The mind can explain grief.
The heart grieves, regardless.
RONIN BAUTISTA
Words/Media
Twenty percent.
Ina* held on to that number. It was her older brother’s chances of recovery.
Twenty percent. One in five.
His heart had already stopped at sunrise before he was brought back. The doctor told them to brace for the worst.
Given the circumstances, twenty percent was not a good number. But a small chance was big enough for Ina. This was her kuya, after all.
They were born four years apart: Far enough not to be confused as twins, but close enough to share interests. He got her into video games. Bust a Groove,Final Fantasy, Tekken 3; whatever was good on the PlayStation. He was Ina’s only friend then, so she adjusted and adapted.
Ina remembers how she’d always wait for her kuya to come home from school. That was always when the fun would really begin.
“When he got into high school, you’d think that teenage years would mean he’d drift away. But no, he introduced me to his friends. That’s why I know all of them. My parents know them.” She’d watch their gigs; he’d scare off her suitors.
Eventually, she found her own set of friends. They were growing up, after all; she could no longer be her brother’s “tail” all the time. They could no longer like all the same things.
He had developed a different taste in movies. He loved to listen to bands she’d never even heard of. “Actually, kuya is a hipster. He doesn’t want to admit it, but he’s a hipster. As in, sobrang laking hipster niya minus the Apple products.” He moved from cardigans and skinny jeans to button-up shirts and slacks, with a “parang yung sa gilid-gilid na kanto” phase in between.
Growing up, of course, meant going to work and seeing each other only during breakfast or dinner. Whenever they had time, they’d go all the way to Eastwood and have a round of drinks. All was well, even if he had a life-threatening hormonal condition. They just had to deal with his temper from time to time. He stopped smoking, at least.
Both of them had grown and changed. Yet deep in her heart, Ina knew her brother would always be up for a video game.
In any fighting game, even when you’re down to your last hit point, it’s still possible to win. In the hands of a determined fighter, one-fifth of a life bar would be more than enough to bounce back.
Ina banked on that. Even though he was in the ICU, Ina knew that her kuya could still fight.
At 12 noon, the heart monitor made the long, beeping sound again.
In that dream, she was suspended in a bag, just like the ones climbers use when sleeping on the wall of a mountain. Right under the bag was a white abyss. Next to her was her father, lifeless, wrapped in blankets.
They discovered her father’s late-stage kidney problem in 2013. Three years later, the family found themselves rushing him to the emergency room month after month due to kidney-related complications. That was when they finally agreed to do dialysis.
During a dialysis session in August 2016, her father needed antibiotics. Her mom bought the medicine. The doctor on duty did a routine patch test. They noticed a red mark on the area where the drug was applied.
“Maybe we shouldn’t give this,” said her mom. “No, that’s okay,” the doctor assured her.
The doctor administered the antibiotics intravenously. Her father’s body froze almost instantly.
“When they rushed him to the hospital, he was immediately intubated, and then it kind of went downhill from there. The infection was not addressed in time, aggravated more by the fact that he had an allergic reaction.”
Her father had sepsis. He was in the ICU for three weeks. They brought him home and had a bed set up in their living room.
“I remember I did my Google certification that day. I was proud that I passed.” She told her father the good news, just like how she usually would. They got to bed at 1 AM. Settling down is never easy when there’s a sickly person at home, Jas explains.
Three hours later, on September 15, 2016, she woke up to her mom’s cries. Downstairs, she saw her father: lifeless, wrapped in blankets.
Approximately one hundred and seven people die every minute, all over the world.
At virtually any given point in time, someone could be dying.
At no point in time is letting go ever easy.
Everyone is bound to experience grief. It is what we feel in response to any type of loss. When a loved one perishes, that state is called bereavement.
Mourning, on the other hand, is the process through which grief is resolved. In theory, anyway.
“Grief, mourning, and bereavement are not pathological, abnormal states that must be treated,” explains Dr. Trina de la Llana, a consultation-liaison psychiatrist for public, private, and educational institutions. Patients visit her for symptoms on depression or anxiety. Part of her job involves probing into their life experiences; some of them would recall the feeling of loss.
“Sometimes, they’re triggers; sometimes, they’re additional blows that they have to take in the context of already existing mental illnesses.”
Other than that, grief is bound to come. And more often than not, we never see it coming.
“I knew he had months, I knew he was going to go – the most I could hope for was a peaceful death.”
They think it started with colon cancer. By the time they found out, there were already growths everywhere, so it was hard to tell.
Her mom, a nurse, said it started with gait abnormalities with her father. He would keep veering to the side whenever he walked. It also seemed like he had dementia.
Looking back, she believes she could have detected that something was wrong with her father. Nobody told her about the constipation and the skin nodules; those were textbook signs. “Had I known…”
Cancer patients are immunocompromised. In such a state, it’s easier for them to get infections. In the case of her father, he got a lot of them at the same time. Obstructed bowels. Pneumonia. Difficult breathing. “Simultaneously. Probably contributory.”
He underwent operation at the Philippine General Hospital. Bea was taking her residency there.
They needed mechanical ventilation for her father. His organs shut down, one after another. His blood pressure was dropping; eventually, he needed higher medication doses to keep it steady. It became harder and harder to wake him up.
One day, in 2016, he just didn’t.
“There are criteria for the diagnosis of brain death,” explains Bea, revealing that she already knew what was coming. “I watched doctor after doctor check for reflexes daddy no longer had.” She told her mother.
They signed the do-not-resuscitate form.
“We sat there, watching his heart rate slow and his blood pressure drop.”
He still remembers the only time she ever got mad at him. As a child, he had rolled up a piece of paper, lighted it with a match, and put it in his mouth. He was imitating Mommy Lola, who was a heavy smoker.
Around five years ago, she was diagnosed with stage 4 lung cancer.
Chemotherapy would only make her weaker at her age. Thus, all they could do was palliative care.
“Make her feel the best while she’s slowly fading.”
At first, she was optimistic. The doctor gave her a spirometer, which measured her lungs’ strength. They framed it as a game. Blow the tube, lola, and make the ball go as high as possible.
Each and every time, she’d go for a high score. One day, she couldn’t do it anymore.
“Eventually, she deteriorated because of the medicine for her pain. She would start hallucinating,” shares BA. One time, she asked for his hand. “Eat that,” she instructed him. But nothing was there.
Mommy Lola liked to feed her seven grandchildren. Both his parents worked full time; his grandmother, who was always around, cooked breakfast, lunch, and dinner. Her specialty: sinigang.
One time, she bought ice cream for BA and his brother. “I don’t know why, but my brother tipped his cone upside-down. Naturally, the ice cream fell, and he cried. ‘Why is Vince crying?’ asked lola. I demonstrated what Vince did, and the same thing happened. I cried too, so she bought ice cream for us again.”
“She never asked if she was dying,” recalls BA. “Maybe she just felt it.”
On May 1, 2014, Mommy Lola died peacefully in her sleep.
First, there’s denial. “This couldn’t be happening. This is is not true.”
Then, there is anger. “Why is this happening?”
Bargaining usually involves a negotiation of some sort with one’s own religious deity. The bereaved would offer drastic changes for the seemingly impossible, like bringing back a loved one from the dead in exchange for money or one’s own life.
Depression follows, when all hope is already lost.
Acceptance means coming to terms with the inevitable. Initially, all stages applied to terminally ill patients, until Kubler-Ross restated it to cover all types of loss and expanded the list to seven. Acceptance still comes at the end, though. Ideally.
While it looks systematic, the Kubler-Ross stages of grief is not the ultimate guide. As de la Llana explains, it is not a step-by-step path, and it definitely doesn’t apply to everyone.
In 2009, clinical psychologist George Bonanno questioned the stages in his book. Simultaneously, he proposed “patterns of grief” in bereaved people.
According to Bonanno, there is a pattern of “prolonged grief” with intense reaction. This lasts for years.
Then, there’s the “recovery” pattern. This one’s for people whose grief subsides, but never really disappears.
But the most common response, based on Bonanno’s observation, is the “resilience” pattern. This is where the bereaved “accept the loss, readjust their sense of what is, and move on.”
Her mom and dad were estranged, and managing them both was tough during the wake. This, on top of attending to guests, working on funeral arrangements, and watching over her mom who “was not in the best shape,” kept her mind off the grief most of the time.
“I think it was when he was buried that the finality of it became very overwhelming.” During the wake, she could still see her brother. When they closed his coffin for the final blessing, it dawned on her that it was the last time she’d see his face.
At that point, Ina realized that she would never see his awkward smile, ever again.
The silence was painful that night after the burial. Her brother, she revealed, was quite a character, and impossible to ignore. “You would know that he’s there because he’s the type of person who would want people to know that he’s there.
“If he’s not talking with anyone, he’d be in his room playing the guitar, sometimes singing as he strummed. He’d talk about short stories he wrote or this obscure film he watched, if he’s not ranting about a ‘pretentious’ writer or how ‘predictable’ The Avengers is.”
Ina never saw this coming. Her kuya had always been there, after all.
She’d told him when she started smoking, or whenever she had problems with boys. Stuff she’d never tell their mom. “Siblings would be more understanding.”
Kuya was always there whenever she had problems. Kuya had all the answers. Not anymore.
It has been more than a year since Ina’s brother died. His used clothes remain unwashed, up to this day.
Jas believes her father didn’t want to be a financial burden. He would react when he heard them discussing his medical expenses. His mind was sharp even if his body was failing, up until the day when he didn’t wake up.
After calling their relatives, Jas left her sister in charge for her father’s wake. Then, she slept. She doesn’t know for how long. Everything felt unreal. Reality didn’t sink in until she woke up for the second time and realized that this time, her father’s death was not a dream.
Hindu culture requires a funeral to be done immediately. There was a temple prayer after seven days, and a house prayer on the twelfth day. Their father was the only man in the house, and only men can be part of the prayers, so they let their male relatives lead the way.
The biggest challenge after her father’s death was managing the household. All of a sudden, she was in charge. “You’re a child of your mom, but at that time you are also an adult who is making the decisions for this family.”
She used to take time to plan her outfits and make-up. Now, she no longer cares about “those things,” focusing instead on her work and side hustles.
“I need to create that stability again, so that we are also in a good place again.”
Her father was both book smart and street smart. He knew a lot about the world. There were many things that only he could understand, many stories that only he could have made sense of. She even told her friends how she was a very different person when her father was still around, even if he was sick. She felt that she had someone to rely on.
Every once in a while, she would come home with a story ripe for the telling. And every single time, she’d realize that the best person to hear it was no longer there.
Bea’s father was “a very provincial macho father.” She was never quite sure how to navigate that as a daughter. They were close, though. In the traditional sense, at least.
Every week, her Daddy would drive her back and forth from their home in Bulacan to her dorm. This went on for eight years, from her pre-med years in Katipunan to her med days in España.
“During his funeral, he had so many friends coming up to me – Ikaw ‘yung anak na doktor! – and it was horrible, not knowing until he was gone that he’d been so proud.”
She took a week off after her father’s burial.
On her first day back at the hospital, she was assigned to the same operating room her father had surgery in.
Bea found herself dealing with one patient after another, all of whom had the same condition as her father. She’d remember him in every single one.
“I felt that the best way to honor his legacy was to help other people.”
During her last month in residency, she was tasked to remove an epidural catheter from a mother who recently gave birth. It was in the same room where her father was admitted.
“Huy, it’s a circle of life, I thought. There’s a new baby where my father died.”
Two hallways down, she started tearing up.
“I was the ‘strong man’ during her wake and funeral.”
BA’s siblings and parents were too emotional and tired. He carried the urn to the car on burial day. He placed Mommy Lola’s ashes inside the crypt. Nobody could do it, so he did.
Ever since Mommy Lola passed, he and his siblings would be wary about movies with grandmothers. Coco brought back painful memories. Up did, too.
But the family grew closer, says BA. They found themselves going out more, especially with their mom. “Mommy Lola was mom’s mom. When she retired, they were always together at home.”
It has been four years since BA’s grandmother passed away.
Whenever the family goes out, some conversations still start with “If grandmother was still alive…”
While grief itself is not an illness, there are increased health risks in bereavement.
In 2013, Reuters Health reported on the “widowhood effect,” where the surviving husband or wife has an increased risk of following his or her dead spouse to the grave. According to de la Llana, altered sleeping patterns, reduced immune response, and heightened physiological stress response are also associated with bereavement.
While experiencing bereavement may have some parallels with a major depressive episode, de la Llana clarifies that it can be differentiated from an actual mental illness. If someone entertains self-harm or considers suicide, considers oneself weak, and is severely impaired from daily activities and relationships, it is time “to seek professional help.”
“Culturally, there are death and dying practices which help those left behind to mourn, and ultimately say their last goodbyes.”
For Filipino Catholics, there’s the “forty days” practice and first death anniversary commemoration, on top of the funeral rites. “Given this ‘time limit,’ the individual’s grieving process does not always adhere to these prescribed intervals.”
Mourning takes time, after all.
“They say it gets better, but you never truly recover. Even if it has already been a long time since. Sometimes, when we talk about Mommy Lola, tears still drop.”
Bea finished her residency at PGH, with memories of her father in almost every corner.
“I can’t explain how – I just kept functioning. Went to work, went home, cried a lot, went back to work, cried at work sometimes, but I kept going.
“In retrospect, being back at work was better for me, because I wasn’t alone with my misery. It gave me a sense of structure.”
For the first few weeks after her father died, Jas cried to sad songs almost constantly. It didn’t help that there were just too many memory markers of her father all over Manila. Bayside strolls. Chinese restaurant sessions. Each of her usual daily haunts would make her remember. “But my second sister has not cried. Until now. And even she doesn’t know why.”
Apart than that, she was too busy for anything else. There were just too much paperwork to work on. Death certificates. Insurance claims.
If only she had some time to herself to go away alone, she would. A bit of quiet time, just to get over everything. And then, she’d be back.
“It’s never going to be okay. You always carry that grief with you. But at least, you have the strength to just go on, every day.”
Ina got into an accident a few months after her brother’s death. When she woke up alone in the hospital, she teared up. “I was not crying from the pain. It was the only time that I had that I could cry over my brother’s death.”
“[The feeling’s] the same. It’s still the same as when kuya left. People often tell me it gets better. Honestly, it doesn’t. You learn to reconcile with it, but it doesn’t get better. You slowly accept the reality that he’s gone, but it doesn’t change the fact that he’s gone.”
You’ll never know when you’ll cry, says BA. Sometimes, you’d just find yourself staring at nothing. You’d think you’re okay until it hits you, without warning.
Jas’s father was also great with kids. He would have been a wise lolo to her children.
Bea’s father would be thrilled about her specialization. He would’ve had friends over for drinks to celebrate.
BA’s lola would still continue feeding them. She would take it personally if they didn’t show up for her sinigang.
Jas is getting projects as a content and strategy manager and writer.
Ina is looking for opportunities closer to her mom.
Bea is back at the PGH operating room, looking after patients.
BA is overseas to get his PhD.
They are still coming into terms with loss. They say they don’t have the right answers, but they all know one thing: Moving forward doesn’t necessarily mean moving on.
The same goes for millions of people around the world who have been left behind. Everybody grieves. Everybody loses people they love. The map to moving forward is rarely the same.
Curiously enough, the best guide might be on BA’s leg.
Three weeks after his grandmother died, BA got a tattoo.
Mexicans decorate sugar skulls to remember their dead. The one inked on his leg has a heart and a rose for eyes. Written above the skull are the words Memento mori. Remember that you will eventually die. Remember that you are mortal.
Below the skull is another phrase: Memento vivere. Remember to live.
Put them together, BA explains, and you will remember: You, too, shall die.
So don’t forget to live. —MF
Ronin is a Christmas-loving wandering scribe who wanted to be a doctor, until he learned it meant cutting dead bodies open. He is currently finishing his MA in Asian Studies (major in Japanese Studies), while teaching journalism classes at UP Diliman’s College of Mass Communication.
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