One day last fall, I arrived on the sixth-floor nursing unit to find something didn’t feel right. When I saw a nursing colleague with tears streaming down her face, my heart dropped. “Dr. Hass, K. died last night,” she said, and started to sob. I stood dumbfounded for a moment. We had lost a beloved coworker to COVID-19.

We have all suffered losses since the onset of the pandemic: smiles, touch, in-person relationships, a “normal life.” But it went to another level for us at Alta Bates Summit Medical Center in Oakland, California, with the passing of teammates last fall—just a few of the almost 600,000 Americans who have died of COVID-19, as of this writing.

It’s natural and desirable to grieve in the wake of so much death and deprivation. But what is grief? Is it another word for sadness? How do we work through it? And what are we working toward, when we grieve?

The difference between sadness and grief

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While related, sadness and grief are functionally quite different.

Sadness is an emotion—and like all emotions we feel it in brief episodes. Moments of truly profound sadness last only minutes at a time. Sadness leads to decreased physiological arousal when we “cry it out.” Crying signals our distress to those around us and elicits their compassion. After the tears, our heart and respiratory rates fall. This allows for some mental clarity that lets the loss sink in and moves us toward a recalibration process. The further we are from the triggering event, the less frequent and intense these episodes of sadness become.

While emotions last minutes, moods—another affective state—can last hours to days, and they are less intense and specific in content. A sad mood can be present for long periods of time after a significant loss. Emotions predispose to moods and vice versa.

Grief, however, contains many emotions and moods. It is a complex and lengthy process that moves us from a place of loss to a new place where we can find some equilibrium without what we lost. While sadness is about fully acknowledging the loss, the grieving process is about getting beyond it. The bigger the loss, the bigger the hole in our life, the longer we grieve. In grief, we can experience a range of emotions, from shock to anger to fear, in addition to sadness.

Moving beyond loss

As I grappled with my sense of loss after K. died, I realized that understanding the grieving process was going to help me as I navigate this world, one that is now full of loss. Here are a few things I have tried to keep in mind.

As we work through our grief, a mindful self-awareness can help us identify our emotions and see them as part of the grieving process. As they come on, we can try to name emotions—“I am so sad”—and feel the experience in our body. By focusing on the body, not the head, we can drop the unhealthy rants and ruminations that can accompany these events.

If we experience the emotions with mindful self-awareness, we can see them as part of a healing process and we will likely be able to handle them more gracefully. This can make catharsis more likely: Instead of circling the event of the loss over and over, we can release the loss, and so reduce its power over us.

In the days after the death of my nursing colleague, my sad mood would be interrupted with flares of anger triggered by thoughts of those not wearing masks or those spreading misinformation about COVID-19. Moving my thoughts to the emotions, I would say to myself: “I am really angry, and I am angry because of these deaths.” I felt the recognition of the emotions helped me better ride the big waves on the grieving journey. 

In the midst of grieving it can seem hard to believe, but most bereavement is met with resilience, according to research by George Bonanno at Columbia University. We will likely have heart-wrenching sadness; we will suffer other intense emotions at moments—but despite the gravity of the loss, our innate resilience will lead the majority of us to recover to near our baseline within months.

In the throes of grief, seeing the light at the end of the tunnel can feel impossible. Worse than that, we might take the fact we are still grieving as evidence of our own inadequacies. In moments of calm, we might take a moment to look forward to a day when we can be ourselves again. That should provide some solace. 

Lucy Hone talks about grieving as marathon, not a sprint, and her research suggests we can learn to cultivate resilience. One way in which we can do this is by being thoughtful about where we place our attention; we may avoid putting ourselves in situations that will trigger us. Another way to develop resilience is to look for the flip side of the negative feelings we experience. For example, we can search for what the departed left us, and we can be grateful for what remains.

While most grief is met with resilience, complicated grieving with persistent negative moods and emotions is common. If you find yourself in that place, you should consider seeking professional help.

Making loss meaningful

In recent years, researchers have moved from seeing “acceptance” as being the end result of grieving, to recognizing meaning and wisdom as the ultimate outcomes. 

Robert Niemeyer’s research has found that efforts to find meaning in loss facilitate the grieving process. As time passes and our sadness lessens, we can achieve a better understanding of the beauty and complexity of life. Through grieving, the loss is transformed to a wisdom that will guide us through future challenges and help us make sense of the world.

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More recently, I talked with Ms. B., who is hospitalized with COVID-19. “I just keep thinking, why is this happening to me and to all of us?” she said. “And then I realized that it is message from God that we need to do a better job of taking care of each other, and I suddenly felt a little better. What do you think, Dr. Hass?”

“Wow,” I said. “Thank you for sharing that and there is definitely some truth there. There is a lot to learn from the pandemic about how we care for each. I need to keep that in mind when I start feeling down.”

Collective grieving

A week after the killing of George Floyd, about a hundred of us from the med center met outside and took a knee for 8 minutes and 38 seconds—the period of time a police officer sat on Floyd’s throat. You could almost feel the grief being forged into some sort of collective wisdom: We must become anti-racist and must be more aware of the injustices in our society.

Anyone who has been to a funeral will understand why every society values collective grieving: You share your sadness, your values, you strengthen community, and that helps build something from the loss. Perhaps the greatest irony of the pandemic is that not only has it caused a great collective grief, it has largely denied our collective grieving, at least in person. There is a possible upside: We are all talking about loss, which brings a solitary process into the open.

It is my hope this essay stimulates more conversation so we can more gracefully move through this profoundly human process. Let’s hope that through the collective grieving caused by COVID-19, we will gain the wisdom and desire to build a more just and open-hearted society.

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