Working on the frontline of medical care has never been more intense, stressful and challenging.  The rapid spread of the virus and the impact on those hospitalised and those caring for them, has not been seen in a lifetime. The deaths are mounting and the situation is tragic, yet frontline health workers are digging deep and fighting long and hard in the face of danger.  Managing this level of virus in packed intensive units is life-threatening, and the potential cost of losing a colleague is very tough to deal with.

Doctors, nurses and other health professionals are used to dealing with death; it’s a difficult part of the job, but is expected at times. What is not expected is the numbers of people presenting with severe symptoms and dying, and even less expected and more shocking, is the tragic loss of health professionals who are colleagues and friends. Even if you are not directly affected, you may be feeling the grief of others in your team, or an impact through the wider NHS network 

The multiple civilian deaths being experienced are an added emotional burden to doctors and nurses on the frontline. But the death of a colleague carries with it a more personal and working cultural dimension that is unfamiliar, and is a loss that wouldn’t have happened ordinarily during ‘normal’ times. 

Sacrificing a life-style for these vocations is something health professionals accept as part of their work, but someone dying in the line of duty is not usual and is much harder to accept.  To lose a colleague like this, is an unfamiliar experience but akin to soldiers losing platoon members, in the service of their country.  Like soldiers returning from a frontline battle, the real challenge for staff may actually be when they leave their shift and return home, or even not until the crisis is over.  It may be something that is never forgotten and depending on the level of personal fear and anxiety experienced during this period, there may well be some post traumatic stress that manifests for some, when images and feelings of the time remain unprocessed. But, the uniqueness of this situation also means the workforce are grieving a common loss and there will be strength in the community experiencing this together.  This will reduce isolation and awkwardness about sharing which will help the emotional processing essential for re-growth post trauma.

The Grief and loss process

Understanding the natural process of grief and that it can also become more complicated in the face of unusual circumstances, can help our ability to cope with loss. We can’t heal what we don’t have awareness of and understanding grief and loss will help lessen the negative impact of unattended or complicated grief. Recognising that grief will be mixed in with all the feelings that emerge following the death of a colleague or friend from work, can help us understand the process of healing.  In some cases, those who died are not people you knew personally or well, but this doesn’t mean that you don’t feel their loss and cannot take time to grieve and mourn them.

Grief is not just one feeling but a whole succession of feelings, which can take longer than expected to get through and which cannot be hurried, but most likely will ebb and flow. We pass through a number of stages, which vary in sequence and in length: Shock or Denial (feeling numb), Protest and Frustration (feeling out of control anxious or angry), Disorganisation and Depression (despair, sadness and guilt), Experimentation, Reorganisation and Integration (learning how to work in the new situation, achieving balance but maybe with changed values). 

Loss at a time of crisis and still having to do your job, probably means that the first stage of denial will allow you to carry on. You may feel numb, confused, lost and carry on as if nothing happened.  This is a way of coping and disconnection from emotions provides a cushion in the short term, but be aware of what might seem like a delayed emotional reaction at the end of shift or possibly more likely at the end of the crisis, when there is time for reflection and to ‘feel’ the feelings.  Re-connecting with emotions is an important step forwards in the process.

During the protest phase, emotions may suddenly feel all over the place and hard to control, but that’s ok and this allows painful feeling to be expressed. It’s normal to be upset or angry at the world for getting this so wrong and acting so late, to be angry at the authorities and all the things that could have been done differently. Or, perhaps you feel scared for yourself and colleagues for the future. Let these feelings out.

It may be hard to concentrate and such normal functions of eating or sleeping don’t come easy. These are normal reactions to distress and loss and should pass in time.  The stage of depression and disorganisation can feel bleak and never-ending, but this lowest point means from this we will move back up into feelings of hope and rebuilding a new but changed life.

What helps and what hinders the process

Don’t:

• Don’t keep your emotions bottled up, but equally if you feel unable to contact your emotions right now, this is probably part of the shock and denial phase of loss, which protects you from the initial pain and helps coping at this early stage.

• Don’t think you are weak for needing help.

• Don’t feel guilty if you are struggling to cope.

• Don’t use drugs or alcohol or other compulsive or addictive behaviours to feel better.

Do:

• Be there for each other at work and accept you will each have your own ways of dealing with grief and be at different stages at different times (there is no normal path).

• Talk and listen to each other about the person who has died, about what’s on your minds and in your feelings.

• Use support networks inside and outside of work.

• Look after yourself: Eat properly and try to get enough rest (even if you can’t sleep).

• Make sure you have time to relax and use breathing or meditation exercises to lower stress

• Recognise your limits and don’t feel frightened to let your manager know if you are finding it hard to cope.

• Give yourself time and permission to reflect and to grieve.

• Seek help and support if you feel you need it and tell people who can help what it is that you need.

• Show kindness and compassion to yourself and others

• Let joy and gratitude into your life when you can

If you are having a really tough time dealing with loss and grief, ask about counselling through work and get help from a professional.

Honoring their memory

The hospital and your working life continues, but this doesn’t mean that you can’t openly mourn the person who died, and one way to do this is to actively honour their memory. Don’t be frightened about raising this issue and discussing your memories of the person with others at work and how to honour them. Through this, you and your colleagues can share your grief in something meaningful.  Perhaps, at the right time, organising a memorial service, a fundraising exercise, plant a tree, or naming a place or area in the work environment after the person who died. It could be suggested to the hospital managers about setting up a medical scholarship in the person’s name.

Other significant, but more private gestures, could be contacting the family to let them know how much you thought of the person, lighting a candle for them, or writing a message to them.  Expression can relieve some of the internal pressure we feel from loss.  Writing or creating through art activities facilitates this well.

Survivor Guilt - It could have been me

Surviving an illness that is fatal for others, can provoke a feeling of guilt; a survivor guilt.  Thinking that it could have easily been you that died, is a traumatic and troublesome thought in itself. Perceiving whether we could or should have done something different in a situation that may have impacted another life, gives rise to this difficult emotion that is often associated with PTSD.  It usually defies logic and sadly some people can blame themselves for things outside their control rather than accept that they were helpless at the time. This isn’t rational, it is emotional and can feel very upsetting.  Remember it is not wrong to feel guilty but if we can accept it is there without judging it further, we have the way to process it and move along from it.  Try not to get stuck on the ‘whys’ as there is no answer to something as unfair and cruel as this, but instead focus on the meaning you can create from your survival.  Remember that your relief and appreciation for your survival can co-exist with your grief for those who died.

If it wasn’t for the dedication and selflessness of the health professionals dealing with this crisis we all would feel completely hopeless and powerless. The nation is indebted to you, the angels and heroes, who are saving many lives and risking your own through your healer’s passion and in the service of the many.  Those who have died, or will die, have made a huge sacrifice in saving the lives of others and we will remember them.