Mar 22, 20218 min read

Hit Hard: How to Deal With Ambiguous Loss

Updated: Apr 11, 2023

Grieving Those Who Are Alive But Not What They Used to Be

Photo by John Torcasio on Unsplash Honest. Raw. Painful…Helpful and Healing

Pat and Tammy McCleod are leaders in the Christian community of Harvard University, serving as campus chaplains. They coordinate student activities, mentor young adults who are growing their faith, and lead mission trips to put Christian beliefs into action.

Like many working parents, the McCleods did their jobs while parenting four children. Chelsea, the oldest child is just beginning her freshman year of college when the action of the book happens. Three boys follow: Zach, Nate, and Soren. Zach is a congenial, devout sixteen-year-old, an all-around good kid in his junior year when tragedy struck.

Pat and Tammy McCleod were at the opening gathering of students at Harvard held at the beginning of every semester when they got the call that every parent dreads but never expects.

Zach had been hit hard during a football scrimmage and had collapsed on the field.

Hit Hard: One Family’s Journey of Letting Go of What Was — and Learning to Live Well with What Is is the story of the McLeod family’s anguish of learning their oldest son had suffered a traumatic brain injury. The book chronicles their struggle through grief, the difficulty presented when each family member deals with loss differently, the feelings of guilt, resentment, and uncertainty.

Hit Hard is painful and sad to read, but it’s also healing. Tammy McCleod, who at the time is a graduate student and begins to research grief, discovers the concept of “ambiguous grief,” a term that exactly describes the kind of loss her family is suffering. Understanding what they are going through gives them a way to begin to deal with this kind of grief.

What is “Ambiguous Loss”?

Ambiguous loss is the term used by Pauline Boss which defines the loss of someone that once was, but will never be again. It describes someone that still is here, but is not here in the same way. Ambiguous loss can take two forms:

1. The first kind of ambiguous loss is the absence of a physical person, even though the person remains with you psychologically or emotionally. Think about “Prisoners Of War” (POWs) or those labeled as Missing in Action, (MIA). Kidnapped or lost children. People who are lost due to natural disasters. (Remember the intense pain of people who had loved ones in the Twin Towers on September 11th and were not able to confirm their status?) Divorce may be an ambiguous loss if you grieve for the spouse who is no longer there physically, but you still feel connected emotionally.

2. The second form of ambiguous loss is when a person is present physically, but is no longer the same, having experienced emotional or mental changes. This kind of loss happens for people who love the victims of Alzheimer’s disease, people who suffer from mental illness or addiction, or those who have suffered traumatic brain injuries.

The McLeod family suffered ambiguous grief because their vital, vivacious, athletic, musical son would never be the same again. Pat McCleod, Zach’s father, described his son before the injury as having four faces —

“relentless joy, I’m-plotting-a-joke-you-don’t-know-about-yet, intimate worship, and irrepressible compassion.”

After his injury, Zach was physically present but not the same as he had been. He was unable to speak, control his body, perform music, play sports, or plot jokes. His body was there but forever changed on the outside.

The Aftermath of Tragedy

After Pat and Tammy got the call about Zach’s injury, they rushed to the hospital. What followed was spending weeks in the Intensive Care Unit of the Hospital, talking to their son, learning medical terms, talking to doctors, holding out hope that Zach would recover, balancing their stints at the hospital with taking care of their other children.

Total exhaustion.

If you have ever been in a similar situation, you know that hospital-sitting is physically grueling and emotionally draining.

Tammy and Pat felt guilty about not being at the scrimmage game when it happened. They felt guilty they weren’t able to give the other children enough of their energy or attention.

The couple, usually so in sync with each other, were now at odds. Pat still loved the sport of football and thought of what happened to Zach as a fluke. Tammy resented the game and felt guilty that she had allowed Zach to play. Pat was so grateful that Zach was alive that he wanted to spend every waking moment with him, putting time with Zach above time with his family. Tammy, who had been extremely close to her son and who had shared a love of music and frequent private worship time together with him, could only anguish about what she no longer had.

“We didn’t lose a son, Tammy.”

“We lost his potential. You can’t deny that.”

Husband and wife could not understand each other’s reaction to the tragedy and couldn’t grieve with each other. As Pat notes,

“From the moment a crisis hits, every marriage becomes an at-risk marriage.”

One Tragedy and Trouble After Another

No doubt about it. The lives of the McLeod family were forever altered when Zach was injured. The book chronicles their journey through the first few years after the accident: innumerable surgeries and medical treatments, a near-fatal bout with pneumonia, a partial skull removal to allow for swelling, and always, the differing approaches to loss that made it hard for each member of the family to express their grief and relate to each other.

Eventually, Zach progresses enough medically to get through rehab where he learns to walk and to communicate by pointing to letters on a hand-held board.

Eventually, Zach’s parents were able to place him in a school that specialized in treating patients with brain injuries.

Eventually, through counseling, Pat and Tammy learned to accept the other’s way of grieving and to respect it, even though it was not the approach that either was capable of adapting themselves.

Just when I thought that the family was beginning to heal and would be able to move ahead, Zach falls over a stair banister and suffers another major brain injury that starts the whole process over again.

And while this is happening, Tammy is diagnosed with thyroid cancer and has to undergo her own surgery, leaving Pat to worry about his wife, his son, and the future of his entire family.

How Do You Grieve Someone Who Is Alive, But Drastically Changed?

Thirty years ago, I had a friend whose sixteen-year-old-son suffered a traumatic brain injury in a car accident. I remember those months and months of hospital-sitting, trying to provide support for the heartbroken parents.

In this case, the son never regained consciousness and remained comatose for nine years before dying of pneumonia. The entire time, there loomed that terrible question of how to grieve someone who isn’t dead. If I had known about “ambiguous grief,” I might have been able to help them more as well as deal with my own grief.

A Time to Mourn…

I have to admit that the book, Hit Hard, was tough to read. It hurt. But there was healing and hope in it when the family began to understand “ambiguous loss” and found a way to express their feelings.

In a two-part ceremony, the family and friends met in a church to openly acknowledge the loss of what was. Modeled on the phrase from Ecclesiastes, “A time to mourn and a time to dance,” the McLeods expressed their loss by setting up four tables that demonstrated what Zach had previously enjoyed. A table called “Lover of God,” held all his prayer journals, his artwork, and his music. A table called “Lover of Sport,” held team pictures of his football, across, and basketball teams, along with his gear and jerseys. The “Lover of Outdoors” table showed his fishing poles, biking gloves, surfboard, and paintball gun. A final table was filled with the cards, gifts, and posters that people had sent Zach encouraging him after his injury.

I was openly weeping by the time I got to the end of the speeches given by the other siblings. Chelsea described the feelings she had had of anger toward God for letting his happen; for being away at school and occasionally laughing and finding a new friend while Zach was struggling for his life. She felt guilty for trying to forget because it hurt too much to remember.

Nate talked about how hard it was to hear his mother always crying in her room and see his father drowning in paperwork and medical bills. How much he missed his older brother, role model, and friend, knowing

“he would lay down his life for me, his brother.”

Soren, the youngest boy, read a poem he had written about a body pillow that Zach had used to help him hold his infant brother.

“You would hold me in your hands every night and we would rest our heads on that pillow. Even though I could not Speak, you knew I appreciated you.”

Each guest was given a sheet of blue paper and invited to write something about Zach they missed on it, sharing it before they put it into a big bottle, reflecting a Biblical concept from Psalm 56:8:

“You [God] have collected all my tears in your bottle.”

A time to dance…

The second part of the ceremony was a celebration of Zach’s birthday, but also a celebration of who Zach is now. A true celebration of life. Zach was the guest of honor, delighted to see the people he cared about all gathered together in one place, smiling.

Friends and family who had helped relieve the family’s grief by embracing it and adding their own voices to the communal loss, went directly to the celebration. At this party, they watched a slideshow of Zach’s progress since his injury and wrote their own personal or funny stories about Zach on gold cards.

And they danced.

In Hit Hard, Pat writes about the value of ritual and the ability to express grief to induce healing. He says,

“The rituals Tammy needed provided hope for all of us. We embraced the ambiguity of both having and not having Zach. Publicly rather than privately. Corporately rather than individually. Communally rather than in isolation.

Something happened to our marriage as we together created and stood side by side through the ceremony of loss and the celebration of life.

Our individual versions of grief melded into one.”

So Many Lessons To Learn From This Book

Even the most steadfast, faithful families can struggle during times of tragedy or intense grief. No one is immune from pain and loss. Zach’s second major brain injury left him even more incapacitated than the first, and eventually, the officials at the school tell Pat and Tammy that Zach won’t progress any further at the school.

The good news is that Zach is happier than ever before, still faithful, and still joyful. He is a person whose exuberance shines through his altered physical appearance in his desire to hug people, his frequent high-fiving, and his continual smile.

Hit Hard delivers many lessons that are helpful to those who are grieving.

“Lamenting” is a concept that modern western culture doesn’t embrace, but it is Biblical practice that is helpful.
Everyone deals with loss differently.
Guilt, resentment, and anger are typical reactions after many tragedies.
The strongest of marriages are tested under duress. It takes explicit commitment to each other, gentleness, and time to heal. Professional counseling is needed.
Every member of the family has lost something. It is not just the parents who have lost a child. In this case, each sibling has lost a brother, and the other children feel like they have lost their parents.
Rituals provide a way to acknowledge grief, celebrate life, and learn to balance the two extremes of “what was” and “what is” in ambiguous grief.

The Litany of Ambiguous Loss

During the “Time to Mourn” ceremony, the family went through a “Litany of Ambiguous Loss,” written by a friend of the McLeod’s, Ron Sanders.

I plan to use this beautiful statement and response piece with a gathering of friends to acknowledge the loss of another friend to Alzheimer's. She’s alive but no longer with us.

If you have suffered an ambiguous loss of any kind, you, too, will find help and encouragement in the book Hit Hard.

Pat and Tammy McLeod have told their story with the hopes of helping others. The book includes resource materials, links to foundations, and ideas on helping you survive this kind of tragic loss.

Pat and Tammy McLeod’s YouTube Video about ambiguous loss.