Month: May 2020

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6 Ways To Cope With Anticipatory Grief During The Coronavirus Pandemic

By María Tomás-Keegan

You can make the best of the current situation.

It’s odd. Not much has changed for me. I’ve worked from home for over 20 years, so nothing new there. I see clients, virtually, so social distancing is no problem. No kids to home-school.

My husband and I are homebodies due to his health, so not being able to go out for fun is not a huge sacrifice. With the exception of my small business has taken a hit, I should be good, right?

Then, what are all these emotions coming up? I’ve never felt anything like this.

All at once, I’m feeling depression over the loss of many things: connection, safety, control, freedom, physical contact, a predictable future, financial security, and new clients.

Based on what I do for a living, I know all too well what comes from loss and how mental health is affected.

It’s grief — but a whole different kind for me. I’ve had my share of losses in the past — sudden ones and some that I knew were coming. Among those losses include both parents, two siblings, jobs, and friends.

Not unlike most of you. Yet, this feels different.

Anticipatory grief could describe it, which means we are grieving before we have fully experienced the loss. It’s typically associated with the impending loss of someone who is very ill—been through that one, too.

And, because there is so much uncertainty around the COVID-19 coronavirus pandemic, it feels as if there is no end in sight. As we think about all that is going on, we find ourselves imagining the worst outcome. It’s human nature.

Even while I’m trying to stay grounded and connected to the people who support me, there is still a pit in my stomach. Although I know in my head that this condition is temporary, the uncertainty is unsettling.

As I attempt to stay connected — with family and friends, clients, and colleagues — I hear a certain degree of dread in their voices.

Some call it fear, anxiety, and panic. It feels like pervasive negative energy that is hard to avoid.

So what can we do to make the best of this roller coaster ride of emotions?

As a life coach specializing in transitions, I learn from the experts.

One of my go-to resources is David Kessler, one of the foremost experts on grief. His recent interview in the Harvard Business Review helped me to sort this out for myself.

When asked what people can do to cope with the grief we’re feeling, Mr. Kessler said:

“Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren’t linear and may not happen in this order. It’s not a map, but it provides some scaffolding for this unknown world.”

There’s denial, which we say a lot of early on: “This virus won’t affect us.”

There’s anger: “You’re making me stay home and taking away my activities.”

There’s bargaining: “Okay, if I social distance for two weeks, everything will be better, right?”

There’s sadness: “I don’t know when this will end.”

And finally, there’s acceptance: “This is happening. I have to figure out how to proceed.”

Acceptance, as you might imagine, is where the power lies. We find control in acceptance: “I can wash my hands. I can keep a safe distance. I can learn how to work virtually.”

What stage do you recognize as yours?

I’m bouncing between bargaining and sadness and acceptance, with a brief visit back to denial and anger. Kessler is right — it’s not a linear journey through grief.

With the stage identified, how do you manage this thing called anticipatory grief?

There are 6 ways to cope with anticipatory grief during this pandemic.

1. Allow your emotions to flow.

Kessler says, “Emotions need motion” and I cannot agree more. Think about what happens when you stuff down anger and you don’t let it out in a healthy way.

You likely feel a lump in your throat or a knot in your stomach. Your hands may shake. And you may develop a massive headache

That’s an emotion that has nowhere to go. It can be so powerful that you lose yourself in it. It’s vital to take steps to alleviate some of the pressure so you can let the feelings go.

First, acknowledge your feelings and give them a name. If it’s grief, call it grief. Anxiety. Fear. Whatever it is, attach the label to it.

Then, find ways to work through each one, with the ultimate goal of releasing the emotion from your body. The relief you feel will be tangible and allow you to move forward from here.

This can be an uncomfortable exercise. But, when you talk it out with someone you trust, it will become easier. However, if you ignore this step, the rest of these suggestions might not be very effective.

2. Notice what you’re thinking.

If you’re watching too much of the media reports, you may be spending more time in the doom and gloom department than you want.

Consequently, your thoughts may take you down a rabbit hole from which it’s difficult to climb out.

When you notice this happening, make a conscious choice to change the negative thought into one that feels better to you.

For example, instead of thinking, this will never end, you might choose to think, this is just temporary, and we’re going to be okay.

3. Be in the moment.

Anticipatory grief happens when your mind projects into the future and imagines the worst possible scenarios.

When you find yourself doing that, it helps to bring yourself back into the present.

In the here and now, what you imagined hasn’t happened. Take a look around and take note of where you are.

I’m sitting in my living room. The sun is shining, there is a slight breeze, and my dog is lying at my feet. I’m okay.

Then, observe how you are breathing. Slow it down. Take in some deep breaths and exhale slowly.

Being in the present can bring about a sense of calm. You can choose to practice this at any time your mind wanders into the ‘badlands’.

4. Control what you can.

The loss of control can be the most unsettling feeling of all. Along with that loss comes a sense of insecurity, anxiety, and fear that you have no power to influence the outcome of the situation.

But, you do.

Minding your mind and staying present will help you feel more control in this uncertain world.

A simple way to feel more in control is to make a list of all the things that are in your power to influence.

For instance, your list might look like this:

  • The time I go to bed and wake up
  • The people I hang with to uplift me
  • What I choose to think about
  • My priorities
  • What I talk about
  • How often I reach out to connect with my family & friends
  • How kind and compassionate I am
  • How much I laugh

Write your list and refer to it every time the powerful emotions come up, which makes you feel totally out of control.

5. Be kind and compassionate, reserve judgment, and bring no harm.

The coronavirus pandemic has affected the entire world. It is an unprecedented time where we can honestly say, “We are all in this together.”

No one is immune and we are all doing the best we can — anticipatory grief and all.

Given these facts, there has never been a better time to live by the Golden Rule: Do Unto Others As You Would Have Them Do Unto You.

I want people to be kind to me, compassionate for my situation. And I don’t want anyone to judge me for doing something right for me, even though it may not be what they would do. As long as I bring no harm, I’m good. And so are you.

Each one of us deals with the profound emotional toll in different ways. It’s the perfect time to allow kindness and compassion to emerge.

Understanding and reserving judgment are the best tools we have to help each other as we move through the loss, grief, and worry that permeates our world today.

6. Find the silver lining.

When things feel most grim, it helps to look for the good.

In my case, the neighborhood has come together to help each other.

If someone is making a run for groceries, we all get a text to ask for our shopping list. One person goes to the store and replenishes the cupboards of many.

Are you spending more time with your family at home? Do you share your deepest worries and concerns with your partner more than you did before?

What has changed for the better because you are working from home, schooling your children, or being more conscious of your sanitary habits?

One friend of mine made me laugh when she said she has greater respect for her kid’s teachers and what they go through every day. And, she continued, she only has two at home, not a classroom-full!

For that, she is grateful. She said her silver lining is that this won’t last forever and she can send her kids back to school one day soon.

What have you noticed more of, get to do now, or enjoy better because of your situation? Focus on those.

One of the guests on my podcast went through great adversity and developed a motto that helped her when things got dark.

She now uses it to help her feel better during this pandemic. She says, “The plus side is…” What’s your plus side?

Lastly, don’t try to do this alone. Isolation is not your friend. Connection is.

Whatever the powerful emotions you feel, don’t keep them to yourself. Find someone you trust and get it all off your chest. The worry you feel about what you can’t know is the same worry everyone else is feeling.

Anticipatory grief and all the accompanying emotions can build up like a pressure cooker.

Staying connected with your people will help you release the pressure and take positive steps to keep moving forward in the best ways you can.

Complete Article ↪HERE↩!

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Some Ways That I’m O.K. Dying

By Mike Birbiglia

This is the first time I have spent long stretches imagining my own death. Usually, the death pass is a perfect thirty-yard spiral. This death daydream takes place in a blinding blizzard in a game that I lose. In this one, I imagine being sick for a while and then developing a hacking cough and then getting pneumonia and then dying. This is an awful death simulation.

I feel like I am O.K. with some versions of my own death. Like, maybe I go for a nice long walk, then I have dinner with my wife and daughter, maybe a phone call with an old college friend, and then a meteor hits the earth. Sign me up for that death. Or maybe this: I take a guitar lesson with Paul Simon. He teaches me “The Boxer” and then, for no justifiable reason, I play the song perfectly—like, better than Simon & Garfunkel in Central Park in ’81—and after I play the final note Paul looks over at me and says, “That was really good, Mike.” And then the building explodes. So obviously, in that scenario, we both die instantly and the headline reads, “Paul Simon and Unknown Comedian Die After Perfect Jam Session.”

There is one last death scenario I’d be O.K. with. To recap, so far it’s:

1. Dinner with my family and then a meteor.

2. Simon & Birbiglia followed by explosion.

The third and final death scenario I’m O.K. with is my wife and daughter and I go to the beach and have a bonfire, which is prepared by bonfire professionals who make sure it’s not too hot but perfect for s’mores. And we make s’mores—no, wait, that’s after we make a bonfire pizza, with dough flown in from Frank Pepe’s, in New Haven. So we do pizza then s’mores and then my wife leans over to me—privately, because our daughter is only five—and she says, “If anything ever happened to you, I want you to know that we would be O.K. and that you’ve given us more than we could hope for in three lifetimes. So, God forbid anything happens—we will be fine.”

And then I say, “I love you both.”

And I walk into the water and am eaten by a shark. Quickly. The key there is “quickly.” And the headline reads, “Unknown Comedian Killed by Shark After He Kills with Thousands of Audience Members.”

Those are the ways I’m O.K. dying. But, these days, it’s much grimmer than that. It’s hacking coughs and scorching fevers and ventilators and intubations and people sharing their final words with their families through a bad connection on a cell phone.

So my only remaining hope in this terrible simulation is that, if I find myself in a hospital, hooked up to a ventilator that is about to be taken from me—that I will be aided by an adequate amount of medical delirium to actually believe that the last thing I see is Paul Simon, leaning over to say, “Mike, you played that final note perfectly.”

Complete Article ↪HERE↩!

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Coronavirus Disrupts Hard Decisions About End-Of-Life Treatment

The coronavirus means more people are dying alone in ICUs. Families are having to make abrupt decisions at a distance about terminal care. Palliative care specialists try to adapt.

By Will Stone

TRANSCRIPT

Palliative care is a specialized branch of medicine that focuses on relieving pain and symptoms in seriously ill patients and those who are dying. Will Stone reports that the coronavirus pandemic has disrupted this kind of care at a time when families are facing abrupt decisions about end-of-life treatment.

WILL STONE, BYLINE: Before coronavirus, Darrell Owens rarely worked in the emergency room. Now he’s there daily. Owens is a nurse practitioner and directs the palliative care program at a hospital run by the University of Washington in Seattle. Owens used to visit with families in quiet conference rooms or at the bedside.

DARRELL OWENS: Cancer patients, stroke – regular routine palliative care patients.

STONE: Back then, he could grab a chair and scoot up right next to the patient and take his time. Palliative medicine focuses on patients’ quality of life and relieving symptoms of serious illness, like pain and anxiety.

OWENS: We are obligated – as much as we are to try to save people’s lives, we are as obligated to save their deaths.

STONE: Across the country, coronavirus has disrupted this sacred task. Owens is adapting. The ER now calls him a lot. He sees every coronavirus patient who’s older or at risk for complications.

OWENS: The conversations are more abbreviated than they would be because, one, you’re behind a mask. You’re in a loud room, completely gowned up, and so you want to limit your exposure.

STONE: All that makes it harder to talk through a patient’s chance of survival and big questions, like do you want to be resuscitated? Do you want to be put on a ventilator? Because of the pandemic, relatives are usually barred from the hospital.

OWENS: You cannot underestimate the stress on family members who cannot visit and now, in a crisis mode, trying to talk this through over the phone.

STONE: It’s this painful new reality that Rich and Rob Mar and their sister Angie Okumoto faced when they lost both of their parents to coronavirus last month. Their mother Elizabeth was in her early 70s, still running a Hawaiian restaurant with her daughter. Rich says she liked to give out hugs.

RICH MAR: One of those people that just quickly made friends and made an impression on everyone.

STONE: They say their mother was in good health before contracting the coronavirus. They brought her to the ER when her breathing got worse. She was asked, did she want to be resuscitated, if necessary, and put on life support? Angie says they didn’t hesitate to say yes.

ANGIE OKUMOTO: You know, yeah, of course. We just had no idea what this virus was going to do.

STONE: They just assumed she would pull through.

MAR: I didn’t know that was the last time I was ever going to talk with her.

STONE: Before they knew it, she was sent to the ICU.

OKUMOTO: For 14 days on the ventilator, she was alone.

MAR: Right. Right.

OKUMOTO: Alone for 14 days.

MAR: That’s the part that hurts the most and what will haunt me forever.

STONE: Near the end, they did get to see her, but she was sedated.

MAR: We were all gowned up. And so we’re, like, trying to talk to her and let her hear our voices.

STONE: Meanwhile, their father Robert was also getting sick. He was 78, an engineer.

MAR: My dad was more of the analytical type. He can give you a practical solution for everything.

STONE: They took him to the same hospital as his wife, where he made his wishes very clear.

OKUMOTO: My dad, from Day 1, he said he did not want to be on life support.

STONE: So Darrell Owens, the palliative care director, started managing Robert’s care.

MAR: He was super compassionate, telling us the facts and being straightforward with us.

STONE: Because Robert had decided against aggressive treatment, he was never moved to the ICU. He was able to have a few visits with his kids, and he wasn’t on a ventilator, so they could talk to him and text. Their father died on March 27, not long after their mother.

MAR: The way he wanted to.

OKUMOTO: With dignity.

MAR: With dignity, yeah. That was very important to him.

STONE: The family is grateful to the nurses and doctors. Still, they grieve those visits they never had. Angie never got to say goodbye before her mom was intubated.

OKUMOTO: If I got to be bedside to my mom earlier, holding her hand and just being present – and that we’ll never know, right? Like, that’s what sucks.

STONE: It’s an experience of death that more families are coming to know – loved ones dying alone and out of reach from a new and poorly understood virus. In New York City, Dr. Diane Meier works in palliative care at Mt. Sinai School of Medicine. During the worst of the surge, the hospital set up a palliative care hotline for families.

DIANE MEIER: So this is completely unprecedented. All the cues you normally get with face-to-face are very hard to pick up over the phone.

STONE: Mt. Sinai doctors are even calling elderly patients at home to learn their wishes just in case they do get infected.

MEIER: Many of our patients had been thinking about it a lot, incredibly relieved that we had reached out to them.

STONE: Meier says it’s a new way of doing palliative care when faced with a virus that moves so fast. For NPR News, I’m Will Stone in Seattle.

Complete Article ↪HERE↩!

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Her greatest fear was dying alone

— two days after she caught coronavirus, she did

Britt Patrick, right, said her mother Jennifer Patrick was a joyful person who loved spending time with friends and family. Jennifer Patrick died of COVID-19 in a Calgary nursing home on April 19.

Nursing professor says everyone should have the chance to say a deathbed goodbye

By Sarah Rieger

Jennifer Patrick was terrified of dying alone.

The 65-year-old was diagnosed with pulmonary fibrosis nearly two years ago. She relied on progressively higher and higher concentrations of oxygen and a few months ago was moved to a Calgary nursing home.

Since the diagnosis, Britt Patrick said her mom just kept repeating her fear — “I don’t want to die alone.”

But two days after she contracted COVID-19 that’s exactly what happened.

On April 19, the 65-year-old from Airdrie, Alta., was having a panic attack, gasping for air. She hadn’t seen a friend or family member in days.

It was her husband’s birthday. They’d spent the last 41 years together but hadn’t seen each other since the Calgary home, Extendicare Hillcrest, was locked down to visitors. Her daughter and grandchildren were two provinces away.

Her nurse, who was sitting by her bedside, left the room to get morphine to ease her panicked gasps for air. When the nurse returned, Jennifer Patrick was gone.

“It was very, very surreal,” Britt Patrick said.

“I feel like maybe my dad should have been allowed in with proper protection just to say goodbye.”

No chance to say goodbye

Patrick said her mom’s COVID-19 diagnosis didn’t come as a shock. The Winnipeg resident knew Calgary was experiencing high numbers of COVID-19 cases, and said she had an ominous feeling, knowing her mom already had a serious respiratory illness.

But the speed of her mom’s death, without a chance to say goodbye, left her reeling.

She doesn’t even remember what they talked about during their last phone call — the oxygen deprivation had increasingly made talking on the phone difficult for her mom.

“That’s frustrating and that’s hard,” she said.

“I know I ended up missing a phone call with her. I had been trying to get a hold of her for quite a while and I finally got a phone call back. I was just getting out the door and I didn’t have time to answer it and I wish I’d taken that two minutes to take that conversation.”

She also doesn’t know what to tell her three children.

“They’re struggling with it, they’re asking, ‘When can we go out there? Are we going to the funeral?’ They’re asking very obvious questions for children that I can’t answer and that’s frustrating, to not be able to let them know when we can visit Grampy, when we can do these things,” she said.

Dying alone all too common during pandemic

While Patrick may feel alone in her grief, tens of thousands of families globally are facing the same harsh reality — forced to say goodbye through a video call or being deprived of even that small connection, due to precautions in place or personal safety decisions made to avoid spreading the infectious disease.

University of Alberta nursing professor Donna Wilson studies end-of-life care, bereavement and what it means to have a good death.

She said while initially many of us were taken by surprise by the pandemic, now that it has been the reality for months, it’s time to find better ways to let people say goodbye.

“There has to be a way around this,” Wilson said.

If a family member thinks it wasn’t a good death … they may have seriously complicated grief.
– Donna Wilson, University of Alberta nursing professor

Wilson said the deathbed goodbye — where loved ones gather around a dying person’s bedside to make amends, and express sentiments that may have previously gone unsaid — is a centuries-old custom for a reason.

“People don’t want to be alone, they want to be surrounded by their family members, the people that really mean something to them… it’s really important because people have the opportunity to say something to the dying person that maybe they never said before.”

She said international research has shown that a good death, which is somewhat expected, largely free from suffering, and in accordance with a patient or their family’s wishes, is vital to the grieving process for those left behind.

“If the family member thinks it wasn’t a good death … they grieve harder and longer and they may never get over the death, they may have seriously complicated grief,” she said.

The families of people who died after getting COVID-19 are sharing the stories of their loved ones to encourage others to do what they can to prevent further spread of the coronavirus. 2:05

That’s the situation Britt Patrick finds herself in.

“You have people who are passing away afraid and alone, why can’t we at least set something up to allow people to say goodbye safely?” she said.

Michael Bittante, the regional director for Extendicare, said while Jennifer Patrick’s family was contacted and informed of her condition, end-of-life visits are not always feasible.

“We continue to provide end-of-life visitation with families when possible, using personal protective equipment and infection control measures. Unfortunately, this is not always possible for a number of reasons, including the progression of a resident’s illness,” he said.

CBC News reached out to Extendicare to clarify the timeline as to when residents are allowed end-of-life visitors, and the company reiterated that it is following provincial directives.

Donna Wilson said it’s important for the government or health officials to step in, as they did to limit visitors to nursing homes, to ensure end-of-life visits happen.

“We’re looking at a lot of people that are going to be really severely damaged if they’re blocked from the deathbed,” she said.

Wilson suggested strategies like bringing in retired nurses to facilitate visits and assist visitors with donning protective equipment, or arranging for visits to be held in private rooms near the entrances of buildings or even in ambulances, that can be cleaned after each visit.

“If you can get a nurse in and out of a hospital safely … you can bring a relative in and out safely.”

Some end-of-life policies were applied too strictly

Dr. Deena Hinshaw, Alberta’s chief medical officer of health, said Wednesday that she knows the protective measures in place at long-term care facilities are causing many residents to feel increasingly isolated and said some end-of-life visitation policies were being applied more strictly than intended.

“There have been some interpretations where some believed the intention of the order was [to only allow visits] in the last few hours of life … it’s very difficult to arrange for visits in that very narrow window,” she said.

“We expect that individuals who are dying must have the opportunity to have their loved ones at their side.”

She said up to two visitors can be allowed to see those estimated to be two weeks away from death, as long as they maintain two metres of physical distance.

While that update doesn’t change anything for Britt Patrick, she’s learned one thing in her grief she wants to share.

“Just take every chance to connect with your loved ones.”

There were 503 cases of COVID-19 in nursing homes across Alberta as of Wednesday.

In the two weeks since an outbreak was declared at Jennifer Patrick’s nursing home, eight residents have died, and 19 residents and 10 staff members have contracted COVID-19.

Complete Article ↪HERE↩!