Encouraging the Inclusion

of Children in Grief After a Sudden Death:

Memory Bags

C L I N I C A L N O T E B O O K

Author: Trish Foley, BA, MPS, Arlington Heights, Ill

Section Editor: Gail Pisarcik Lenehan, RN, EdD, FAAN

Trish Foley is Chaplain and Patient Advocate, Emergency Department,Northwest Community Hospital, Arlington Heights, Ill.

For reprints, write: Trish Foley, Northwest Community Hospital,800 W Central Rd, Arlington Heights, IL 60005;E-mail: pfoley@nch.org.

J Emerg Nurs 2004;30:341-2.

0099-1767/$30.00

Copyright n 2004 by the Emergency Nurses Association.

doi:10.1016/j.jen.2004.03.032

August 2004 30:4

The family is here. Those 4 words are dreaded by

ED staff when a death has occurred in the emer-

gency department. The words hold special signif-

icance for me; when I was 9 years old, I had already

experienced death and dying in my own family. One of

my brothers suffered severe head trauma, and another

brother died at the age of 13 years. He drowned while

swimming with friends after school. I remember it all as if it

were yesterday. Most of all I remember being pushed away

and being told I did not understand, to ‘‘leave your mom

alone, she’s upset.’’ This experience only pushed my pain

deeper into a place where it would take a long time to

access. This experience in part became the foundation for

my current career and my strong interest in children’s crises.

In times of pain and grief, children learn how to deal

with loss by watching adults, through what the psychologist

Kohut calls ‘‘mirroring.’’ The child learns from his or her

parent that it is okay to cry, to tell stories, and to feel sad or

angry, afraid or confused. Attempts by parents to ‘‘protect’’

their children from pain may possibly do more harm. A

case in point: One night during my chaplain internship, I

responded to a code blue on the Pediatrics Unit. The code

team was desperately trying to resuscitate a 10-year-old

boy, and despite their best efforts, the child died. This child

had been scheduled to be discharged later that day, so the

death was totally unexpected. I was with the mother during

the code. Afterward, the father raced into the unit with

their 7-year-old child. The doctor came to inform the

family that the patient had died. The 7-year-old began to

sob and the mother, perhaps thinking it comforting, told

him, ‘‘Don’t cry, be strong.’’ The child stopped crying.

During the conference between the physician and family,

JOURNAL OF EMERGENCY NURSING 341

FIGURE 1

Aidan holds his teddy bear in memory of a loved one.

CLINICAL NOTEBOOK /Fo ley

the parents requested that the child wait alone in the

hallway. The child stood there, still wearing his cowboy

pajamas, being separated from his parents when it seemed

he needed them most. I decided to stay with the child in the

hallway and told him that it was okay to cry when you feel

sad. I fought back my own tears as I held the child, realizing

later that I was doing for this child what no one had done

for me—giving him permission to grieve.

In our emergency department at Northwest Commu-

nity Hospital, we provide grieving adults with a packet of

information and resources regarding grieving, but we did

not have anything available for the children involved. After

a 6-week period during which there were 2 dozen deaths

involving young parents who died suddenly, I believed we

needed to offer something to children as well. We have an

active and vital pediatric service, and I arranged a meeting

with the coordinator of Pediatric Emergency Services and

the director of Children’s Services to discuss development

of a ‘‘Memory Bag’’ for children.

The eventual product we developed is a bag with the

hospital logo on it, as well as the sentiment, ‘‘I will

remember you.’’ Inside the bag is a handmade teddy bear,

a coloring book on working through grief for 2 age groups,

crayons, and a journal for children to write in. The costs

incurred were minimal. The teddy bears were donated by

Teddy Bear Ministries, a volunteer group from the local

Methodist Church, and the bags were donated by the

hospital’s foundation. The hospital community services

program funded our purchase of books and crayons.

The bag has been well received. I have distributed

dozens of bags, and in each case, children’s eyes have lit up

when handed the bag. Every child I have seen has hugged

his or her bear closely, sometimes crying into the bear

(Figure 1). One grandmother sent me a note to let me

know how important the bears are to her grandchildren,

and that they carry their bears everywhere they go.

Another time I saw 3 small children whose mother had

committed suicide. The children came in, clearly trauma-

tized at having found their mother. They clung to their

bags as if they were lifelines.

We would never tell someone with a broken limb to

bear it and be strong. We ask where their pain is and then

we treat it. A broken heart, however, we are not so

comfortable treating.

342

Telling someone not to cry is the same as telling

someone not to urinate. The body has the same need to

release physiological pressure. The inability to release such

physiologic pressures can result in physical manifestations

of this pressure, such as depression, headaches, and gas-

trointestinal disturbances. Grief is really about passion. I

believe that joy is feeling deeply for what we have and

sorrow is feeling deeply for what we have lost. Attached to

each teddy bear is a poem I wrote that I read to the

children as I give them the memory bags. It says:

The memory is important. We find meaning in being

able to ‘‘do’’ something, but memories are about learning

just to ‘‘be.’’ The gift memory bags focus on children and

bring the gift of closeness to other grieving family mem-

bers. Together everyone can heal the grief.

Acknowledgement

I gratefully acknowledge the support and partnership of the Coordinatorof Pediatric Emergency Services, Barb Weintraub, RN, MSN, MPH,CEN, and Kathy Ferket, RN, MSN, the Director of Children’s Services.I also thank Rosemary Kucewicz, RN, BSN, the director of the Emer-gency Department, whose vision and support enabled me to realize a lotof these dreams and ideas.

JOURNAL OF EMERGENCY NURSING 30:4 August 2004