job-protected leave in a 12 month period." Your employer may require you to use accrued paid leave at the same time.

Leave can be intermittent. DOL's guidance describes using FMLA leave "once a month for appointments with a mental health therapist." You do not have to take it in one block.

You are protected for using it. Employers "are prohibited from discriminating or retaliating against employees for having exercised or attempting to exercise any FMLA right," and cannot count FMLA leave against you in points-based attendance policies.

• Decide what you will say, once, and reuse it. One sentence for colleagues, one for clients. Saying it the same way every time costs less than improvising.
• Name who is allowed to ask. Tell one or two people the full story. Let them absorb the questions from everyone else.
• Ask for the specific change, not for sympathy. A later start, a quieter workspace, one fewer client, or no travel this quarter is a request a manager can act on.
• Protect the tasks that need concentration. NCI lists sleep loss and deep fatigue among ordinary grief reactions. Both wreck detailed work. Move it to your best hour of the day.
• Plan your exit route. Decide in advance where you will go for twenty minutes if a wave arrives at work.

NCI defines complicated grief as symptoms that "don't improve and last for a long period of time, cause extreme distress, affect multiple areas of their lives, and decrease the ability to take part in daily activities."

Work is one of those areas. If you have been back for months and still cannot do the job you could do before, that is a reason to talk to a clinician. It is also the point where FMLA's mental health provisions may become relevant, because a diagnosed and treated condition is what the law recognizes.

Ask the hospice or oncology team that cared for your relative about their bereavement service. Many run one, and many will see family members.

• Call or text 988 now, or call 911, if you are thinking about acting on thoughts of death.
• Call your doctor today if you cannot get through a workday without alcohol or drugs.
• Call your doctor today if you have stopped eating or sleeping for days at a time.

In the United States, the 988 Suicide and Crisis Lifeline is available "24/7/365" by call or text to 988. It covers "emotional distress," not only suicidal crisis.

• Grief, Bereavement, and Coping With Loss (PDQ) — NCBI Bookshelf, National Library of Medicine
• Grief, Bereavement, and Coping With Loss (PDQ), Patient Version — National Cancer Institute
• Family and Medical Leave Act: Frequently Asked Questions — US Department of Labor
• FMLA and Mental Health Conditions — US Department of Labor
• 988 Suicide and Crisis Lifeline