The Grief That Begins Before Goodbye

Anticipatory grief, the doorway, and the spiral that carries us after

By Abigail Bruce, NP

Holistic Nurse Practitioner, Certified Coach, Birth and End-of-Life Doula, and Nature Guide

The Candle and the Calendar

Twenty-five years ago this week, my mother, Mary, died. On the anniversary I lit a candle and watched the flame find its stillness in the July light, and I felt the old tide turn in my chest, right on time.

Grief keeps a calendar the mind forgets and the body remembers. Two nights ago, the tears arrived before the date did. I was out on an evening run when the sobs came up through me in waves, unannounced, the way weather moves in off the ocean. I did not fight them. I have learned not to. And then, that same day, I danced in my kitchen, longer and more freely than I have danced in years, and the joy was as real as the tears had been. Both were grief. Both were love. All of it carried on the same breath.

And this same tender week holds a second candle: the anniversary of a little sister, not by blood but by upbringing, who left this world far too soon. Two flames in one week. The heart makes room.

That morning I wrote to a friend who is like a big sister to me. We are family in the way that grief makes family: she is daughterless, I am motherless, and we belong to each other. Grief reaches for witness. I wrote about my mother. About the fears and the worry and the not knowing that began when I was seven. About how hard it is to be present when your mother is fighting for her life. About how we learn, in those years, to live in the betwixt and between and to see beauty in little things: joy in a smile, grace with the light.

And something happened that only writing to a true friend makes possible: I heard myself. In the mirror of her presence, I saw my own grief whole, maybe for the first time, and I saw that the country I had been describing has a name. It is the terrain I have spent my whole life learning to walk. The liminal. The betwixt and between. The grief that begins long before the goodbye.

If you are carrying a loss right now, recent or decades old, or watching one approach from the long before, I am writing this for you.

I write this as a daughter, and I write it as a guide. Over the years, so many of the people who found their way to me came in the wake of loss: parents, siblings, partners, best friends, loved ones of every kind. Some lost suddenly, in a single phone call. Some slowly, across years of watching. And I have walked the other side of the threshold too, companioning the sacred passage of those who are dying, as an end-of-life doula and minister of ceremony, just as I have stood at the door where life arrives, as a birth doula. Along the way there have been ceremonies for conscious uncoupling and for recommitment, for endings and beginnings of every kind. Different doorways. The same terrain.

In all of it, my work is never to hand someone a map. It is to help each person find their own healing passage: to face what is here, to allow it, accept it, transmute it, and anchor into their own knowing, their own power, their own sovereignty. And then, with the grace of God or the steadiness of their own higher self, to learn to love again, to create joy, and to let delight and wonder sprinkle themselves in between the dark places. That is the spirit in which I offer what follows.

The Long Before

I was seven years old when my mother was diagnosed with cancer. I did not have a word for what began in me that year, but I can tell you exactly how it felt. It felt like living in two worlds at once, the way anyone watching a loved one through terminal illness, a slow decline, or an addiction that pulls them in and out of reach learns to live. There was the bright, ordinary world of school and horses and summer, a girl growing up. And underneath it, always, there was the other world: the hospital smell, the hushed voices, the studying of my mother’s face for news, the knowing that could not be unknown. She would not be here forever. The ground I stood on was already moving.

Life would ask me to learn this country twice. Years after my mother, there was another long before: a sister of my heart in whom we began to see the loss and the distancing well before the goodbye came. A different disease than my mother’s. The same terrain. The long before does not always look like hospitals. Sometimes it looks like someone slowly slipping out of reach while still standing in the room.

And sometimes the long before looks like a disease that takes the body a piece at a time. Cancer. Huntington’s. ALS. Parkinson’s. Dementia. The slow unlearning of what a body could once do, while you stand beside your parent, your partner, your best friend, carrying what may be the heaviest feeling in all of caregiving: helplessness. You cannot fix it. You cannot stop it. You can only love them through it. And almost no one tells you that this loving-while-losing is grief, already begun, or that the helplessness is not a failure in you. It is the honest weight of loving someone a disease will not give back.

Clinicians now call this anticipatory grief, and research has caught up to what every child of a long illness already knows in her body: the grieving truly does begin before the loss. Studies of family caregivers describe it as pre-loss grief, a real and measurable sorrow that rises and falls across the years of an illness. And here is the finding I most want you to hear. A recent review in the nursing literature concluded that support given to families before the death, presence, communication, accompaniment through the dying, may soften the anxiety, depression, and grief that come after it. The work of the heart cannot be done in advance. But the heart can be held while it works, and being held changes everything that follows.

No one held that language out to me at seven. What held me was the barn. The horses knew. They always knew. They read my small body the way only animals can, and they let me lean my fear against their enormous calm. Nature was my first grief companion, decades before I would stand beside my own clients in the cold Pacific or under the redwoods and watch the living world do for them what it once did for me.

Anthropologists have a name for the country my family lived in through those years. Arnold van Gennep mapped it more than a century ago, and Victor Turner gave it the phrase I love best: betwixt and between. The liminal, from the Latin limen, meaning threshold. It is the middle passage of every rite of passage, the place where you are no longer what you were and not yet what you will become. Turner understood something most of us are never taught. The in-between is not a hallway to hurry through. It is sacred ground. It is where transformation actually happens.

A family living with serious illness lives on that threshold for years. You learn to hold hope and fear in the same hand. You learn that presence is the only real currency, because the future is not yours to spend. And you learn, if you are lucky and loved, to find beauty in small things. My mother taught me this herself, from the infusion chair. Even there, especially there, she pointed me toward the humor, the wonder, the awe hiding in people and animals and gardens and mountains and cups of tea. She called them the pearls of the day, and she strung them right through the middle of her dying. That was the strange gift folded inside the hardest years of my childhood. The long before taught me to be awake.

The Doorway

Then there is the death itself. I call it the doorway, because that is what it was.

My mother was a nurse and a midwife. She worked the threshold where souls arrive. I became a nurse who accompanies people through the thresholds of birth, illness, and dying. The family trade, it turns out, is doorways.

Every wisdom tradition I have studied, East and West, treats death as a threshold rather than a wall. The Tibetan teachings speak of the bardo, the between-state that consciousness moves through. The Celtic world speaks of thin places, where the veil softens. My nursing life has taught me the same truth in plainer clothes. I have been present at deaths, and I have been present at births, and the room feels the same. Enormous. Quiet at the center. A door standing open.

When my mother crossed that threshold, I stood on this side of it, far too young and suddenly motherless, and the world reorganized itself around her absence. What I did not know then, and want you to know now, is that the doorway changes both of you. She went through it. And I became someone new on this side of it: a woman initiated, early and against her will, into the deepest curriculum a human life offers.

Because here is what I believe, after a lifetime of walking beside people through illness, birth, and dying. We are souls having a profoundly human experience. We come into these bodies the way divers zip into wetsuits, and we go down into the whole ocean of human feeling. Nothing here is forbidden. Joy, terror, tenderness, rage, wonder, boredom, ecstasy, grief. All of it is included in the price of admission. Grief may be the deepest dive of all, and even so, it is not a malfunction of the human experience. It is the experience. It is love, continuing, in the only form left to it.

The Spiral

We were taught that grief moves in stages, a tidy staircase that climbs from denial to acceptance, and then you are finished. I want to say this as plainly as I can, as a clinician and as a daughter. That is not how grief moves. Twenty-five years in, I can tell you: grief moves in a spiral.

Bereavement researchers Margaret Stroebe and Henk Schut describe healthy grieving as an oscillation, a natural swinging between turning toward the loss and turning back toward life, and they are clear that this movement can continue for a lifetime. Grief has no finish line. At anniversaries, at weddings, at the birth of a child, at one song on the radio, the pendulum swings back toward the loss. This is not relapse. This is rhythm. The ocean does not fail when the tide comes back in.

The spiral is the shape I trust most, because it is the shape of so much that is alive: the nautilus shell, the fern unfurling, the far arms of the galaxies, the whorl of a fingerprint. A spiral returns to the same place, but never at the same depth. Every year I circle back to this week of July, and every year I meet my mother’s death from a new turn of my own becoming. In my twenties I met it as a young woman still raw at what was stolen. In midlife I met it as a healer who finally understood what those years had made of me. This year I meet it as a woman who ran sobbing under the evening sky and then danced in her kitchen, and understood that both were prayers.

Only a week before this anniversary, the spiral showed me its whole range inside a single drive. I was heading into the city for work with eighties music up loud, feeling young and vibrant, when I felt my mother’s spirit arrive: a familiar wave that rarely comes, and is unmistakable when it does. For a moment she was inside me, hands on the wheel, singing joyfully, her strong arms, her smile, her sweet voice. A moment later it was as if I sat in the passenger seat, looking at her tenderly, remembering the joy we shared driving and singing together: James Taylor, the Beatles, Dido, or chanting in harmony until the car sounded like a monastery, like Hildegard von Bingen, a powerful woman of her time who channeled the voice of God. Then Forever Young came on, and in an instant I felt my mother’s sadness. Her fear. Her grief that she would not be living much longer. I felt it as if it were my own. She was forty-seven then, the age I am now, four years before she would die. Still fighting. Still determined to be a mother to my sister and me, a wife, a sister, a friend, and a nurse to those in her care. There it is, the spiral. I cried the rest of the way to work, fully accompanied by my mother’s spirit, joy and grief and love sharing the same stretch of freeway.

What let me walk into work and be present for the people who needed me was not pushing the wave away. It was a practice I teach called jarring. Think of catching fireflies. You gather the feeling gently into a jar, alive and glowing, never sealed forever, because you see it and you know it must be set free. But you keep it safely for now, so you can get on with your day, and later, when there is time and space, you open the jar and let the wave move all the way through you. Grounding, clearing, and years of my own healing work let me pivot into the present without abandoning her, or myself. That is not suppression. Suppression pretends the firefly does not exist. Jarring honors it, and promises it the open sky.

And this is what I most want you to know about the spiral: it does not only return us to sorrow. It returns us to joy. The same turning that brings back the ache brings back the singing, the strong arms, the sweetness of everything that was real. A spiral of grief is always, in equal measure, a spiral of love, and some years the turning comes up on the joy side first.

When my beloved elder cats died, two Septembers apart, companions who had witnessed my entire adult life, the grief for my mother spiraled up alongside them, fresh, and asking for new eyes. Not because I had failed to heal. Grief is grief is grief, the way pain is pain is pain: each new loss calls up the echoes, and we are reminded of our big hearts, our passages, and how far around the spiral we have come. I was no longer the girl of seven or twenty-one. I could cry it all the way through on an evening run and then dance in the middle of a field, grounded, feeling deeply, still able to play. That is the mystery of the spiral.

I tell you all of this not because my grief is special. It is not. I tell you because yours moves the same way, and because someone needs to say to you what no one said to me: the return of old grief inside a new loss is not a setback, and it is not a sign you never healed. It is the spiral, working.

That is the secret the spiral teaches. We do not grieve the same loss over and over. We grieve it anew each time, as the new person we have become, and every turning of the spiral is also a turning of consciousness. Grief, met honestly, is one of the great awakeners. It strips away the trance of someday. It asks the only questions that matter. Who are you, now that this has happened? What is this one life for? What will you love, knowing what love costs?

The Bond That Does Not Break

There is one more thing the old models got wrong, and the correction matters too much to leave out.

For most of the last century, the stated goal of grieving was detachment. Cut the bond. Let go. Move on. Then researchers began actually listening to the bereaved. Dennis Klass and his colleagues, sitting with parents who had lost children, found that healthy grievers do not sever the relationship at all. They continue it. The bond changes form, moving inward, becoming memory and ritual and conversation and felt presence. This continuing bond is now understood as an adaptive, healthy, even beautiful dimension of grief, not a pathology to cure.

Neuroscience has now followed the bereaved into the scanner and found something breathtaking. Grief researcher Mary-Frances O’Connor describes the brain as holding two truths at once: the memory of the death, and a deep encoding of the loved one as everlasting, still ours, still somewhere. She calls grieving a form of learning, slow and experiential, as the brain works to reconcile gone with everlasting. Sit with that for a moment. The most rigorous science we have looked into the grieving mind and found, written into our very neurons, the refusal to file love under finished.

Twenty-five years on, I can testify. My mother and I are still in relationship. She is in the candle I lit for her this week. She is in the way I hold a frightened client’s hand, because I know what it is to be the frightened one. She is in the horses, still, and in the garden, and in the sea. Love is not interrupted by death. It is translated.

And when the waves come, as they came for me on that run, I let them. It is what I tell my clients, and what I found myself writing to my friend that morning. Honor the waves. Do not hold them in. The tears are not the wound. The tears are the healing, moving.

If You Are in the Before

Maybe you are reading this from the long before. Someone you love is ill, or aging, or caught in an addiction, or slowly leaving in any of the ways people leave while still alive, and you are living in two worlds, the way I did at seven. If that is you, I want to offer you what no one offered me. And if the person you are grieving is still here, hear this first: what you feel is grief, real grief, and you are allowed to call it that.

You are not grieving wrong by grieving early. What you feel is real, it has a name, and you do not have to hold it in until the ending makes it official.

Let yourself be in the between. You do not have to be hopeful all day or heartbroken all day. You are allowed to swing, to laugh in the hospital hallway, to cry in the grocery store, to feel numb on an ordinary Tuesday. The swinging is the health.

Go outside. This is the nurse in me and the nature guide in me speaking with one voice. Research keeps finding that time in the natural world is associated with better mental health and wellbeing, and I have watched the forest and the shoreline hold what people cannot yet say. Walk. Put your hand on a tree. Let something ancient and alive stand beside you. If you are curious what that can look like when it is held with intention, I have written about what really happens in a nature healing session and about the quiet medicine of wonder.

And be with them. Presence is the practice. Not fixing, not performing hope. Just being there, awake, in the unrepeatable now of their company. My nursing lineage, Jean Watson’s Caring Science, teaches that a single authentic caring moment between two people is itself healing, for both. Your presence is not a lesser offering than a cure. The time you are dreading losing is still here. Do not miss it by grieving it so completely in advance that you forget to live it.

One Breath, Both

Tonight the candles will burn down. And somewhere, someone reading this is holding her heart in her hand, setting the table for sorrow and celebration at once, because that is what love does. It calls the whole feast holy.

Twenty-five years have taught me this. Grief is not the price of love. Grief is love, walking the spiral, learning the terrain of the betwixt and between, waking us, year by year, to what we are: souls in human wetsuits, diving deep, missing each other across the veil, and finding each other again in candlelight, in horses, in songs that make us dance, in the exquisite range of joy and tears carried on one breath.

If you are walking this terrain now, in the before, at the doorway, or somewhere along the long spiral after, you do not have to walk it alone. Accompaniment through the liminal seasons of a life is the heart of my work, and it would be an honor to walk beside you. You are welcome to reach out for a free discovery call, or simply to begin by stepping outside tonight and letting the sky hold you.

Light a candle. Honor the waves. Notice the pearls of the day. And do not miss your own becoming.

Keep reading

Soaked and Grinning, Still Walking the Bridge, on courage, wonder, and grit for big change.

How to Survive & Thrive During Major Life Transitions, for when the change is already underway.

The Quiet Medicine of Wonder, on letting yourself be moved, right where you stand.

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Abigail Bruce, MS, ANP-BC, APHN-BC, is a double board-certified Integrative and Advanced Practice Holistic Nurse Practitioner, certified life coach, hypnotherapist, meditation teacher, intuitive and nature guide, birth and end-of-life doula, and non-denominational minister licensed for ceremony and marriage in California, based in the San Francisco Bay Area, working with clients in person and online, including in Chicago, New York City, and Charlotte. Her holistic mental health practice includes a longstanding collaboration of more than a decade with a board-certified psychiatrist. She presents on holistic mental health, most recently at Medscape Psychiatry in Chicago, and welcomes invitations to speak, teach, and join podcast conversations on grief, life transitions, and nature-based healing. An avid trail runner and lifelong animal lover, she lives close to the redwoods, horses, and coastline she writes about. Coaching, hypnotherapy for wellbeing, and nature immersion sessions are offered in support of whole-person wellness and are not a substitute for medical or mental health diagnosis or treatment. The personal stories in this piece are the author’s own; in stories from her practice, names and identifying details may be changed or blended to protect privacy.

Sources

Turner, V. (1967). Betwixt and Between: The Liminal Period in Rites de Passage. In The Forest of Symbols. Cornell University Press.

Nielsen, M. K., Neergaard, M. A., Jensen, A. B., Bro, F., & Guldin, M. B. (2016). Do we need to change our understanding of anticipatory grief in caregivers? A systematic review. Clinical Psychology Review, 44, 75-93.

Schwalbach, T., et al. (2025). Family bereavement support interventions in specialist adult palliative care: A rapid mixed-methods systematic review. Journal of Advanced Nursing.

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.

Klass, D., Silverman, P. R., & Nickman, S. (Eds.). (1996). Continuing Bonds: New Understandings of Grief. Routledge.

O’Connor, M.-F., & Seeley, S. H. (2022). Grieving as a form of learning: Insights from neuroscience applied to grief and loss. Current Opinion in Psychology, 43, 317-322.

Watson, J. (2008). Nursing: The Philosophy and Science of Caring. University Press of Colorado.

White, M. P., et al. (2019). Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Scientific Reports, 9, 7730.