You Just Received a Certified Letter in the Mail

You Just Received a Certified Letter in the Mail

Joan Johnson-McCloyn

April 3, 2011

Description exposure


This exercise is a training tool. It can be used to help individuals in the medical field to gain some of the feelings and emotions of dying and preparing for death. It is designed to help gain empathy for the patients and families they serve. Expect emotions and expect to be internally moved. That is the purpose.

Exercise Introduction

You just received a certified letter in the mail. Upon opening the letter there is a sheet explaining that a distant relative has passed away. This relative was financially well off and chose to bless all of his descendants, even the ones he did not know personally. There was a cashier’s check enclosed for $250,000.


In the table below fill in each of the columns with, the five most important people in your life, five places you would go, five items you would purchase, and five events that you would like to enjoy.

People / Places / Items / Events
Christie / New York / Wardrobe / Olympics
Jeremy / Easter Island / Home Theater / Skydiving
Richard / Australia / Swimming Pool / Son’s Graduation
George / Florida / Cadillac / Superbowl
Jane / Isreal / Home / World Series

After the money has been placed securely in the bank you relaxed and plan on the dreams you want to fulfill.

Your plans begin to change

You wake one morning shortly after this event to find that you just don’t feel well. Your energy level is down but you just can’t put your finger on the way you feel. A call to the doctor is in order. At the appointment the doctor decides to run a few blood tests. The next morning a call comes in from the doctor for a follow up visit.

The worry begins to mount

At your follow up appointment the doctor has you come into his private office for a consult and informs you that you need some extra testing. The nurse has already set up your appointments and you are given the schedule including you next doctor’s appointment.

The tests begin

After many tests you enter the private office of your doctor once more, to be informed that you have a form of cancer surgery is needed order. It will be touchy butyou are assured that everything looks good.

The money begins to shrink

Because of the cost of your surgery you must remove oneof the items from you list that you were going to purchase.

After the surgery but you are given the unfortunate news. The cancer has progressed you need an extensive regime of chemotherapy and radiation.

More money gets used

Because of your health remove two of the events that you wanted to enjoy and one of the places you wanted to go.

Your treatments are very expensive even with the good insurance you have. You will need to let go of two more of the items you wanted to purchase.

Your chemotherapy and radiation treatments are progressing but it is taking a big toll on your health, energy, and finances. You decide that you need to let go of two more of the places you wanted to go.

Isolation was not in your plans

You have another meeting with your doctor and are told that because of the drugs being administered and your compromised immune system you will need to be mindful of how many people you are exposed to. You will need to let go of two more events you planned to enjoy.

The choice of expensive hope

The doctor explains that there is research drug being tested that may help but the cost is not covered by your insurance. You let go of the other two items you were going to purchase to pay for this drug in the hopes that it may help.

Health vs. travel

Your health is so declined that you feel there is no possibility of the trip you had planned on so you let go of one more place.

Your grieving stages have begun

You now have one place and one event on your list. Your hopes are fading and the doctor is not giving you much hope. The treatments and drugs you have taken during your fight have taken their toll on you. You begin to question in your mind if you had been better off without the treatments, without the drugs, without the nausea, without even the doctors. Why has this happened to you? What did you do that was so bad in your life to deserve this? Could you have changed anything? What are your regrets?

The important people

You have five important people in your life. One of these people has a hard time dealing with sickness. They love you dearly but can’t take seeing you like this. Remove this oneperson from your list because they can’t bare the pain in their heart to see you in such a state of ill health.

Dreams fade away

You develop a serious infection and they place you in ICU. Between the cost involved and the state of your health you need to give up on the dream of the onelast place you wanted to go and theonelast event you wanted to enjoy.

Reality sets in

You are trying coming to terms with the end of life. You are in the ICU fighting for every breath you take. You are allowed to have two visitors in the room. Your life is passing before your eyes. You need to choose the two people you need to have in the room and take the other two off your list.

This is loss. This is grief. This is dying and death.

Exercise prologue

Although your patients have many different scenarios each begins to lose their hopes and dreams as their diseases progress. With the losses they endure they feel many things.....

Anger.....regret...... fear...... depression...... sadness

We have the privilege to serve people as they go through the emotions you have just experienced. Some go through it slowly, others faster. Their caregivers and families also give up their hopes and dreams and feel these emotions.

The care we give, if only for a moment in their day, helps them to know that someone cares, someone loves, someone is willing to listen. Their pain is not limited to the physical body it cuts deep into their souls. (Johnson-McCloyn, 2010)

The Stages of Grief (Kubler-Ross, 1969)

A Normal Life Process

Stages of Five Grief

  1. Denial and Isolation.
  2. Anger.
  3. Bargaining.
  4. Depression.
  5. Acceptance.

Grief And Stress

Recovering From Grief

A Normal Life Process

At some point in our lives, each of us faces the loss of someone or something dear to us. The grief that follows such a loss can seem unbearable, but grief is actually a healing process. Grief is the emotional suffering we feel after a loss of some kind. The death of a loved one, loss of a limb, even intense disappointment can cause grief. Dr. Elisabeth Kubler-Ross has named five stages of grief people go through following a serious loss. Sometimes people get stuck in one of the first four stages. Their lives can be painful until they move to the fifth stage - acceptance.

Five Stages Of Grief

Denial and Isolation.

At first, we tend to deny the loss has taken place, and may withdraw from our usual social contacts. This stage may last a few moments, or longer.


The grieving person may then be furious at the person who inflicted the hurt (even if she's dead), or at the world, for letting it happen. He may be angry with himself for letting the event take place, even if, realistically, nothing could have stopped it.


Now the grieving person may make bargains with God, asking, "If I do this, will you take away the loss?"


The person feels numb, although anger and sadness may remain underneath.


This is when the anger, sadness and mourning have tapered off. The person simply accepts the reality of the loss.

Grief And Stress

During grief, it is common to have many conflicting feelings. Sorrow, anger, loneliness, sadness, shame, anxiety, and guilt often accompany serious losses. Having so many strong feelings can be very stressful.Yet denying the feelings, and failing to work through the five stages of grief, is harder on the body and mind than going through them. When people suggest "looking on the bright side," or other ways of cutting off difficult feelings, the grieving person may feel pressured to hide or deny these emotions. Then it will take longer for healing to take place.

Recovering From Grief

Grieving and its stresses pass more quickly, with good self-care habits. It helps to have a close circle of family or friends. It also helps to eat a balanced diet, drink enough non-alcoholic fluids, get exercise and rest. (Mark R Brent, 1981)

Most people are unprepared for grief, since so often, tragedy strikes suddenly, without warning. If good self-care habits are always practiced, it helps the person to deal with the pain and shock of loss until acceptance is reached.

(Kubler-Ross, 1969) (Mark R Brent, 1981) (Johnson-McCloyn, 2010)


Johnson-McCloyn, J. (2010). Bereavement and Grief. Salt Lake City.

Kubler-Ross, E. (1969). The Five Stages of Grief.

Mark R Brent, H. U. (1981). An Attributional Analysis of Kubler-Ross'Model of Dying.

Teach me to DiePage 1