How do we mourn when apart?

Grief does not have a straight path, and the coronavirus known as COVID-19 is complicating that already chal- lenging journey. One of the essential needs we have is connection to the people we love. That need is heightened in times of crisis. When illness strikes, we want our loved ones close by. When our family members are seriously ill or dying, we drop everything to be near them. When we are grieving, we gather with family and friends to hug and touch and honor the deceased.

None of these things can happen now, and people are hurting, badly.

As a psychotherapist specializing in grief and loss, I am hearing pleas from my colleagues for guidance on how to help the ill and the dying and their families to cope. There are patients who are critically ill and dying who simply cannot see their families. Staff in health-care facilities are struggling to find creative ways to help. The ultimate impact of not being able to say goodbye face to face is difficult to measure, and the impact will likely last a long, long time.

One woman struggles with being unable to see her dying sister in the hospital where no visitors are permitted. A man worries his father does not understand why he has not come to see him in his nursing home. Many cannot see dying loved ones in hospice because facilities are closed to outsiders.

The impact on these and other families in similar situations is immeasurable, as is the burden on the health-care workers to be proxies for family, to deliver last messages, to sit at the bedside and hold the hands of the dying.

In my work as a grief therapist, I often tell patients that there is not one way to grieve, that there is no way out but through. That said, grief does follow a relatively typical arc and most people are able after some predictable time to integrate the loss and reengage in ordinary life.

However, I have also seen that there are clear triggers for a more difficult grief or that lead to what is called “complicated grief.” In complicated grief, the emotions are more severe and pervasive, the feelings of loss unrelenting and the grieving period prolonged.

One of the risk factors for complicated grief relates to the circumstances or consequences of the death itself.

It can happen if the circumstances of the death are sudden or traumatic, if the bereft was unable to see their loved one as they were dying or if things were left unsaid or if, after the death, there was an obstacle to the traditional rituals that are the stepping stones to starting the grieving process.

One woman I spoke to recently is struggling because her mother died days ago but cannot be buried. The funeral was canceled. She expressed guilt about failing to honor her mother appropriately and a sense of the loss feeling unreal because she cannot begin to grieve.

COVID-19 has created an environment that may lead many to suffer from more profound or complicated grief. In this atmosphere, I urge those who are facing losing a loved one from a distance to reach out for professional support now to address the anticipatory grief and to process the added complexity ahead of the loss.

Preparing for loss with the support of a grief therapist can make the later grieving process easier. There may well be no true substitute for holding the hand of your beloved in their last moments. We cannot prevent the heartbreak that COVID-19 will inflict on those who will not be able to hear that final message from their dying loved ones. All we can do is try to anticipate the emotional damage this crisis will inflict and try to make the journey of grief a little less painful.

Israeli is a clinical social worker and therapist.