Traumatic Grief co-existing with Post Traumatic Stress
Being a hospice nurse, I spoke often to community organizations, healthcare professionals, and faith communities on the topic of Grief. I spoke about the different kinds of grief – normal, complicated and disenfranchised grief. Topics such as “grieving well”, “breaking bad news”, “saying goodbye” were the most frequent.
I first spoke on the topic of “traumatic grief” to an audience of active duty service men and women in the USAF, at Wright-Patterson Air Force Medical Center in Ohio. I had recently completed certification as a “train the trainer” and was a facilitator of the End of Life Nursing Education Consortium (ELNEC) module for Veterans, created by ELNEC to address the needs of our country’s Veterans at End of Life.
Veterans receiving hospice care at the end of life had never grieved all the losses, prior to their terminal illness and approaching death, or the death of a spouse. The military culture is a culture of stoicism, absolutely necessary for the mission, focused on defense, protecting our country’s freedoms. The deaths of comrades were sudden, violent, and horrific, multiple deaths being witnessed at one time, or back to back. They had to keep going, not taking time to be with the pain and overwhelming feelings.
The traumatic grief of soldiers includes the magnitude of loss beyond the battlefield. The loss of health due to diseases associated with war related conditions (Agent Orange causing cancers), loss of a body part due to injury, loss of strength, loss of a spouse or an adult child, or a young grandchild. Loss of identity as a soldier.
Traumatic Grief experienced by nurses in the pandemic
Traumatic grief, as experienced by those in service to our country, is being experienced by the frontline workers battling this pandemic of COVID-19. Nurses on the front line are surrounded by death, multiple deaths at the same time and back to back – of colleagues, friends, family members, and patients who are dying alone, and the grief of family members unable to say good-bye.
Nurses and healthcare workers are bringing previous death experiences to this pandemic. Many adults, including nurses and physicians have a history of the adverse childhood experiences (ACE). As a child these experiences may have been the death of a parent, close grandparent, divorce, domestic abuse, loss of home, or a parent unable to care for them as a child. The horrific loss of life, and life as we knew it, the many other losses with the pandemic has the feel of traumatic grief.
As a culture we do not grieve well. Similar to the stoicism of our military culture, healthcare professionals are not being given the time to recover and heal before returning to work. Loss of money, loss of job security, loss of paid sick time benefits, understaffed units are all factors leading to traumatic grief. Overwhelming grief is suppressed, pushed to the bottom of the dark lake of collective trauma.
Traumatic grief has similar symptoms of PTS
Trauma is experienced in the body. We cannot talk our way out of trauma. Traumatic grief will need healing in similar ways of healing from PTS. Traumatic grief has symptoms of nervous system overwhelm, dissociation, sleep difficulties, sudden and unexplained anger, and behaviors of alcohol and drug addictions. Horrific stories take on a life of their own in the mind.
Being present to others, patients, families, and team members becomes difficult. Not being fully present means not seeing with attunement. Important messages and cues are missed in caring for patients, and in communicating.
To be in the presence of a human being in despair, one cannot help but feel the despair in the nervous system of their own bodies. Energy and space are shared in a coherent field. To be present with grief, one must “stay”. Stay in the moment, grounded, fully present. Not easy to do alone.
Collective trauma needs collective healing. When one is healed, all who are present and participating are healed. A nervous system co-regulation means that my nervous system and your nervous system have the capacity to support each other, co-creating a coherent field for healing to occur.
Walking through the valley of the shadow of death, together
The recovery from trauma will be essential for many months ahead, possibly years into the future. Nurses will be experiencing increasing PTS in the aftermath of COVID-19. Alongside PTS, will also be Traumatic Grief, as experienced by our country’s Veterans returning from war. Predictions are already being made that the PTS of COVID-19 will surpass that experienced after 9/11. Creating an organizational culture of recovering and healing from collective trauma, a space will also be created for healing from traumatic grief.