I had a discussion recently with a patient who was approaching their one-year mark of dialysis treatment. They shared with me that some people referred to it as their anniversary, which made them feel very uneasy. I explored this topic further with them. I discovered, through our discussion, that the word “anniversary” felt very triggering, almost unnerving to them. Initially this seemed to be a surprising response.

 If we think about the word anniversary, it is often associated with celebrated events, like marriage, and is generally marked by the exchange of gifts. It is not usually (if not at all) connected to a chronic illness or its treatment. Oftentimes, undergoing dialysis treatment means an increase in expenses, reduced work hours or job loss, diminished societal roles and feeling excluded or disconnected from others. Patients frequently feel significant loss and grief due to these impacts.

This made me reflect on the way we often view loss and grief and how it relates to dialysis treatment. It’s not uncommon for us to think that as time passes, the distress should have lessened.  In effect, the patient who has experienced the loss should be feeling “better” and able to celebrate this milestone. In other words, since the patient is receiving adequate medical care, they have gotten used to the dialysis treatment.  Seemingly their psychosocial issues would have been sorted out for the most part, and they should be feeling well. However, this is not the case. Although no two people are the same and grief looks different for all of us, I have often observed that those experiencing loss and grief will move back and forth in their journey, feeling great one day and then a sensation of being completely crippled the very next day.

I have found both in readings on the topic and through my own personal experience with grief, that the second year (and on) is often marked by trying to cope with the permanence and irreversibility of the loss. Not only that, but we feel that we are navigating this with little to no social support. This is no easy task!

This is a gentle reminder for us as clinicians, that grief is not linear. Personally, I believe we need another term for anniversary, (or eliminating the use of it totally), because referring to the one-year mark of being on dialysis as an anniversary not only confuses the patient but their support system as well. Perhaps it could be referred to as a reflection or memorial period? While there are certainly some positive things about reaching this one-year mark, it can also be a time of sadness and deep reflection for the person. As clinicians, we are called to acknowledge and provide a supportive space for both.

Image by Matty Rogers from Pixabay