Grief and Hope Can Coexist
Most of us recall exactly where we were on 9/11. If you’re anything like me, you also remember the days and weeks following it — specifically the veil of grief that quietly bound us together.
When the planes hit the twin towers, I was a medical resident in the cardiac ICU at Johns Hopkins doing morning rounds with my team. I was 7-months pregnant, hair in a knot, belly stuffed into light-blue XXL scrubs. I will never forget the moment in that ICU bay when the eyes of eight doctors and nurses moved in sync from the intubated patient before us to the television mounted on the wall above her. Silence befell the group as we watched history unfold.
Probably like you, I remember being glued to the TV for weeks on end — watching and praying and trying to make sense of the horror. (I also regularly sneaked into the on-call room with a portable ultrasound machine to check on my unborn son. With jelly on my belly, I would study his tiny lips and limbs and ponder the world he’d soon be born into.)
Most memorable in those weeks, however, was watching the movements of ordinary people. A gentleness overcame us. Strangers smiled at one another. We needed each other. We were there for each other. We were jolted into looking at things bigger than ourselves. 9/11 was like a “control-alt-delete” on our collective psyche. Whether we knew it or not, we were suffering and trying to heal at once.
As we face the next chapter of the pandemic, I long for that sense of collectivism. An abandoning of differences. A forgiveness. A reconciliation. I’m old enough (and I’ve done enough therapy) to realize how easy it is to hold grudges and dig our heels into fixed beliefs during stressful times like this; I’m perhaps naive enough to think we can do better. As a physician for over twenty years, I’ve also had the privilege of witnessing patients’ post-traumatic growth. I’ve experienced it myself.
One of my least favorite expressions (second only to “It’s all good” which, to me, is code for “allow me to sugar-coat this painful reality”) is “What does not kill you makes you stronger.” It implies that something’s wrong with you if you aren’t more resilient after trauma. Finding meaning out of loss doesn’t just happen. It takes work. It takes time. It requires grace and self-compassion. It necessitates asking for help.
As for the ongoing trauma of COVID-19, I’m probably like you: a little shocked we’re here. When I started this newsletter back in March 2020, I had no idea I’d be writing about COVID 18 months later — or that this virus would continue to run roughshod through the country, taking lives, livelihoods, and our sense of normalcy in its wake. It has robbed us of important connections. Families have been torn apart by loss. Relationships have been strained by ideological differences, varying risk tolerances, and accumulated stress. I wrote about the medical manifestations of collective trauma for the Huffington Post back in April 2020 but didn’t imagine the magnitude of death and destruction we still face.
A reminder about trauma: you don’t have to have lost a loved one in the Twin Towers or from COVID-19 to have experienced it. Trauma occurs as a result of violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences. But trauma can be defined as an emotional response to any event or experience that is deeply distressing or disturbing. Like many medical doctors and psychologists, I apply this trauma definition loosely; trauma can refer to something upsetting, such as going through a divorce, cancer treatment, or 18 months of a pandemic.
Why does this matter? Because trauma, grief, and loss are part of the human condition. Because these experiences inform our thoughts, feelings and behaviors which, in turn, affect our health. And because addressing our interior world — and connecting the dots between our mental and physical health — is necessary to be fully healthy.
Finding meaning after trauma isn’t always on the mental menu. Many of us don’t have the luxury of moving away from pain or “zooming out” on suffering. Moreover, there is no one-size-fits-all prescription for processing difficult experiences. But some of the simple ways I help my patients start the process of steering themselves away from post-traumatic stress and toward post-traumatic growth:
Create brain space. In order to process complicated thoughts and feelings, we need time and space to step outside of the moment. Sometimes this means purging the calendar of things that aren’t 100% necessary. Sometimes it means taking a long hiatus from social media. Sometimes it means recognizing and letting go of endless loops of negative self-talk to clear the path toward quiet self-reflection.
Practice gratitude. You might associate this concept with a $4.99 journal in the check-out aisle at TJMaxx, but counting our blessings is trendy for a reason. When we consciously think through the simple pleasures in our lives, our dopamine levels — and sense of calm — increase. We also open the door for hope and healing.
Prioritize self-care. I know: now you’re picturing a mug at TJMaxx. But truly, madly, deeply I mean it: we’ve got to put ourselves first. Sleep, exercise, healthy eating, and social connections form the foundation for our health and well-being — yet are often the first things to go when we’re under duress. I regularly remind my patients (and myself) to try to take care of themselves like they do their kids, their work, or their pets. Caring for ourselves isn’t selfish; it lays the groundwork for improved health.
Identify your support team. It’s hard to navigate hard times alone. Whether it’s a group of girlfriends, a religious leader, or a therapist (or all of the above), asking for help is an important step toward a healthier future. Professional help is absolutely essential for people with complex trauma, depression, anxiety, substance-use disorder, or PTSD; it’s also appropriate for anyone seeking guidance and support through a difficult time.
COVID is a beast. The pandemic has been brutal — in different ways — for each of us. So what keeps me going through the last 18 months? How do I try to find meaning during this wretched time for us all?
First, I practice gratitude for the progress we’ve made and for the stunning effectiveness of the COVID vaccines. For the latest good news:
The vaccines remain extraordinarily effective against death and severe disease. Three new studies released last week remind us how protected we are. Of course breakthrough infections are expected and no longer rare given the high contagiousness of Delta. (I wrote extensively about breakthroughs here.) But most breakthrough infections present as a cold or flu-like illness and are a sign of vaccine success.
The vaccines reduce the risk of transmitting the virus (including Delta) to others. Multiple robust studies including those out of Singapore, The Netherlands, and China show us that vaccinated people clear the virus faster compared to unvaccinated people.
The vaccines are astonishingly safe and do not produce worse variants.
There has yet to be a variant that evades immune protection from the vaccines. That includes mu!
Vaccinated people are significantly less likely to develop long COVID after a breakthrough infection.
It seems possible that the FDA might authorize the Pfizer vaccine for kids ages 5-11 by the end of October, though Rochelle Walensky told The Today Show “by the end of year” this morning. By the way, this terrific webinar put on by the British Medical Journal about vaccines in kids is really worth watching.
Second, I visualize the path forward. The road out of this hellscape is through widespread population immunity (the combination of vaccine-induced immunity plus natural immunity from COVID-recovered people — not that we want the latter). I have written about breakthroughs, boosters, and natural immunity here and here. Scott Gottlieb had a terrific article in The Atlantic yesterday about living with COVID as we head toward inevitable endemicity.
Third, I try to take care of myself — including asking for help. I saw my own doctor on Friday. I took a long walk with a friend on Saturday. My husband and I started rewatching our all-time favorite series, The Wire. (It reminds me of my Baltimore days.) I’m making sure to get at least 7 hours of sleep. I reach out to friends regularly. I continue to check in with my therapist. Like most people, I cannot “human” alone. I know my limits, I wave the white flag and cry mercy when I’m overwhelmed. Like you, I am a work in progress.
Fourth, I maintain strong human bonds. The relationships with my medical colleagues around the country — plus the spirit of collaboration and intellectual curiosity — have helped keep me going for the last 18 months. In constant communication with them — reviewing emerging data, processing new developments, and checking my biases — I’m in awe of the selflessness and integrity of my medical compatriots.
My friends, family, and you, dear readers, have also kept me going. Having a front-row seat to this pandemic has its ups and downs, and I’m grateful that you have stuck with me for over 18 months! Let’s keep going.
I am humbled by this virus, but similar to the days and weeks following 9/11, I remain humbled by the power of the human spirit to come together in times of crisis. As we move into this next chapter of COVID, I hope we can all take time to step away from the moment we’re in and reflect outward.
Despite ongoing uncertainty and shared vulnerability, it’s important to keep our eyes on what’s possible. The pandemic will end. Post-traumatic growth is possible. Grief is normal. Hope is healthy. We need both, together, to move forward.
I will see you next week. Until then, be well.