Coping With Grief and Loss During COVID-19

Paige Heitman talks with Phil Cox, interim director for the Auxiliary and Pastoral Care, about experiencing grief and loss in the time of COVID-19 during a recent radio broadcast of Phelps Health’s Ask the Professionals program. Listen to this show or one of our other shows.

Paige Heitman: Today, we have Phil Cox, interim director for the Auxiliary and Pastoral Care at Phelps Health, on our program. Phil, welcome back. We always love having you on our show.

Phil Cox: Thank you. It is good to be back.

Paige: Yeah, so before we dive in today to talk about grief and losing a loved one, tell us what your experience has been like over the last year dealing with COVID-19 and working at Phelps Health. What has been going on?

Phil: Well, it is very different than anything that we have ever experienced or that I have ever experienced. Grief has taken many forms. For one thing, the Phelps Health visitor policy has changed. Families have not been able to visit their loved ones in the hospital. So, that alone has caused separation and grief, just from not being able to visit. And there was even a period of time when chaplains were not visiting patients, and we were not able to provide the support and the comfort that we normally do. We would hear from patients that they really missed someone to visit, someone in their family, someone they were close to. Medically, we do what we can, but there is also the spiritual and emotional support that patients get from family pastors and so forth.

Phil: And obviously, as COVID-19 hit us hard the last couple of months, we have had greater acuity. People are sicker. We have had more deaths, and our staff has felt the heaviness of that and the responsibilities of that. I was talking this morning to one of our staff members. We have seen [how caring for very ill patients has taken its toll] on our own staff, and that's been heavy.

Paige: How has that grief affected our teams and our departments at Phelps Health? I know it really has taken a toll.

Phil: Yes, it has, and we still do our work, we still get everything done. It is just that we have not been able to—well, for one thing—we cannot really gather into the groups that we normally would.

Paige: There is no community anymore.

Phil: Exactly.

Phil: We have lost the feeling of community that we normally would [have]. Even the small prayer group that we always had on Thursday mornings in the chapel [at Phelps Health], we are not doing that. We have not [met] since last March. And it is not quite the same when I send out an email prayer, and people say they really like it, but it is not an in-person group. I really look forward to being able to gather again [in person].

Paige: Even patient care is completely different too, because before somebody goes into a room, they have to put on so much PPE (personal protective equipment) before they even go in and see a patient. [Our staff] cannot hold their [patient’s] hand. They cannot [give patients] a physical touch; [maybe] they cannot be as close to [their patients], or [maybe] they cannot hear [their patients] because they are wearing a mask or a face shield, and so on. There are so many limitations to the type of connection that we [can] make with patients now.

Phil: Exactly.

Paige: And that is a form of grief too, right?

Phil: It is. Our staff feels those limitations. And I have seen staff, especially in the ICU, when they would just want to say a word or two to a patient, but they have to do a whole different thing [put on all of their PPE]. It is very labor-intensive. [For instance, staff is facing] the limitations of not being able to do the job [the same way], not [being able to do] the same flow of work. The workflow is totally different. So, I can see that strain on [our staff]. By now, they have gotten into that flow, but it is still not the normal way of operating. [They have] the question in their minds of, "Am I still providing the care that I need to?" I feel [these concerns] when I walk through [these departments].

Paige: We come in and we do our job every day, but we are all carrying a very heavy weight.

Phil: Absolutely.

Paige: So is there a quick fix to grief?

Phil: No, there is no quick fix at all. In fact, some people feel like it is a very slow fix, and there is no one fix, except for the fact that [grief] is not intellectual. We would love to flip a switch and say, "Okay, I have got that behind me. Now, let me move on,” because there are so many emotions involved. Usually, what we do not address are the emotions involved, so we tend to try to help each other by saying things that only address the intellect, and we do not address the emotions. That draws [grief] out even further, because we do not know how to address those emotional things.

Paige: Whenever you say emotions, what emotions are tied to those feelings of grief that maybe we are not addressing that we should address?

Phil: Well, it is the sadness; it is the frustration, and sometimes it is anger. It is all the normal emotions that you would have, and [these emotions] do not come in stages; they do not come in a linear way. They come sometimes all at once, sometimes one at a time, sometimes three at a time, and they come at unexpected times. They come when you are driving in the car, and you hear a song; they come when you are walking in the grocery store, and you pick out a certain food; they come when you're at work, and a certain thing happens. Smells are very powerful. Sometimes [it is like you are] being ambushed, and [often this happens at] times when you do not want to lose it emotionally. [These emotions] come at unexpected times, and again, it could be several emotions at once, and it is very hard to [handle].

Paige: So how do we deal with [these emotions] instead of just saying, "You know what, I'll deal with this later," or, "It doesn't matter," or, "I'll just eat my feelings and never have to deal with it"?

Phil: [We need to be] honest with our feelings, and that is something that we have not been taught. In fact, by the time we are 15, one study showed that we have probably been bombarded with about 23,000 signals that it is bad to feel bad. Think about it: if a child comes home with all ‘As’ on the report card and they are happy, and they expect us to be happy, no one says, "Don't be happy. You'll get a ‘D’ eventually." That would be crazy. But if they come home sad, for some reason, we tend to say, "Don't feel bad. Eat a cookie," or, "It will be better." So, they realize at some point early on that it is good to feel happy, but not good to feel bad. We learn early on to stuff those bad feelings, and by the time we are an adult, that seems to be all we know how to do. So we stuff those [feelings], and we learn all these myths [such as], "Be strong. Don't feel bad."

Paige: "Man up."

Phil: That is right. "Man up; suck it up; shake it off." That is what I learned growing up as a boy, "Replace the loss; give it time." [We learn] all those things, so we are not honest with our feelings. In some cases, we are not allowed to express those feelings, and so we walk around with all these rocks in our backpack, as we say, and they get heavier and heavier. So, these emotions, the grief accumulates, and all of us grieve for various reasons. If we do not learn to unload [these emotions], then they get heavier and heavier.

Lee Buhr: Phil, I remember I had a couple of friends that died years ago, and I kind of went to the funerals, and did what I had to do. I never cried, but I was just glad I knew them. Then, Bosco, my dog, who I have told you about many, many times, died in 2012. We had to put him to sleep. And I cried for three days. I cried the day they put him down, and I cried after that. And I firmly believe that all of those pent up [emotions, like], "Oh I'm strong. I don't need to do this; I'm not going to cry. I'm Lee Buhr.”

Lee: [I kept thinking], "No problem, no problem. I can handle it." And I often believe that what happened to me with Bosco, and I loved Bosco, I loved him so much, but I often believe that all of those pent-up little things that happened to me prior to that day [all resurfaced].

Phil: Absolutely, no question. In fact, when I go through grief recovery with someone, either in a group or individually, we sometimes begin [with] what [brought] them to my group or my class. [A lot of times it], is a certain thing, a certain loss.

Paige: Like a catalyst.

Phil: Yes, and then when [people] get to a certain point where they decide to work on a relationship, after they have looked at a lot of their relationships or losses in their life, they realize, "I need to work on a different loss." [For instance], if they lost a spouse, they say, "I really need to work on my father or my mother, even though it has been years [since that instance occurred]. I need to work on that one first, and then I can work on others later." [How this works is] you get the tools you need to work on other losses, and [my role is] sort of like a master gardener. I am going to help you learn how to pull these weeds out of your life, and then you'll have all the tools you need to keep doing that. But, it is common for [people] to say, "I know what brought me here [to grief recovery or when they begin to feel emotions], and I need to work on that loss, but first, I need to work on other losses." We never compare losses, [because how people experience loss is different].

Lee: It was an amazing experience; it was very cleansing in a lot of ways. I really felt a lot of weight [lift] off of me, and I had never really felt it that much. At that particular time, I thought, "There is a lot more to this than just my dog passing."

Phil: Yes.

Lee: You have often said that grief is manifested in different ways. Somebody loses a child, that's a terrible thing, but if somebody loses a dog, and they are crying the same way, [others may] think, "Well, it is just a dog." Well, no, it is not just a dog to that person.

Phil: That is right. Grief is [felt] 100%.

Paige: Lee, whenever you were talking, it made me think of a question. Whenever people are grieving the loss of a loved one, whether it is a dog, like Bosco, or it is loved ones, maybe a wife or a really close friend, what if that person was your support person, the person that you went to for finances, or that was the person you went to whenever you were grieving? What happens when that is the person that is gone? What do you do?

Phil: Well, it is important to find someone else. If those people helped you in a very practical way, then it is important to find somebody else who can do those things for you. Now, they are not going to replace that person, because one of the myths [of grief] is to replace the loss, and you cannot just do that. Find someone, even if emotionally they do not replace that person, to help you with the things that you need to do, because life does go on. Finances go on; bills have to be paid and so forth. So, it is very important to find someone that you trust to help you with those things. On the other part of it, [find] a good listener. [This can be] someone else you trust, and it may be different people, [who will] listen to you without offering advice, without analyzing or judging or criticizing. [Who will] just hear you when you need to talk. Sometimes, you can coach people [by saying], "Don't fix me. I am not broken. My head is not broken; it is just my heart. I just need to talk right now. It is a bad day. Just hear me."

Lee: One of the things I have learned from you over the years is I never use the phrase anymore, "I know how you feel," because I don't know how [someone else] feels.

Phil: Exactly.

Lee: I usually say, "I'm sorry for your loss."

Phil: Even if they lost their dog or their friend, all you can say is, "I know how I felt when I lost mine, and I felt bad. It was hard for me. My heart was broken." You do not know [how they are feeling], because their relationship was unique to them.

Paige: Perception is reality, right? So, even if we think we understand, we should not assume that.

Phil: That is right.

Phil: One of the things people say when I ask [them], "What have people said to you?" [They respond], "Well, I am so tired of people telling me they know how I feel, because they do not." That is true. We do not.

Paige: One thing I always try to say is, "That must be really difficult. Help me understand. Tell me more."

Phil: “Help me understand” is an excellent way. And, then you are quiet. It gives them a chance.

Paige: Yes.

Phil: “Help me understand how that affects you” That is a really good thing to say.

Paige: I have to give kudos to my mother-in-law for that. She is a really great listener. Especially in light of COVID-19, we've lost so many loved ones. A lot of times we do not even get the chance to say goodbye. How do we talk to somebody who we know is dying and the only chance we get to say goodbye is over the phone or via Skype? And so [our goodbye is not able to be done in person]. How do we say goodbye to them? How do we talk to them?

Phil: Still talk to them. You have to do it the best way you can. Still tell them the things that you want to tell them, and be honest. I was with a family [and the experience was a] little bit different than normal, [because I was] in the room as the person was dying. The [family] did a little more than normal. They said things in a more detailed way, and I remember thinking, "This will help them in the long run." They went through very specific things that they needed to say to their loved one. And I thought, "This is very healthy." Even though [the experience] was very hard, very sad, very emotional, they did some very specific things. In fact, [they did] almost the same thing that I do with people in grief recovery, [only] they were doing it at [the] bedside as the death was taking place. I thought, "Wow, I could not have told them anything more to do than what they were doing." They did it instinctively, and I thought, "Wow, this is really good." [They were] telling stories, and when people start telling stories about those people, that is always good. That is a healthy thing to do, because again, we are reviewing their life; we are reviewing our life with them, and that is always a good thing.

Paige: What about stories after the death of a loved one? Is it important to keep their memory alive?

Phil: Oh, absolutely. And that is partly what we do. In fact, if we try not to talk [about them], that makes it worse. Again, we are stuffing [those feelings]. When we gather with family, and they act like they do not want to talk, just say, "I would like to talk. Remember when…? Remember the garden they planted? Remember what they cooked? Remember their fishing places?" [Talk about] all those things, and that loosens [people] up. That keeps [our loved one’s] memory alive, and it is very important. We did not want to lose them. We never want to lose our loved ones.

Paige: Do you have to keep their traditions alive though? That's one thing that my family really struggled with when my Nini died about seven years ago. That was my grandma. She was the matriarch of the family, and whenever she died, everybody wanted to continue to have gatherings at her house, which is my uncle's house now. And, that just does not happen anymore. We tried to do it for the first couple of years, and then we all just kind of decided, this just is not going to work. It was awkward the first couple of years of [not having gatherings] there.

Phil: Yes. Well, that is hard, because sometimes you realize that there is a person that is the glue that holds everyone together. If you see that [keeping a tradition] is not going to work, you have to let that be okay. To force [something] is not necessarily good. And, it is good to talk about that. [We could say], “Maybe we need to let go of this and do something different. [We could] either gather at someone else's house, or do it a different time of the year.” Whatever you can manage to do. We found [this] out in our own family when our mom died.

Lee: And like we say, Phil, “life goes on.” Life doesn't stop.

Phil: That is right.

Lee: And for the living, you have to find a way to make adjustments. It is hard to do, but eventually [these adjustments] do seem normal in some way.

Paige: Grief is different for everybody. Lee, you have mentioned this. I know for myself that I don't grieve the loss of my Nini anymore. But, I know for some of my family members, like my uncle, he still does.

Phil: Sure.

Paige: So grief does not have to last just one year, right? It is different for everybody?

Phil: It is different for everybody. That is right.

Paige: There are a couple of myths surrounding coping with the loss of a loved one. One of those is that once your period of grief is over, you will not feel [that] grief ever again the rest of your life. Why is that just not true?

Phil: Well, because, there always will be sad times. What I hope to do with people is to keep those [sad times] from turning into pain. When I think of my mom or my dad, there will be sad times. I wish they were here, especially my mom, but it does not turn into painful memories. [When these sad times do not turn into pain is] when we know we have made progress.

Paige: I think that is a really great way to wrap up our show today, Phil. I think it is really important to remember our loved ones and to remember how important they are. It is also really important to remember how great it was to have them in our lives. Right?

Phil: Absolutely.