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End of Life: A Family Narrative

End of Life: A Family Narrative SAGE-Hindawi Access to Research Journal of Aging Research Volume 2011, Article ID 105985, 7 pages doi:10.4061/2011/105985 Research Article 1 1 2 1 Helen K. Black, Miriam S. Moss, Robert L. Rubinstein, and Sidney Z. Moss Behavioral Research Institute, Arcadia University, 450 South Easton Road, Glenside, PA 19038, USA Department of Sociology and Anthropology and Center for Aging Studies, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA Correspondence should be addressed to Helen K. Black, blackh@arcadia.edu Received 19 October 2010; Accepted 16 March 2011 Academic Editor: Laraine Winter Copyright © 2011 Helen K. Black et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper is based on ethnographic research that examines family reaction to an elderly husband and father’s end of life. From a group of 30 families in our study (family defined as a widow aged 70 and over and two adult biological children between the ages of 40 and 60), we offer an extreme case example of family bereavement. We report our findings through the open-ended responses of a widow and two children who were interviewed ten months after the death of the husband and father. Three general themes emerged: (1) how the family imputes meaning to the end of life, (2) changes in the roles of family members, and (3) the family’s ways of coping with the death, particularly through their belief system. A key finding is that the meaning family members find in their loved one’s death is tied to the context of his death (how and where he died), their perception of his quality of life as a whole, and their philosophical, religious, and spiritual beliefs about life, death, and the afterlife that are already in place. 1. Introduction Ourpaper contributesto the literature on endoflife and family bereavement by placing the death of an elderly man in The trajectory of family life—incipience, development, and the cultural context of his family’s narratives about his dying decline—includes the end of life. An important aspect of end and death. First, we examine the salient terms used in our of life studies is the context in which death occurs [1, 2]. In paper, such as the nature of the family, family roles before and the case of an elderly husband and father, his family members after the husband’s and father’s death, and finding meaning are usually participants in the end of life process and in his life and death. We describe the methods we used in our interpreters of the meaning of his death [3]. Much has been research, present findings through a unique case study, and written about this stage by scholars in various disciplines offer a discussion. [4–7], yet there is little research on the responses of family members as a family when asked how death occurred for 2. Finding Meaning through Belief Systems their loved one and its meaning to them. Our paper springs from a study entitled “The Meaning of In this paper, we view religion, spirituality, and the syn- the Death of the First Elderly Parent: A Family Perspective,” cretized belief systems of individuals and families as a cultur- which investigated family (including the wife/widow and ally and socially driven way of forming values about the end two biological adult children) members’ reactions to the of life. Personal belief systems are tools used to interpret the husband and father’s end of life. This paper explores how one world and what we see within that world [8]. A belief system family communicated their experiences in the forum of the both provides and seeks meaning in the wake of negative research interview. We focused on how family members events. made meaning of the husband and father’s end of life In regard to dying and death, a crucial aspect of a belief throughtheir rolesin the family, and theiruniquewaysof system, whether formal religion, personal spirituality, or coping with anticipated and actual loss, especially through a folk religious belief, is in its functions of creation and their belief systems. continuity. A belief system creates or discovers an answer to 2 Journal of Aging Research the why of suffering and to the meaning of life and death them using standard methods of qualitative research. This [9]. A belief system may also attempt to create or maintain method includes data review, which asks the broad questions, continuity with the deceased in a way that makes sense to the “What is in the data?” and “How is this data relevant to the bereaved and their notion of the loved one’s and the family’s topic under study?” The next step is a large level sorting of singularity [10]. each transcript, which codes for broad themes and topics intraindividually [14, 15]. We also did fine-grained analyses, which include coding for subthemes and patterns within 3. Methods respondents’ entire transcript. Our method enabled us to better understand the respondents’ interpretations of ques- 3.1. Theoretical Framework. We situated our research in tions we asked them. The data we used in this paper emerged a theoretical approach to end of life experiences that is from gross level sorting and fine-grained analysis. We note social constructionist in nature [11]. This approach is that as new data were transcribed and ideas and themes based on three frameworks. The first is phenomenology emerged, we back checked them selectively or universally and the sociology of knowledge, which focuses on how with data from respondents who had already completed an people understand everyday life and see meaning making interview. and interpretation as key human actions. The individual is the creator of a personally meaningful world of lived experience and is best able to explain his world [12]. The 3.3. Rationale for Use of the Case Study. Our use of one family second is drawn from the psychology of religion, which (three persons, the widowed mother, and two adult children) is strongly cultural and shows belief systems as cultural to illustrate the family responses to the father/husband’s lens through which individuals interpret and restructure end of life justifies the case study method as a necessary negative experiences [9]. The third is rooted in contemporary and sufficient means of showing a phenomenon of lived bereavement theory which explores family interactions at the experience. In this case, it is the family’s perception of the end of life, the meaning of loss, the tie with the deceased, and meaning of the husband and father’s end of life [16]. expressions of mourning within the family context [13]. We use the case that follows because it shows a con- centrated family experience. That is, all members of this family—father, mother, and three adult children—lived 3.2. Data Collection and Analysis. This paper emerges from together in the family home for over 50 years. Their enduring data collected from NIA-funded research “The Meaning of intimacy with each other created a unique context for a the Death of the First Elderly Parent: A Family Perspective.” family response to the end of life and produced insight into In the original study we interviewed 30 families, consisting of the goal of our research: the exploration of how a family a widow aged 70 and over and one or two adult children, aged comes together around the decline of the elderly father 40 to 60, from six months to one year after the father and and husband and whether the family makes a collective husband’s death. We recruited respondents from the notice meaning of his death. The case study disclosed the family’s of death that appeared in local newspapers. We collected united experiences of grief, as well as, each member’s data for this study through formal ethnographic interviews unique perception of the death due to having a particular and informal conversation. Data were processed through relationship with the deceased [16]. audiotaping and transcription for analysis or detailed in We used three themes to organize major aspects of the analyzable field notes. The case that follows was culled from family’s narrative: (1) how the family imputes meaning to both processes. the end of life; (2) the past and present role of each family The subjects of this paper had private interviews in their member and, (3) the family’s ways of coping with the death, homes approximately ten months after their loved one’s particularly through their belief systems. We see the themes death. Each interview lasted approximately two hours in two as interrelated. That is, finding meaning in a loved one’s sessions. An IRB-approved consent form was obtained from death is an aspect of coping with loss. Meaning can also be each family member at the beginning of the first interview. found through: (1) recalling his good works and death as an The main tool of the study was the semistructured end to his suffering, (2) a belief system that assures his exis- interview schedule, which included open ended questions tence in an afterlife, and (3) continuing or expanding each that spanned two sessions. The first interview session focused family member’s present role in the family. Three themes on the reaction of the interviewee to the husband or emerged from our data, based on family members’ answers father’s decline and eventual death. This interview also to interview questions, spontaneous remarks throughout explored the respondent’s opinion of his end of life care. the interview, and our interpretation of their nonanswers, The first interview also examined respondents’ reactions silences, pauses, emotion, and body language. to rituals performed after death and beliefs about religion, spirituality, and an afterlife. The second interview asked for opinions related to other family members’ reactions to the 3.4. The Marino Family (a Pseudonym That Reflects the Ital- husband and father’s dying and death and an assessment ian-American Background of This Family). We present the of relationships among family members in general and Marino family. Joseph Marino, Sr. died in February of 2009, specifically in relation to the loved one’s end of life. ten months before the start of our interviews. He was 87 The general approach to data analysis in the project and a survivor of colon cancer, open heart surgery, and a was as follows: after transcribing interviews, we analyzed minor stroke. He endured several other health problems for Journal of Aging Research 3 two years prior to death. His widow, Frances, is aged 84. He must have suffered terrible, but he never let The couple had been married 64 years at the time of his us know. “Cause he looked like Omar Shariff death. Their first son, Joseph, Jr., is a lawyer. At age 62, he until the day he closed his eyes.” He was going to has never married, is semiretired, and works from a private doctors all the time to get blood work done. He office in the family home. The middle child, Cub, is 60 years finally said, “No more doctors. No more blood old and also single. He held odd jobs throughout life and work.” His body was tired. is currently unemployed. Pauline, the 52-year-old daughter When asked to tell the story of her father’s death, Pauline and youngest child of the family, is “between jobs.” Although said: she left home to marry when she was in college, she returned after the two-year marriage ended in divorce. Joseph Jr. lived It was Saturday morning. He kept saying to my away from home for six years on an extended work project. mother,“Fran,when you coming in?” He could He returned home when the work was completed. Cub never not stand to be in a room without her. And I left the family home. heard her go in and scream over and over. We According to family members’ accounts, Joseph Sr. sat all ran in. No stress on his face. I think it was a alone in the kitchen on a Saturday in February, 2009. All peaceful death. And his father passed away the family members were home and in different rooms of the same way. It was like in the Godfather movie. large suburban house. Frances “heard a thump,” ran to the kitchen, and found Joseph Sr. on the floor, next to his Although “knowing” he was “fading at least a year before chair. All family members responded to Frances’ scream. In his death,” Pauline clarified that no one in the family retrospect they believe that he “just slipped off the chair” and “expected” him to die. She explained: “My father was the died. cement of the family.” Family members agreed that Joseph Sr. gave the family its purpose as a family. The metaphor 3.5. Themes. We explore how the Marino family reacted to of cement was apt and recurring in Pauline’s narrative. Joseph Sr.’s end of life within three inter-related themes: Joseph Sr. was a stone mason, construction worker, and (1) how the family imputes meaning to the end of life; (2) the carpenter. He had built their home, its “insides,” and its past and present role of each family member; (3) the family’s several additions “with his own hands.” ways of coping with their experience, particularly through Because of his central role in the family, Pauline feared their belief system. that the “entire family” might “come apart” when Joseph Sr. Family members organize thoughts and feelings sur- died. rounding the loved one’s end of life in the interview nar- rative. We suggest that individual and family belief systems Before he died, I was frightened. I did not know provide a way to discover meaning in the life and death of how I was going to react. God forbid the day the deceased, as well as, an important means of coping with it would happen, I thought we would all be loss [17]. hysterical. We were upset and sad, but he died in his own chair and his own home. And we all rallied together because he kept us together 3.5.1. Theme One: How the Family Imputes Meaning to the because he was at peace. End of Life. Pauline was the first person interviewed in the Marino family. As the youngest child, Pauline believes For Pauline, the meaning of her father’s death emerges that throughout her life she was considered “special” and from the precariousness of her position in the family, despite “protected” by her father and grandfather, who lived with the the family unity she felt when he died. She now feels “at family when she was a child. When asked, Pauline described the mercy” of her brother, Joseph, Jr. and his “controlling” the last year of her father’s life. personality. She believes that her childhood fear of him stunted her ability to trust people. He had a stroke the day before New Year’s Eve, 2007. Within the next year he really went down. My brother used to be boss of all the attorneys at But they never diagnosed anything. He dropped N Corporation. So he thinks that now my father a lot of weight. Then he developed urinary infec- is gone... It started from when I was a child. My tions. He got inflammation of the blood and parents both worked. My grandfather used to they could not find what caused that. I’m big protect me, then he passed away but I could tell on holistic things like cranberries for infections. my father when Joseph (Jr.) bullied me. When it But nobody listened to me. My mother was in was just me with Joseph, he would put me in the control. My oldest brother was next in line. chair in the corner when I was bad, or scare me Pauline notes important family characteristics. There is about monsters and I would scream and cry. I a long-standing family hierarchy, and because she is the said, “You wonder why I am the way I am today.” youngest child and a daughter, she occupies the bottom See, even though the last two years (of father’s rung and feels disrespected and unheard. She also attributed life)he was notabletodoanything anymore, qualities to her father that the family agreed upon: he was an it was just that physicalness of him being here, uncomplaining, loving, and “handsome superman.” protecting me. 4 Journal of Aging Research Pauline suggested that the meaning of Joseph Sr.’s life To his family, Joseph Sr. was literally “larger than life.” and death centers in their home; the house itself symbolizes Although Joseph Jr. believes that his father loved his children his attributes, such as physical strength and protection. But equally, his father was especially proud of the authoritative the meaning of the home has changed for Pauline. She positions Joseph Jr. held in the corporate world. “It was commented, “My father had a strong physical presence. It’s important to my father that we stay together and that I take gone out of the house. It’s cold in here.” care of the family. I take this seriously.” Joseph Jr. described Joseph Jr. agreed with Pauline that the family “came himself as the family member that others turn to. When together” at the end of his father’s life. He attributed his asked who supplied support when he was grieving, he replied strength and the family’s solidarity to prayer. evenly: I told you I prayed to have strength to accept this We all ran into the kitchen that day in February. when it came. We bonded together in an hour But I knew his time had come, and I felt thankful of pain. They all look to me now. Not that I because it looked like he went to sleep. And I could take my father’s place, but if push comes knelt down and kissed him, and held his hand to shove, I’m the one they come to. I see the and told him how much I loved him. The Lord loss of my father had its toll on my mother. My granted my wish—I was able to accept it because brother and sister have enough to contend with Iknewhis time hadcome. their own lives. So grieving is a luxury I cannot afford. Similarlytothe wayPauline describedher father as “tired,” Joseph Jr.’s phrase, “his time had come” suggests that Joseph Jr. said that the family is “different now. What’s his perceived readiness erased visions of Joseph Sr. fighting missing in the family is this sense of a rock. Now that he’s death. All family members, however, believe that Joseph Sr. gone, we’re not the same, we’re less.” This statement describes was afraid of dying. Joseph Jr. also feared his father’s death, the family’s sense of depletion. but for reasons different from Pauline’s. Frances, Joseph Sr.’s widow, believes “it’s a lie” when someone says they are prepared for a loved one’s death. She His death was something I feared for the last always told her husband, “You can die one day after me; fiveyears. Hewas failingphysically.Iprayed for not before.” Because “it was difficult to see my superman the Lord to give me strength to bear God’s will. failing” and she knew he was afraid of death, the couple never A few days before he died, my father said, “I’m discussed this subject. not going to any more doctors or any hospitals.” He aged magnificently. He never looked ill, he When we went to bed, he would always say, “See just got even better looking. The nurses that you tomorrow.” He did not say it Friday night. came here would say that to me. He was a But we all kissed him, as was our tradition. He superman; he looked like a superman. A few had a feeling his time was coming. It was a days before death, he became just a shell of a bitter-sweet experience. Bitter because we lost person. ourfather and the centerofour family. But sweet in that it was a fitting end for a good man. Frances said that she found meaning in her husband’s In fact, Saint Joseph, as you might know, is the death by participating in our research. “We’re not educated patron saint of a happy death. for death and we should be.” She regrets that they did not talk about death but she knew he was “unable.” She laments One meaning that Joseph Jr. found in his father’s life and that she did not “assure him that I loved him just as much as death was to emulate him, despite believing he would never he loved me,” and hopes he was unaware of how impatient reach his father’s stature. she feltattimes. I wish I had my father’s physical capabilities, his In the last year he’d go in the shower but he personal courage and fortitude. He was fearless. could not do it by himself. I would go in with If somebody threatened us, he was like a raging him and bathe him. I would help him on with lion. And just to be good the way he is. But I just his clothes; I would cream his face. And he do not have that innocent goodness he had. would just look at me and say, “I cannot believe Interviewer: What do you mean by innocent you have to do this.” I’d say, “Joe, if the shoe was goodness? on the other foot, you’d do this and more, too.” Joseph, Jr.: It’s that he did not really hate He was astounded by how much I did for him people... with the exception of one cousin who without him asking. disrespected my mother. But he would not talk She found another meaning in her husband’s ill of people. And he would take great joy in death. a nice tomato in the yard, or after he finished He loved me so much; he adored me. A highlight doing some concrete work. But as I’ve gotten of his life was when I decided to go out with him, older I’m doing better at it. He was physically when we were engaged, when we got married, very strong. His little finger was the size of my and when we had children. I realized after he thumb. died that I loved him as much as he loved me. Journal of Aging Research 5 Unlike other widows in our study, Frances noted that Joseph said his role as “head of the family” was given to him another meaning she found in her husband’s death is that symbolically by his mother a few years before his father died. she “must be there more” for her children. She also feels, One day she got up from her seat at the foot of the table and similarly to other widows in our study, that she is paying a said to him, “You should sit here now.” He felt honored. great price for being so beloved by her husband. “Without Joseph Jr. described his father’s relationship with Pauline him, my life has very little meaning.” as “doting.” He thinks his father was “frustrated” with Cub because of his weak work ethic. And although Joseph Jr. sees himself as taking on his father’s role due to his “ranking, 3.5.2. Theme Two: The Past and Present Role of Each Family Pauline definitely does not see it that way, and Cub sees me Member. The most important role in the family continues as a usurper, taking my father’s place, but with no right to to be held by Joseph, Sr. Perhaps because he remained the do so.” Joseph understands that “Pauline thinks I’m trying “cement” of the family even at the end of life, his widow’s to be the boss. While my father was here she knew I could and children’s roles seemed less definitive after his death. The not be in control.” Pauline often threatens to leave the family family wondered whether their roles still existed or whether home when their mother dies. Joseph Jr. thinks “she’d feel they could carry out those roles. lost without my brother and myself.” During our first interview, Joseph Jr. described his father Pauline admitted she is afraid of the future; life without with adages that mythologized him, such as “good as bread”, herfatherrepresentsa lack of security. Both Frances and “like Saint Joseph,” and “the Saint Joseph of the neighbor- Joseph Jr. recognize Pauline’s vulnerability, but they view it hood.” Both Pauline and Joseph Jr. described their father as “a differently. Frances remembers that Joseph Jr. helped Pauline saint.” Frances disagreed and said she had a more “realistic” out financially “countless times” and will continue to do so. view of her husband. She remembered that the children She knows that Joseph is “glad” to help his siblings “with always “looked up to Joe, whereas I had the firm hand.” As money.” Yet, Frances recognizes that the help Pauline needs disciplinarian, she thinks she was considered the “bad guy” is more emotional than financial and worries that Joseph Jr. by her children. The adult child she most worries about is does not share this understanding. Joseph reiterated: Pauline. Now I’m the head of the family. My mother She was always a challenge. She never really did thinks that way too. So for that reason I sort of anything with her life, with her education. My publicly defer to my mother as being the head of husband spoiled her. She was supposed to go the family, but it’s really me. on to become a lawyer, like her brother. Then she got married, then she got divorced. So she Roles in the family and the meaning of events, such as never really did anything. And she never did Joseph Sr.’s death, are enhanced by symbolic gestures. Along housework. with Frances giving up her place at the table to Joseph, the family decided to forgo decorations the first Christmas Frances described both of her sons as “good looking but after Joseph Sr.’s death. The holiday was a reflection of their not as handsome as my husband.” “Joe was hardest on Joseph powerful emotional state. They suspended their Christmas Jr. He wanted him to be somebody. And he is.” She described rituals (lights throughout the house, a large crec ` he, a her youngest son, Cub, as “not the dexterous type and he Christmas Day open house). Frances described the family does not want to be. He’s the lazy type (laughs) but very dinner. “When Pauline broke down, everybody broke down.” affectionate.” Frances did not seem disappointed in Cub; she simply asserted that neither son reached the pinnacle of 3.5.3. Theme Three: Coping with the End of Life, Particularly manhood in looks or strength that her husband had. Through Belief Systems. Belief systems help individuals and Because Frances’ identity consisted mainly of being a families endure the loved one’s dying and the grief that wife and mother, she misses her role as the most important follows his death. Frances is uncertain about the content person in Joe’s life. Frances does not want to be dependent of her beliefs, but knows that she lacks the ardor of her on others and in fact thinks of herself as “more independent children’s faith. now,” but “less secure and less safe. I always thought I was It would help if I could say that I believe in independent, but my independence was through Joe.” She an afterlife. But deep down, I do not. And my believes that Joseph Sr. made her feel independent by driving mind tells me no. The children come back at her “everywhere” and doing whatever she asked of him. Her husband bolstered her self-esteem by his devotion to her. me, “How can you say you’re a Catholic? The Resurrection, you know, Mother.” And I said, I’m really alone, really. You could say, Well, how “Well, I’d be lying. Do you want me to lie?” can you say that? You have three children. Yes, Frances handles her grief by focusing on the children. She I have three children, but I hide a lot from knows she must accomplish some practical tasks before she them, they’re not fully aware of what I’m going becomes ill or incapacitated. She must help her children through. And I would not want them to be. realize how much she cares about them and not to worry Of all family members, Joseph Jr. seemed the most con- about her. tent in his life and family role after his father’s death, perhaps Pauline managed her father’s decline and death through because he believes he exceeded his father’s expectations. her spirituality, which blended Catholic dogma, new age 6 Journal of Aging Research spirituality, the spiritual significance of coincidence and about the meaning of the husband and father’s life, dying, clairvoyance, and possession of a “sixth sense.” The coinci- and death. Their recollection of experiences and roles from dences she encountered before our interview convinced her the recent and distant past shaped and continues to shape that her family should participate in our study. relationships with other family members. Pauline reported that her grandfather wanted her mother We used three themes to organize the major aspects of to attend Beaver College (now Arcadia University). Receiving the family’s narrative of Joseph Sr.’s end of life: (1) how the a letter from Arcadia University requesting participation in family imputes meaning to the end of life, (2) the past and research on end of life was a “sign.” On the first meeting, present role of each family member, and (3) The family’s Pauline said that the interviewer (H. K. B.) “could pass for the ways of coping with their grief, particularly through their double of their good neighbor.” Pauline believed her father belief systems. choreographed these coincidences. Frances, Joseph Jr., and Pauline found meaning in view- She attributed her ability to handle her father’s death ing Joseph Sr.’s qualities as remarkable. They described him to “prayer,” which helped her through the funeral that she with superlatives and viewed his peaceful death as befitting remembers “in a haze.” Accepting his death was due to his “good” life. Similarly, most family members in our study “Divine intervention.” “The peacefulness of him, I think highlighted whatever was notable about their loved one’s helped us cope.” life and death, what distinguished him from others, and his Joseph also looked to his belief system to help him endure irreplaceable role in their families and their lives [1]. Unlike his father’s decline and passing. When Joseph was asked how other families, however, it was not Frances who sanctified her important his Catholic beliefs are in everyday life, he replied: husband’s life [20], but the children who viewed their father as “saintly” and as possessing “an innocent goodness.” It’s the center of my life. It’s the focus of my life... . And I think that my Catholicism was a In regard to family roles, Joseph seemed to relish his major part in helping me to come to terms and new role as “head of the family.” Frances said she must take being prepared for my father’s death. And in on the task of “getting the children ready for when I’m not assuming my role in life as head of the family, here any more.” Pauline believed that her role in the family now that my father is not here. So, yes, it’s the became precarious when her father died. Although their roles core of my life. are peculiar to their unique family, the idea of “taking on” or “trying out” a new role in the family after the death of The Marino family felt a sense of pride in the dignity the husband and father was not unusual in our sample of they displayed when Joseph Sr. died. They believed they had families. Many “new” roles of adult children centered on “done right” by adhering to his wishes for “no more doctors concern for their mother and how and where she will live or hospital.” Pauline spoke for the entire family. “We had no out her life [21]. Unlike Frances, most widows did not feel it regrets.” was their job to comfort bereaved children. Rather, widows in our sample felt disappointed that their children could not 4. Discussion understand the loss they were experiencing [22]. Pauline’s and Joseph’s belief systems helped them endure It may be expected that an elderly husband’s end of life their father’s end of life. Joseph Jr. finds great comfort in will disrupt his widow’s sense of self, her life roles, and his Catholic faith, and Pauline thinks that her “sixth sense” notions about the future [18]. The expectation for such a attunes her to manifestations of her father’s presence in disruption in the lives of adult children is lessened by the her life. Frances does not find solace in traditional Catholic breadth of their social worlds. Their grief is often diffused by tenets, such as a belief in an afterlife, but continues to pray to the competing needs of spouses, children, and grandchildren Jesus and favorite saints daily. Similar to Pauline and Frances [19]. We note that the significant persons in the Marinos’ Marino, most family members we interviewed followed an lives were each other. Among participants in our study, the idiosyncratic spirituality. Sources for belief systems were a Marinos were the only adult children who remained in the blending of beliefs and practices of various religions, family family home throughout their lives. The singularity of their and cultural myths, stories, and superstitions, and popular living arrangements and relationships with each other made versions of traditional religions. them an extreme case example [16]. It is likely that the Marinos, because of the intensity of the The encapsulated world of the Marinos engendered family tie, remain more dependent on each other for their consistency not only in each of their narratives about Joseph roles and for the meaning they create from Joseph Sr.’s life Sr.’s end of life, but also in the emotional investment they and death than more typical families in our study. Yet, the made in him. Widow and children agreed that he was the Marinos typify most bereaved families, who, like links in a “cement of the family,” and all worried that the family might chain in which a major link is gone, go about their lives, “come apart” without him. Family members united around sometimes tightening the remaining links. their belief that Joseph Sr. wanted them to “stay together” in the family home. In regard to their unified grief, the Marinos may have Acknowledgments differed in degree but not in kind from other widows and adult children in our study. Most of our respondents united The authors are extremely grateful to the family of Mr. around the “we” of the family in constructing a narrative Marino for sharing their stories of his death with us. Data Journal of Aging Research 7 described here were gathered in a research project entitled, [22] K. A. 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Nesse, “Prospective patterns of resilience and maladjustment during widowhood,” Psychology and Aging, vol. 19, no. 2, pp. 260–271, 2004. [14] E. Mischler, Research Interviewing: Context and Narrative, Harvard University Press, Cambridge, Mass, USA, 1986. [15] S. David, Interpreting Qualitative Data: Methods for Analyzing Talk, Text and Interaction, Sage, Thousand Oaks, Calif, USA, [16] B. Flyvbjerg, “Five misunderstandings about case-study research,” Qualitative Inquiry, vol. 12, no. 2, pp. 219–245, [17] D. Carr,R. M.Nesse, and C. B. Wortman, Spousal Bereavement in Late Life, Springer, New York, NY, USA, 2006. [18] N. Abeles, T. L. Victor, and L. Delano-Wood, “The impact of an older adult’s death on the family,” Professional Psychology: Research and Practice, vol. 35, no. 3, pp. 234–239, 2004. [19] D. Umberson, Death of a Parent, Cambridge University Press, Cambridge, Mass, USA, 2003. [20] H. Z. Lopata, Widowhood in an American City, MW Books, [21] M. Moss and S. Moss, “The death of a parent,” in Midlife loss: Coping strategies,R. Kalish, Ed., Sage, Newbury Park,Calif, USA, 1989. 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End of Life: A Family Narrative

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Copyright © 2011 Helen K. Black et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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SAGE-Hindawi Access to Research Journal of Aging Research Volume 2011, Article ID 105985, 7 pages doi:10.4061/2011/105985 Research Article 1 1 2 1 Helen K. Black, Miriam S. Moss, Robert L. Rubinstein, and Sidney Z. Moss Behavioral Research Institute, Arcadia University, 450 South Easton Road, Glenside, PA 19038, USA Department of Sociology and Anthropology and Center for Aging Studies, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA Correspondence should be addressed to Helen K. Black, blackh@arcadia.edu Received 19 October 2010; Accepted 16 March 2011 Academic Editor: Laraine Winter Copyright © 2011 Helen K. Black et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper is based on ethnographic research that examines family reaction to an elderly husband and father’s end of life. From a group of 30 families in our study (family defined as a widow aged 70 and over and two adult biological children between the ages of 40 and 60), we offer an extreme case example of family bereavement. We report our findings through the open-ended responses of a widow and two children who were interviewed ten months after the death of the husband and father. Three general themes emerged: (1) how the family imputes meaning to the end of life, (2) changes in the roles of family members, and (3) the family’s ways of coping with the death, particularly through their belief system. A key finding is that the meaning family members find in their loved one’s death is tied to the context of his death (how and where he died), their perception of his quality of life as a whole, and their philosophical, religious, and spiritual beliefs about life, death, and the afterlife that are already in place. 1. Introduction Ourpaper contributesto the literature on endoflife and family bereavement by placing the death of an elderly man in The trajectory of family life—incipience, development, and the cultural context of his family’s narratives about his dying decline—includes the end of life. An important aspect of end and death. First, we examine the salient terms used in our of life studies is the context in which death occurs [1, 2]. In paper, such as the nature of the family, family roles before and the case of an elderly husband and father, his family members after the husband’s and father’s death, and finding meaning are usually participants in the end of life process and in his life and death. We describe the methods we used in our interpreters of the meaning of his death [3]. Much has been research, present findings through a unique case study, and written about this stage by scholars in various disciplines offer a discussion. [4–7], yet there is little research on the responses of family members as a family when asked how death occurred for 2. Finding Meaning through Belief Systems their loved one and its meaning to them. Our paper springs from a study entitled “The Meaning of In this paper, we view religion, spirituality, and the syn- the Death of the First Elderly Parent: A Family Perspective,” cretized belief systems of individuals and families as a cultur- which investigated family (including the wife/widow and ally and socially driven way of forming values about the end two biological adult children) members’ reactions to the of life. Personal belief systems are tools used to interpret the husband and father’s end of life. This paper explores how one world and what we see within that world [8]. A belief system family communicated their experiences in the forum of the both provides and seeks meaning in the wake of negative research interview. We focused on how family members events. made meaning of the husband and father’s end of life In regard to dying and death, a crucial aspect of a belief throughtheir rolesin the family, and theiruniquewaysof system, whether formal religion, personal spirituality, or coping with anticipated and actual loss, especially through a folk religious belief, is in its functions of creation and their belief systems. continuity. A belief system creates or discovers an answer to 2 Journal of Aging Research the why of suffering and to the meaning of life and death them using standard methods of qualitative research. This [9]. A belief system may also attempt to create or maintain method includes data review, which asks the broad questions, continuity with the deceased in a way that makes sense to the “What is in the data?” and “How is this data relevant to the bereaved and their notion of the loved one’s and the family’s topic under study?” The next step is a large level sorting of singularity [10]. each transcript, which codes for broad themes and topics intraindividually [14, 15]. We also did fine-grained analyses, which include coding for subthemes and patterns within 3. Methods respondents’ entire transcript. Our method enabled us to better understand the respondents’ interpretations of ques- 3.1. Theoretical Framework. We situated our research in tions we asked them. The data we used in this paper emerged a theoretical approach to end of life experiences that is from gross level sorting and fine-grained analysis. We note social constructionist in nature [11]. This approach is that as new data were transcribed and ideas and themes based on three frameworks. The first is phenomenology emerged, we back checked them selectively or universally and the sociology of knowledge, which focuses on how with data from respondents who had already completed an people understand everyday life and see meaning making interview. and interpretation as key human actions. The individual is the creator of a personally meaningful world of lived experience and is best able to explain his world [12]. The 3.3. Rationale for Use of the Case Study. Our use of one family second is drawn from the psychology of religion, which (three persons, the widowed mother, and two adult children) is strongly cultural and shows belief systems as cultural to illustrate the family responses to the father/husband’s lens through which individuals interpret and restructure end of life justifies the case study method as a necessary negative experiences [9]. The third is rooted in contemporary and sufficient means of showing a phenomenon of lived bereavement theory which explores family interactions at the experience. In this case, it is the family’s perception of the end of life, the meaning of loss, the tie with the deceased, and meaning of the husband and father’s end of life [16]. expressions of mourning within the family context [13]. We use the case that follows because it shows a con- centrated family experience. That is, all members of this family—father, mother, and three adult children—lived 3.2. Data Collection and Analysis. This paper emerges from together in the family home for over 50 years. Their enduring data collected from NIA-funded research “The Meaning of intimacy with each other created a unique context for a the Death of the First Elderly Parent: A Family Perspective.” family response to the end of life and produced insight into In the original study we interviewed 30 families, consisting of the goal of our research: the exploration of how a family a widow aged 70 and over and one or two adult children, aged comes together around the decline of the elderly father 40 to 60, from six months to one year after the father and and husband and whether the family makes a collective husband’s death. We recruited respondents from the notice meaning of his death. The case study disclosed the family’s of death that appeared in local newspapers. We collected united experiences of grief, as well as, each member’s data for this study through formal ethnographic interviews unique perception of the death due to having a particular and informal conversation. Data were processed through relationship with the deceased [16]. audiotaping and transcription for analysis or detailed in We used three themes to organize major aspects of the analyzable field notes. The case that follows was culled from family’s narrative: (1) how the family imputes meaning to both processes. the end of life; (2) the past and present role of each family The subjects of this paper had private interviews in their member and, (3) the family’s ways of coping with the death, homes approximately ten months after their loved one’s particularly through their belief systems. We see the themes death. Each interview lasted approximately two hours in two as interrelated. That is, finding meaning in a loved one’s sessions. An IRB-approved consent form was obtained from death is an aspect of coping with loss. Meaning can also be each family member at the beginning of the first interview. found through: (1) recalling his good works and death as an The main tool of the study was the semistructured end to his suffering, (2) a belief system that assures his exis- interview schedule, which included open ended questions tence in an afterlife, and (3) continuing or expanding each that spanned two sessions. The first interview session focused family member’s present role in the family. Three themes on the reaction of the interviewee to the husband or emerged from our data, based on family members’ answers father’s decline and eventual death. This interview also to interview questions, spontaneous remarks throughout explored the respondent’s opinion of his end of life care. the interview, and our interpretation of their nonanswers, The first interview also examined respondents’ reactions silences, pauses, emotion, and body language. to rituals performed after death and beliefs about religion, spirituality, and an afterlife. The second interview asked for opinions related to other family members’ reactions to the 3.4. The Marino Family (a Pseudonym That Reflects the Ital- husband and father’s dying and death and an assessment ian-American Background of This Family). We present the of relationships among family members in general and Marino family. Joseph Marino, Sr. died in February of 2009, specifically in relation to the loved one’s end of life. ten months before the start of our interviews. He was 87 The general approach to data analysis in the project and a survivor of colon cancer, open heart surgery, and a was as follows: after transcribing interviews, we analyzed minor stroke. He endured several other health problems for Journal of Aging Research 3 two years prior to death. His widow, Frances, is aged 84. He must have suffered terrible, but he never let The couple had been married 64 years at the time of his us know. “Cause he looked like Omar Shariff death. Their first son, Joseph, Jr., is a lawyer. At age 62, he until the day he closed his eyes.” He was going to has never married, is semiretired, and works from a private doctors all the time to get blood work done. He office in the family home. The middle child, Cub, is 60 years finally said, “No more doctors. No more blood old and also single. He held odd jobs throughout life and work.” His body was tired. is currently unemployed. Pauline, the 52-year-old daughter When asked to tell the story of her father’s death, Pauline and youngest child of the family, is “between jobs.” Although said: she left home to marry when she was in college, she returned after the two-year marriage ended in divorce. Joseph Jr. lived It was Saturday morning. He kept saying to my away from home for six years on an extended work project. mother,“Fran,when you coming in?” He could He returned home when the work was completed. Cub never not stand to be in a room without her. And I left the family home. heard her go in and scream over and over. We According to family members’ accounts, Joseph Sr. sat all ran in. No stress on his face. I think it was a alone in the kitchen on a Saturday in February, 2009. All peaceful death. And his father passed away the family members were home and in different rooms of the same way. It was like in the Godfather movie. large suburban house. Frances “heard a thump,” ran to the kitchen, and found Joseph Sr. on the floor, next to his Although “knowing” he was “fading at least a year before chair. All family members responded to Frances’ scream. In his death,” Pauline clarified that no one in the family retrospect they believe that he “just slipped off the chair” and “expected” him to die. She explained: “My father was the died. cement of the family.” Family members agreed that Joseph Sr. gave the family its purpose as a family. The metaphor 3.5. Themes. We explore how the Marino family reacted to of cement was apt and recurring in Pauline’s narrative. Joseph Sr.’s end of life within three inter-related themes: Joseph Sr. was a stone mason, construction worker, and (1) how the family imputes meaning to the end of life; (2) the carpenter. He had built their home, its “insides,” and its past and present role of each family member; (3) the family’s several additions “with his own hands.” ways of coping with their experience, particularly through Because of his central role in the family, Pauline feared their belief system. that the “entire family” might “come apart” when Joseph Sr. Family members organize thoughts and feelings sur- died. rounding the loved one’s end of life in the interview nar- rative. We suggest that individual and family belief systems Before he died, I was frightened. I did not know provide a way to discover meaning in the life and death of how I was going to react. God forbid the day the deceased, as well as, an important means of coping with it would happen, I thought we would all be loss [17]. hysterical. We were upset and sad, but he died in his own chair and his own home. And we all rallied together because he kept us together 3.5.1. Theme One: How the Family Imputes Meaning to the because he was at peace. End of Life. Pauline was the first person interviewed in the Marino family. As the youngest child, Pauline believes For Pauline, the meaning of her father’s death emerges that throughout her life she was considered “special” and from the precariousness of her position in the family, despite “protected” by her father and grandfather, who lived with the the family unity she felt when he died. She now feels “at family when she was a child. When asked, Pauline described the mercy” of her brother, Joseph, Jr. and his “controlling” the last year of her father’s life. personality. She believes that her childhood fear of him stunted her ability to trust people. He had a stroke the day before New Year’s Eve, 2007. Within the next year he really went down. My brother used to be boss of all the attorneys at But they never diagnosed anything. He dropped N Corporation. So he thinks that now my father a lot of weight. Then he developed urinary infec- is gone... It started from when I was a child. My tions. He got inflammation of the blood and parents both worked. My grandfather used to they could not find what caused that. I’m big protect me, then he passed away but I could tell on holistic things like cranberries for infections. my father when Joseph (Jr.) bullied me. When it But nobody listened to me. My mother was in was just me with Joseph, he would put me in the control. My oldest brother was next in line. chair in the corner when I was bad, or scare me Pauline notes important family characteristics. There is about monsters and I would scream and cry. I a long-standing family hierarchy, and because she is the said, “You wonder why I am the way I am today.” youngest child and a daughter, she occupies the bottom See, even though the last two years (of father’s rung and feels disrespected and unheard. She also attributed life)he was notabletodoanything anymore, qualities to her father that the family agreed upon: he was an it was just that physicalness of him being here, uncomplaining, loving, and “handsome superman.” protecting me. 4 Journal of Aging Research Pauline suggested that the meaning of Joseph Sr.’s life To his family, Joseph Sr. was literally “larger than life.” and death centers in their home; the house itself symbolizes Although Joseph Jr. believes that his father loved his children his attributes, such as physical strength and protection. But equally, his father was especially proud of the authoritative the meaning of the home has changed for Pauline. She positions Joseph Jr. held in the corporate world. “It was commented, “My father had a strong physical presence. It’s important to my father that we stay together and that I take gone out of the house. It’s cold in here.” care of the family. I take this seriously.” Joseph Jr. described Joseph Jr. agreed with Pauline that the family “came himself as the family member that others turn to. When together” at the end of his father’s life. He attributed his asked who supplied support when he was grieving, he replied strength and the family’s solidarity to prayer. evenly: I told you I prayed to have strength to accept this We all ran into the kitchen that day in February. when it came. We bonded together in an hour But I knew his time had come, and I felt thankful of pain. They all look to me now. Not that I because it looked like he went to sleep. And I could take my father’s place, but if push comes knelt down and kissed him, and held his hand to shove, I’m the one they come to. I see the and told him how much I loved him. The Lord loss of my father had its toll on my mother. My granted my wish—I was able to accept it because brother and sister have enough to contend with Iknewhis time hadcome. their own lives. So grieving is a luxury I cannot afford. Similarlytothe wayPauline describedher father as “tired,” Joseph Jr.’s phrase, “his time had come” suggests that Joseph Jr. said that the family is “different now. What’s his perceived readiness erased visions of Joseph Sr. fighting missing in the family is this sense of a rock. Now that he’s death. All family members, however, believe that Joseph Sr. gone, we’re not the same, we’re less.” This statement describes was afraid of dying. Joseph Jr. also feared his father’s death, the family’s sense of depletion. but for reasons different from Pauline’s. Frances, Joseph Sr.’s widow, believes “it’s a lie” when someone says they are prepared for a loved one’s death. She His death was something I feared for the last always told her husband, “You can die one day after me; fiveyears. Hewas failingphysically.Iprayed for not before.” Because “it was difficult to see my superman the Lord to give me strength to bear God’s will. failing” and she knew he was afraid of death, the couple never A few days before he died, my father said, “I’m discussed this subject. not going to any more doctors or any hospitals.” He aged magnificently. He never looked ill, he When we went to bed, he would always say, “See just got even better looking. The nurses that you tomorrow.” He did not say it Friday night. came here would say that to me. He was a But we all kissed him, as was our tradition. He superman; he looked like a superman. A few had a feeling his time was coming. It was a days before death, he became just a shell of a bitter-sweet experience. Bitter because we lost person. ourfather and the centerofour family. But sweet in that it was a fitting end for a good man. Frances said that she found meaning in her husband’s In fact, Saint Joseph, as you might know, is the death by participating in our research. “We’re not educated patron saint of a happy death. for death and we should be.” She regrets that they did not talk about death but she knew he was “unable.” She laments One meaning that Joseph Jr. found in his father’s life and that she did not “assure him that I loved him just as much as death was to emulate him, despite believing he would never he loved me,” and hopes he was unaware of how impatient reach his father’s stature. she feltattimes. I wish I had my father’s physical capabilities, his In the last year he’d go in the shower but he personal courage and fortitude. He was fearless. could not do it by himself. I would go in with If somebody threatened us, he was like a raging him and bathe him. I would help him on with lion. And just to be good the way he is. But I just his clothes; I would cream his face. And he do not have that innocent goodness he had. would just look at me and say, “I cannot believe Interviewer: What do you mean by innocent you have to do this.” I’d say, “Joe, if the shoe was goodness? on the other foot, you’d do this and more, too.” Joseph, Jr.: It’s that he did not really hate He was astounded by how much I did for him people... with the exception of one cousin who without him asking. disrespected my mother. But he would not talk She found another meaning in her husband’s ill of people. And he would take great joy in death. a nice tomato in the yard, or after he finished He loved me so much; he adored me. A highlight doing some concrete work. But as I’ve gotten of his life was when I decided to go out with him, older I’m doing better at it. He was physically when we were engaged, when we got married, very strong. His little finger was the size of my and when we had children. I realized after he thumb. died that I loved him as much as he loved me. Journal of Aging Research 5 Unlike other widows in our study, Frances noted that Joseph said his role as “head of the family” was given to him another meaning she found in her husband’s death is that symbolically by his mother a few years before his father died. she “must be there more” for her children. She also feels, One day she got up from her seat at the foot of the table and similarly to other widows in our study, that she is paying a said to him, “You should sit here now.” He felt honored. great price for being so beloved by her husband. “Without Joseph Jr. described his father’s relationship with Pauline him, my life has very little meaning.” as “doting.” He thinks his father was “frustrated” with Cub because of his weak work ethic. And although Joseph Jr. sees himself as taking on his father’s role due to his “ranking, 3.5.2. Theme Two: The Past and Present Role of Each Family Pauline definitely does not see it that way, and Cub sees me Member. The most important role in the family continues as a usurper, taking my father’s place, but with no right to to be held by Joseph, Sr. Perhaps because he remained the do so.” Joseph understands that “Pauline thinks I’m trying “cement” of the family even at the end of life, his widow’s to be the boss. While my father was here she knew I could and children’s roles seemed less definitive after his death. The not be in control.” Pauline often threatens to leave the family family wondered whether their roles still existed or whether home when their mother dies. Joseph Jr. thinks “she’d feel they could carry out those roles. lost without my brother and myself.” During our first interview, Joseph Jr. described his father Pauline admitted she is afraid of the future; life without with adages that mythologized him, such as “good as bread”, herfatherrepresentsa lack of security. Both Frances and “like Saint Joseph,” and “the Saint Joseph of the neighbor- Joseph Jr. recognize Pauline’s vulnerability, but they view it hood.” Both Pauline and Joseph Jr. described their father as “a differently. Frances remembers that Joseph Jr. helped Pauline saint.” Frances disagreed and said she had a more “realistic” out financially “countless times” and will continue to do so. view of her husband. She remembered that the children She knows that Joseph is “glad” to help his siblings “with always “looked up to Joe, whereas I had the firm hand.” As money.” Yet, Frances recognizes that the help Pauline needs disciplinarian, she thinks she was considered the “bad guy” is more emotional than financial and worries that Joseph Jr. by her children. The adult child she most worries about is does not share this understanding. Joseph reiterated: Pauline. Now I’m the head of the family. My mother She was always a challenge. She never really did thinks that way too. So for that reason I sort of anything with her life, with her education. My publicly defer to my mother as being the head of husband spoiled her. She was supposed to go the family, but it’s really me. on to become a lawyer, like her brother. Then she got married, then she got divorced. So she Roles in the family and the meaning of events, such as never really did anything. And she never did Joseph Sr.’s death, are enhanced by symbolic gestures. Along housework. with Frances giving up her place at the table to Joseph, the family decided to forgo decorations the first Christmas Frances described both of her sons as “good looking but after Joseph Sr.’s death. The holiday was a reflection of their not as handsome as my husband.” “Joe was hardest on Joseph powerful emotional state. They suspended their Christmas Jr. He wanted him to be somebody. And he is.” She described rituals (lights throughout the house, a large crec ` he, a her youngest son, Cub, as “not the dexterous type and he Christmas Day open house). Frances described the family does not want to be. He’s the lazy type (laughs) but very dinner. “When Pauline broke down, everybody broke down.” affectionate.” Frances did not seem disappointed in Cub; she simply asserted that neither son reached the pinnacle of 3.5.3. Theme Three: Coping with the End of Life, Particularly manhood in looks or strength that her husband had. Through Belief Systems. Belief systems help individuals and Because Frances’ identity consisted mainly of being a families endure the loved one’s dying and the grief that wife and mother, she misses her role as the most important follows his death. Frances is uncertain about the content person in Joe’s life. Frances does not want to be dependent of her beliefs, but knows that she lacks the ardor of her on others and in fact thinks of herself as “more independent children’s faith. now,” but “less secure and less safe. I always thought I was It would help if I could say that I believe in independent, but my independence was through Joe.” She an afterlife. But deep down, I do not. And my believes that Joseph Sr. made her feel independent by driving mind tells me no. The children come back at her “everywhere” and doing whatever she asked of him. Her husband bolstered her self-esteem by his devotion to her. me, “How can you say you’re a Catholic? The Resurrection, you know, Mother.” And I said, I’m really alone, really. You could say, Well, how “Well, I’d be lying. Do you want me to lie?” can you say that? You have three children. Yes, Frances handles her grief by focusing on the children. She I have three children, but I hide a lot from knows she must accomplish some practical tasks before she them, they’re not fully aware of what I’m going becomes ill or incapacitated. She must help her children through. And I would not want them to be. realize how much she cares about them and not to worry Of all family members, Joseph Jr. seemed the most con- about her. tent in his life and family role after his father’s death, perhaps Pauline managed her father’s decline and death through because he believes he exceeded his father’s expectations. her spirituality, which blended Catholic dogma, new age 6 Journal of Aging Research spirituality, the spiritual significance of coincidence and about the meaning of the husband and father’s life, dying, clairvoyance, and possession of a “sixth sense.” The coinci- and death. Their recollection of experiences and roles from dences she encountered before our interview convinced her the recent and distant past shaped and continues to shape that her family should participate in our study. relationships with other family members. Pauline reported that her grandfather wanted her mother We used three themes to organize the major aspects of to attend Beaver College (now Arcadia University). Receiving the family’s narrative of Joseph Sr.’s end of life: (1) how the a letter from Arcadia University requesting participation in family imputes meaning to the end of life, (2) the past and research on end of life was a “sign.” On the first meeting, present role of each family member, and (3) The family’s Pauline said that the interviewer (H. K. B.) “could pass for the ways of coping with their grief, particularly through their double of their good neighbor.” Pauline believed her father belief systems. choreographed these coincidences. Frances, Joseph Jr., and Pauline found meaning in view- She attributed her ability to handle her father’s death ing Joseph Sr.’s qualities as remarkable. They described him to “prayer,” which helped her through the funeral that she with superlatives and viewed his peaceful death as befitting remembers “in a haze.” Accepting his death was due to his “good” life. Similarly, most family members in our study “Divine intervention.” “The peacefulness of him, I think highlighted whatever was notable about their loved one’s helped us cope.” life and death, what distinguished him from others, and his Joseph also looked to his belief system to help him endure irreplaceable role in their families and their lives [1]. Unlike his father’s decline and passing. When Joseph was asked how other families, however, it was not Frances who sanctified her important his Catholic beliefs are in everyday life, he replied: husband’s life [20], but the children who viewed their father as “saintly” and as possessing “an innocent goodness.” It’s the center of my life. It’s the focus of my life... . And I think that my Catholicism was a In regard to family roles, Joseph seemed to relish his major part in helping me to come to terms and new role as “head of the family.” Frances said she must take being prepared for my father’s death. And in on the task of “getting the children ready for when I’m not assuming my role in life as head of the family, here any more.” Pauline believed that her role in the family now that my father is not here. So, yes, it’s the became precarious when her father died. Although their roles core of my life. are peculiar to their unique family, the idea of “taking on” or “trying out” a new role in the family after the death of The Marino family felt a sense of pride in the dignity the husband and father was not unusual in our sample of they displayed when Joseph Sr. died. They believed they had families. Many “new” roles of adult children centered on “done right” by adhering to his wishes for “no more doctors concern for their mother and how and where she will live or hospital.” Pauline spoke for the entire family. “We had no out her life [21]. Unlike Frances, most widows did not feel it regrets.” was their job to comfort bereaved children. Rather, widows in our sample felt disappointed that their children could not 4. Discussion understand the loss they were experiencing [22]. Pauline’s and Joseph’s belief systems helped them endure It may be expected that an elderly husband’s end of life their father’s end of life. Joseph Jr. finds great comfort in will disrupt his widow’s sense of self, her life roles, and his Catholic faith, and Pauline thinks that her “sixth sense” notions about the future [18]. The expectation for such a attunes her to manifestations of her father’s presence in disruption in the lives of adult children is lessened by the her life. Frances does not find solace in traditional Catholic breadth of their social worlds. Their grief is often diffused by tenets, such as a belief in an afterlife, but continues to pray to the competing needs of spouses, children, and grandchildren Jesus and favorite saints daily. Similar to Pauline and Frances [19]. We note that the significant persons in the Marinos’ Marino, most family members we interviewed followed an lives were each other. Among participants in our study, the idiosyncratic spirituality. Sources for belief systems were a Marinos were the only adult children who remained in the blending of beliefs and practices of various religions, family family home throughout their lives. The singularity of their and cultural myths, stories, and superstitions, and popular living arrangements and relationships with each other made versions of traditional religions. them an extreme case example [16]. It is likely that the Marinos, because of the intensity of the The encapsulated world of the Marinos engendered family tie, remain more dependent on each other for their consistency not only in each of their narratives about Joseph roles and for the meaning they create from Joseph Sr.’s life Sr.’s end of life, but also in the emotional investment they and death than more typical families in our study. Yet, the made in him. Widow and children agreed that he was the Marinos typify most bereaved families, who, like links in a “cement of the family,” and all worried that the family might chain in which a major link is gone, go about their lives, “come apart” without him. Family members united around sometimes tightening the remaining links. their belief that Joseph Sr. wanted them to “stay together” in the family home. In regard to their unified grief, the Marinos may have Acknowledgments differed in degree but not in kind from other widows and adult children in our study. Most of our respondents united The authors are extremely grateful to the family of Mr. around the “we” of the family in constructing a narrative Marino for sharing their stories of his death with us. Data Journal of Aging Research 7 described here were gathered in a research project entitled, [22] K. A. DeMichele, “Memories of suffering: exploring the life story narratives of twice-widowed elderly women,” Journal of The Meaning of the Death of the First Elderly Parent: Aging Studies, vol. 23, no. 2, pp. 103–113, 2009. A Family Perspective (Supported by NIA Grant number 5R01AG31806-2, Robert L. Rubinstein PI). We are grateful to NIA for its support of our research. References [1] V. Cigoli and E. Scabini, Family Identity: Ties, Symbols, and Transitions,Lawrence Erlbaum Associates,New York, NY, USA, 2006. [2] M. Kagawa-Singer and L. J. Blackhall, “Negotiating cross- cultural issues at the end of life,” Journal of the American Medical Association, vol. 286, no. 23, pp. 2993–3001, 2001. [3] R. L. Winzeler, Anthropology and the Study of Religion, Altamira Press, New York, NY, USA, 2000. [4] L. Bregman, Introduction to Religion, Death, and Dying: Perspectives on Dying and Death, Praeger, Santa Barbara, Calif, USA, 2010. [5] B.Hayslip and C.A. Peveto, Cultural Changes in Attitude toward Death, Dying, and Bereavement,Springer, ,New York, NY, USA, 2005. [6] R. Kastenbaum, Death, Society and Human Experience, Allyn and Bacon, Boston, Mass, USA, 2007. [7] A. Kleinman, Culture and Depression, Oxford University Press, [8] S. Eisenhandler, Keeping the Faith in Late Life,Springer, New York, NY, USA, 2003. [9] H. Black, Soul Pain: The Meaning of Suffering in Late Life, Baywood, Amityville, NY, USA, 2006. [10] G. Smith, AShort HistoryofSecularism, I.B.Tauris, New York, NY, USA, 2008. [11] P. Berger and T. Luckmann, The Social Construction of Reality: A Treatise in the Sociology of Knowledge, Anchor Books, Garden City, NY, USA, 1966. [12] R. L. Rubinstein, “Narratives of elder parental death: a struc- tural and cultural analysis,” Medical Anthropology Quarterly, vol. 9, no. 2, pp. 257–276, 1995. [13] G. A. Bonanno, C. B. Wortman, and R. M. 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