Denial starts even before one’s passing, when the gravity of the illness and prognosis is underestimated. Once the last breath is taken and the family realizes that this final, anger begins to take over. In my own experiences in our American culture, this may take many different forms. Anger may be projected internally or even acted out upon someone or something. In Gabon, this stage seems to be invariably and immediate, an intense cathartic process. I will never forget the sights and sounds of this second stage of grief here. It begins with a chant of cries that marks death’s presence. I have seen mothers and wives hurl themselves into a whirlwind, thrashing their bodies around on the floor. The first time I witnessed it I felt paralyzed, not knowing what to do or say. How to deal with such animated displays of grief is not something we were taught in school. I thought, should I leave or look away out of respect, or should I run to comfort them? This part of medicine is not about formulas or algorithms. This is the part of Medicine where you must learn to follow your heart. When in doubt, offering your hand or open arms is often all that is needed.
Just as in the United States, it is customary to dress in dark attire to mourn the loss of a loved one. While this spans several days back home, in the Gabonese culture, this act of mourning continues for a period of six months to a year. When the family is ready to say good-bye, the somber wardrobe is no longer worn, and a celebration commences in honor of their loved one’s passing. It is a village wide celebration that lasts 24 hours. A special pagne, or tissue, with the most vivid African colors and pattern, is chosen and worn by the family. It is a time for dancing, singing and fellowship; it is a time to celebrate their loved one and life.
We were fortunate to visit such a celebration, and I must say it helped soften the sharp edges of my memory in witnessing families confront death. Some of my greatest lessons with my patients have not been seeing them in the hospital or clinic setting, but seeing them in their daily lives. The highlight of this particular celebration came with watching the traditional dances of some of the young women and girls in the village. They were dressed identically in their special pagne attire, had their faces painted white, and their arms were wrapped in a raffia, which accessorized their dance like pom-poms at a football game. The raffia moved around their arms with much vivacity, matching the joy in their faces, as they danced in a circle and sang together. It is times like this that serve to raise the morale in a landscape, often very harsh and relentless here in Gabon.