When my mother had a recent medical crisis, on my way home from the hospital nearly in tears, I called a first cousin. 

I was overwhelmed by a grief that felt new and heavy. I reached for someone who loves me and my mom, someone who has been in our family for longer than I have. She was kind enough to answer and stay on the line. She listened, was empathic, and said the right things.  

After we spoke, I felt I still needed more. So, I called my aunt. Similarly, I felt heard, empathized with, and truly supported. While the conversation left me feeling better than the one with her daughter, somewhere in the middle of that conversation, I became aware of a particular ache that her kindness could not reach. 

Neither of them was Tony, my only sibling. 

They did not grow up watching my mother and father argue over who was more stubborn. Ironically, both of their stubbornness played a significant role in the delay to seek medical care. Neither my aunt nor my cousin shared the particular mix of exasperation, understanding, and tenderness that comes from being raised by the same person.  

They couldn’t finish my sentences about what my mother is like, laugh at exactly the right moment, share a sarcastic quip, or be quietly furious alongside me in the way that only a sibling can be. They tried which helped, but it was not the same. 

This is not a criticism of my cousin or my aunt. Rather, it is a statement about what siblings and sibling relationships are. 

Siblings are the people who know our parents the way we do, from the inside of the same family, from the beginning. They share early memories, understand the dynamics and roles within the family system. They do not need the context explained. When a parent gets sick, a sibling would be the person who shares the weight of it, practically and emotionally, in a way that no one else quite can.  

For surviving siblings, that person is simply not available. Not because they would not come. Because they are gone. 

What I did not fully understand until my mother’s medical crisis is how specifically and sharply sibling loss reappears in moments like this. I had lived with Tony’s absence since February of 2020. And while I have understood grief to be an everchanging shape, I discovered a new dimension of it entirely as I navigated my mom’s health. 

I only have one sibling, and now he is dead. I share this not to center my own experience, but because what is true for me is true in some form for every surviving sibling: the significance of a sibling’s death does not lessen because other siblings remain. The one who is gone is still gone, and caregiving has a way of making that absence impossible to ignore. 

Caregiving was never supposed to be a solo act. When siblings grow up in the same family, there is an unspoken assumption that the weight of aging parents will one day be shared. The phone calls to doctors. The appointments, the decisions, the research into what comes next. The 3 a.m. worries about what is going to be required of you. Siblings divide this labor, not always equally, but they divide it. When you are the only surviving sibling, there is no division. There is only you. And for those with living siblings, the division of labor shifts and becomes heavier shining a light on the sibling’s absence. 

Underneath the exhaustion of this is a fear that is harder to name. 

The fear of being abandoned through death and of eventually being “the last one standing” gives way to fears about being forgotten, losing the sense of the past that grounded you, and wondering whether you cannot survive all of it. 

These fears are not irrational. They are a clear-eyed look at what sole surviving means. And it deserves to be acknowledged rather than rushed past. 

Dr. Kenneth Doka coined the term disenfranchised grief to describe losses that go unacknowledged and unsupported by the people and systems around us. Sibling loss is already a significant disenfranchised loss. People assume that because we are adults, and because we are not the deceased’s spouse or parent or child, our grief is somehow less significant.  

Add caregiving to that, and the invisibility compounds. You become the person holding everything together while carrying a loss that most people around you have already moved on from, or perhaps never fully recognized in the first place. 

What I want surviving siblings who are caregiving to know is this: what you are carrying is not one grief. It is at least two, layered and entangled, and they do not come apart cleanly no matter how much you might want them to. My parents could argue for hours over who was more stubborn, and neither would concede. Grief, it turns out, works the same way. The grief of sibling loss and the grief of a parent’s decline are both certain they have the right of way. Both refuse to yield. 

The grief of what should have been shared is real. The grief of watching a parent struggle without the sibling who would have stood beside you (or at least answered the text or call) is real. The gap that your cousin’s kindness, your aunt or uncle’s support, your friend’s sympathy, or your spouse’s love cannot fully fill is real. It is not a reflection of what those people failed to give you.  

It reflects who your sibling was and what they cannot be replaced in doing. 

You called someone. Someone answered. That matters. 

And you still had to hang up the phone and do this alone. That matters too. 

Both things are true. Both things deserve to be held. 

Dr. Angela Dean

Angela M. Dean, PsyD, FT, is a licensed psychologist, Fellow in Thanatology, founder and owner of The Broken Pack, as well as the CEO and clinical director of Dean Psychological and Well-Being Associates in Wexford, Pennsylvania. She is also the host of The Broken Pack: Stories of Sibling Loss, a podcast dedicated to giving voice to one of grief's most overlooked populations. Dr. Dean's path into grief work is both professional and deeply personal. The loss of her own brother a month prior to the COVID-19 pandemic introduced her to the particular invisibility of sibling grief, a loss that rarely receives the acknowledgment it carries, and one that reshapes identity, family structure, and the sense of a shared future in ways that are rarely named. That experience became the foundation for The Broken Pack, which she founded in 2022 with a vision to change how sibling loss is understood and supported. In her private practice, Dr. Dean works with individuals navigating grief, loss, and life transitions, as well as those living with chronic illness, anxiety, and the psychological effects of medical conditions. This clinical work sits alongside years of specialized training and practice in psychosocial oncology. She trained at the University of Pittsburgh Cancer Institute and WVU Medicine before joining the UPMC Hillman Cancer Center, where she provided psychological care to patients and families navigating cancer and its aftermath. She is a longstanding member of the American Psychosocial Oncology Society, active in the Caregiving and Healthcare Disparities Special Interest Groups since 2014. This background deepened her understanding of anticipatory grief, disenfranchised loss, and the ways that medical systems often fail to recognize the emotional complexity of those living alongside illness and death. It also informs her understanding of non-death losses including caregiving grief, chronic illness, anticipatory loss, and secondary losses that accumulate alongside medical uncertainty, experiences that rarely receive the language or recognition they deserve. She holds a Level 2 Certification in Meaning-Focused Grief Therapy (MFGT) from the Portland Institute for Loss and Transition, training grounded in the work of Dr. Robert Neimeyer. Her clinical approach centers on narrative, meaning-making, and continuing bonds, frameworks that inform both her therapeutic work and her writing. Dr. Dean's work has appeared in the OMEGA: Journal of Death and Dying, where she reviewed Doka and Martin's Grieving Beyond Gender. She has been cited in The Atlantic and has presented at ADEC on sibling loss, ethics, and the algorithmic invisibility of grief. She serves as adjunct faculty at Chatham University, teaching grief counseling to graduate psychology students. She writes about sibling loss, disenfranchised grief, meaning reconstruction, non-death and anticipatory loss, and the intersection of personal and professional grief. Her work is informed by the conviction that grief does not resolve on a timeline, and that the people least likely to be asked how they are doing are often the ones carrying the most. Dr. Dean is based in the Greater Pittsburgh area and sees clients via telepsychology across Pennsylvania, West Virginia, and PsyPact states.

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