This blog is written for healthcare workers specifically, though we are all likely to lose loved ones in the days ahead.
I “graduated” from regular visits with my psychologist a few months ago, but decided I should check in this week, because I knew the days and weeks ahead may be filled with great suffering and loss. What follows are some notes from that discussion, or how to prepare for processing a great humanitarian crisis. In the days, weeks, and months to come, our healthcare workers will work in front-line roles which will expose them to widespread trauma and pain.
They say in the last great pandemic (the Flu of 1918), everyone knew someone who died. Based on the numbers coming out of Italy and Spain, we may be looking at something similar here in the US, or perhaps worse.
When I reached out to my psychologist earlier this week, I was not spiraling and holding it together. But I was seeing it all around me and starting to worry about the grim choices ahead of healthcare workers to come. So I set up some time to think through- how can we prepare ourselves to manage the pain and the grief, en masse. What follows are recommendations from that discussion.
- Eye contact and ventral vagal breathing: Those of us on the front lines will likely spiral here and there from time to time in the coming days. A great way for us to ground and reconnect someone back to center is to keep eye contact and breathe together. The suggested pace is 4 seconds to breathe in, 6 counts to breathe out. Simply breathing slowly can pull your heart rate into a normal zone and release a flood of positive endorphins. When people are losing their connection, it is our imperative if we are in the right place, to pull them back to a grounded state.
- Teams: I asked my psychologist, before we had the concept of PTSD, what did the military do to keep ‘shell shocked’ people functional so they could keep on fighting. In prior decades, there was no option to pull people out of battle. The answer was, try to keep them focused on the team and the mission. We will all need to keep our fellow front-line colleagues in mind as those in the fight with us, and to stay in close emotional (not physical) contact with each other to get through this.
- Your bench: who are 2-4 people who you can talk to? Real talk. Not “how are you doing,” “I’m ok,” but “I’m really scared and worried about x/y/z.” It is best if at least a few of those you designate have known you since you were a child because you will automatically be able to be more vulnerable.
- Grounding objects: what are your lucky charms? I wore my ‘ringmaster of the shit-show’ socks on a hard day. It felt like a talisman. Is there a special object you can hold to touch and keep you centered? Something with deep meaning to you? Something to physically connect to?
- Abstract worry: It’s easy to spiral about the many beloved people we may lose knowing the emerging mortality statistics. Perhaps it’s better to just focus all that worry on a single person who can serve as an emblem so it’s more manageable. Many people are also worried about their own mortality. I have asthma and auto-immune disease, but I don’t think I could stand to be anywhere else but on the front lines. My psychologist asked me where I could serve the greatest good, and also to reflect on what I thought about death. My response: many people die for no reason at all, but if this virus take me out, I can think of no worthier cause (though of course, I hope to make it through).
- Ritualizing grief: We are likely to lose loved ones and colleagues. Sometimes grief is the worst when it is unstructured. Sometimes we have to postpone grief to just get through serving in a crisis. Many religions structuralize grief. The Jews have Shiva, a specific time to set aside for loss, and the year that follows which mandates the Mourner’s Kaddish for certain relationships. Hinduism also includes the Sraddha rites, setting forth schedules for mourning. You don’t have to practice those faiths to consider some way to add some structure. I told her when the time came to grieve, I would make Saturday my day to breathe and relax and Sunday my day to sit with any pain.
- Bright siding: Many of us by nature are snarky, sardonistic types. Standard wellness messaging often falls flat when we insiders know the scope of suffering and loss to come. But we also know from our colleagues in Washington state how much it matters to keep the troops functional, but it can’t ring hollow or like kool aid. This is fraught. No one wants to be Pollyanna about this. But as someone on the brink of exhaustion myself, I have found the little spots of sunlight a crucial way to keep going. This was one which made me breathe just a little slower: http://gurpreetkgill.com/what-if/
- Chinese Medicine: This framework teaches us that the lungs are the organs of grief. How interesting then, that this virus which often causes the worst symptoms in the lungs, should also produce significant grief from the losses to come. Why is grief associated with the lungs? My own theory: there are two kinds of crying. One is with the eyes- tears streaming down the face. The other is with the whole body originating in the lungs. It’s the ugly cry, the out of control heaving and breathing heavily cry which so physically involves the lungs. Many of us will being doing this in the days ahead. Those in healthcare may not have any opportunity to do so fully for awhile as we keep fighting. It will be months and years later. But let us keep in mind the very organs which may fail in our loved ones and perhaps even ourselves hold the keys to our processing grief and healing.
To my fellow healthcare workers, please take care of yourselves and each other. To everyone else- thank you for the goodwill and love you are showing us. Babysitting for those who need childcare, sending us baked goods to the hospitals, praying for us, saying a few kind words in the elevators. We need it all.
These are unprecedented times. No one has a playbook. In prior disasters or humanitarian crises, things were contained to a single location, or perhaps a few continents. This particular event hits the entire world. If ever there was a moment to show us our interconnectedness, this is it.
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HBR Article: That Discomfort You’re Feeling is Grief.