By Jessica Judge, LICSW APHSW-C
Old Colony Hospice & Palliative Care
“It’s his smile.”That was what I heard that got me thinking about the cumulative loss that occurs in chronic and terminal illness. We often talk about grief in terms of physical loss, the loss that comes after death. But when someone is diagnosed with a terminal illness, grief often begins long before that moment. It arrives alongside fear of the unknown, an unexpected chapter no one imagines being part of their story.
As we begin to lose pieces of the person who is dying, reality sets in. The subtlest changes can be the most emotionally impactful. In these everyday moments and quiet realizations, we may find ourselves grieving in silence.
Anticipatory grief is the natural emotional response to an impending loss. As a caregiver, friend, or family member, you are asked to navigate the complexity of living in two realities at once, trying to stay present while also imagining life without this person. Anticipating loss can lead us to predict outcomes that may never come to fruition. It is human to begin forming a narrative before the story has fully unfolded.
So how do we balance the anxiety and sadness of anticipatory grief with the need to remain present?
Too often, I hear people say, “I know it’s bad, but I feel like she/he is already gone.” Feelings of guilt are normal, shaped by societal expectations of what grief is “supposed” to look like. But the truth is, grief, both anticipatory and after loss, does not follow a linear path. It is deeply personal and unique to each individual experiencing it.
In the depths of grief, it is easy to lose sight of what once helped us cope. When our minds feel pulled in competing directions, it can be grounding to return to something simple and human: our stories.
We all carry stories shaped by our experiences and connections. These stories become our memories, our legacies, and the moments we return to for meaning. It is important to give yourself the space and grace to feel sadness, while also recognizing that pain and joy can coexist.
In end-of-life care, clinicians often use the term “life review,” which is a practice rooted in storytelling. Through storytelling, we remember moments of joy, faith, pain, laughter, sorrow, and perseverance. We reconnect with the person beyond their illness.
In a world where stories are shared instantly on social media, I sometimes wonder if we are losing something tangible, something lasting. Printed photographs and photo albums feel like a forgotten treasure. And yet, when words are hard to find and silence takes over, they can become something more: a therapeutic tool, a bridge to connection, a catalyst for storytelling.
A photo album cannot stop loss. But it can remind us, gently and powerfully, that even as we grieve what is changing, we can still hold on to what has been. And in that space, grief and joy are not opposites, but companions.
About the Author: Jessica Judge has been a hospice social worker for just over five years and a medical social worker for 10 years. She holds a special place for working with families and patients through stages of advanced illness. For more information, email info@oldcolonyhospice.com.
