Steadfast Through Change

When the Strong Become Unsteady

There is a particular kind of grief that comes with watching someone who has always managed, quietly, reliably, without complaint, begin to fall out of step.

These are the people who know how to push through. Who understand hierarchy and order. Who were taught, explicitly or implicitly, that pain is something to be assessed, endured, and moved past. They are not reckless; they are disciplined. They don’t dramatize discomfort. They simply adapt and keep going.

Until they can’t.

When the body starts to betray them, it doesn’t do so politely. It doesn’t announce itself with a single clear diagnosis or a neat timeline. Instead, it arrives in fragments: a little less breath on the stairs, a hesitation where confidence used to live, a tool once dismissed that suddenly becomes essential. A walker. A railing. A pause.

What unfolds here is not a single event, but a transition.

Health-related transitions rarely happen all at once. They are incremental, uneven, and often ambiguous. Sociologist Michael Bury described serious illness as a biographical disruption, a rupture that forces people to renegotiate who they are, what they can do, and what they imagined their future would look like (Bury, 1982). Long before any formal label is applied, the disruption is already underway.

For the person inside that body, this loss is not just physical. It is existential. Independence was never just a preference, it was an identity. To need help feels like failure, even when logic says otherwise. To accept care feels like becoming a burden, even when no one else sees it that way. Control, once internal and unquestioned, begins to slip outward.

There are moments in these transitions when the shift becomes explicit. At some point, the language of care changes; questions are asked not about what can be done next, but about what should not be done. Being asked to speak about resuscitation, a standard part of hospital care, can feel like crossing an invisible line. It is not a decision about giving up, but an encounter with limits: of medicine, of the body, of control itself. For someone whose life has been defined by perseverance, this moment can feel like a profound loss of agency, even as it offers a final form of it. For those standing beside them, it often marks a transition from helping to witnessing, from problem-solving to simply holding space. They make clear that control is changing hands, and that choosing limits may be one of the last ways autonomy is expressed.

And for the ones who love them, especially those who want to help, there is another transition unfolding at the same time.

How do you care for someone who is not ready to be cared for?

How do you offer support without erasing dignity? How do you insist on safety without sounding like command? How do you convince someone that a tool meant to help them move forward is not a symbol of defeat?

Often, you don’t. Often, you wait. You bring the walker “just to try.” You frame help as strategy rather than surrender. You respect that autonomy matters, even when it slows things down. You learn that caregiving, at least at the beginning, is less about doing and more about standing close, ready, patient, quiet.

Transitions scholars have long noted that caregiving roles are frequently assumed gradually, without clear boundaries or markers (Schumacher and Meleis, 1994; Meleis et al., 2000). This ambiguity can be emotionally taxing. The desire to help can clash with the equally strong desire of the person receiving care to remain in control of their own life. Both are reasonable. Both can coexist. And both can hurt.

There is also the cruel uncertainty of medical limbo. When symptoms are treated before they are fully understood. When tests come late. When decline accelerates faster than explanations. Waiting rooms become classrooms in humility. Control, once carefully maintained, is handed over to strangers in uniforms of a different kind.

There are moments when order briefly reasserts itself.  When someone names the steps: first restore what keeps the body going, then attend to strength, then endurance.  It is not a promise, only a framework.  But for those who understand structure, it offers something essential, a way forward that does not deny disruption, yet refuses to define it as defeat.

Running quietly alongside all of this is anticipatory grief, the mourning that begins before a loss is complete. Even when the person is still present, still recognizably themselves, there can be grief for what has already changed: routines, roles, shared assumptions about the future (Rando, 2000). This grief is rarely named and often carried silently by both the person experiencing decline and those who love them.

What matters deeply in these transitions is dignity.

Dignity is not preserved by denying change, but by acknowledging it without stripping away agency, meaning, or identity. Dignity-conserving care emphasizes respect for personhood even as physical capacity shifts (Chochinov, 2007). Independence does not disappear simply because help is required; it is redefined.

Watching this is hard. Loving through it is harder. Not because care is unwelcome, but because the transition itself is a loss. Roles shift. Power redistributes. The strong must learn to receive. The helpers must learn to wait.

There is no manual for this stage. No rank to consult. No order to follow that makes it easier.

There is only presence. Respect. And the slow, often uncomfortable work of transition, learning how to care without overtaking, how to accept help without losing oneself, and how to move forward when strength looks different than it once did.

This reflection was written in the midst of a transition that is still unfolding, without clear markers or conclusions. While prompted by the present moment, it echoes other seasons of caregiving and gradual change, those I have witnessed, those I have lived, and those that quietly shaped my family long before I had language for them. Like many such transitions, it has required more waiting than action, and more attention than certainty. Perhaps that is what transitions ask of us most, not answers, but a willingness to notice what is changing, and to recognize that there is a quiet dignity in adapting to shifting ground, even when the body no longer moves as it once did.

True strength is revealed not in holding fast, but in learning how to march differently when the order changes, and in realizing that strength is never lost, only carried in new ways.

--Anne TM Konkle

References

Bury M. Chronic illness as biographical disruption. Sociol Health Illn. 1982 Jul;4(2):167-82. doi: 10.1111/1467-9566.ep11339939.

Chochinov HM. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ. 2007 Jul 28;335(7612):184-7. doi: 10.1136/bmj.39244.650926.47.

Meleis AI, Sawyer LM, Im EO, Hilfinger Messias DK, Schumacher K. Experiencing transitions: an emerging middle-range theory. ANS Adv Nurs Sci. 2000 Sep;23(1):12-28. doi: 10.1097/00012272-200009000-00006.

Rando TA. (Ed.). (2000). Clinical dimensions of anticipatory mourning: Theory and practice in working with the dying, their loved ones, and their caregivers. Research Press.

Schumacher KL, Meleis AI. Transitions: a central concept in nursing. Image J Nurs Sch. 1994 Summer;26(2):119-27. doi: 10.1111/j.1547-5069.1994.tb00929.x.