“Grief is like the ocean; it comes in waves ebbing and flowing. Sometimes the water is calm, and sometimes it is overwhelming. All we can do is learn to swim.” – Vicki Harrison
I should have seen it sooner, but I didn’t. I was in a meeting about budget cuts and reductions in travel and social expenses and it suddenly hit me that what I am feeling, and maybe what many others are feeling, is grief. What we are grieving may be the same or different – attacks on identity, diversity and inclusion initiatives and civil rights; loss of grant funding and threats of much more; possible Medicaid cuts and other clinical reimbursement risks; threats to endowments, supporting scholarships and key programs as well as federal student loans; challenges to international students, residents, and faculty and their ability to learn and work here; loss of trust in science and healthcare more broadly; loss of life, loss of health, and growing fear of war and violence, to name just a few – but the grief is palpable, and understandable.
For those of us less familiar with work on grief and grieving, I thought I’d say a few things, so we might be able to recognize it in ourselves and others. Let me begin by saying that there is no right way to grieve, and grieving looks different for everyone. Elisabeth Kübler-Ross, Swiss-American psychiatrist, described five stages of grief, and the stages are neither prescriptive nor necessarily linear. They can also last for minutes to months or may not happen at all. So, what are they?
A common first stage is denial, which can look like a rejection of facts, shock, numbness, or disconnection from reality: “This isn’t really happening to us or won’t happen.” This can be very protective, especially when feelings are intense. Anger is described as the second stage: “You failed me; you aren’t doing enough to protect me; those people are responsible for this; others aren’t suffering like me/ us.” Who that anger is directed to may be random or misplaced, and it is hard to see in the moment. Bargaining comes next, which may take the form of trying to go back in time to change what is and go back to the way things were: “We have always done it this way; if I do this, can I get that; what about making a different choice?” Depression and sadness come when we start to feel the full weight of what has happened or is happening. Spontaneous crying or disproportionate reaction to an unrelated event may take you by surprise. And finally, there can be acceptance. This doesn’t mean things are back to normal, but instead is a form of coming to terms with a new reality: “what can I do now to preserve what really matters to me and us?”
I find myself going back and forth in these stages, any given day or hour. That’s why I love the quote by Vicki Harrison: “Grief is like the ocean; it comes in waves ebbing and flowing. Sometimes the water is calm, and sometimes it is overwhelming. All we can do is learn to swim.” Of course, swimming can feel impossible at times, especially when you’re in deep water and being hit by wave after wave, leaving you struggling just to stay afloat. So, how can we learn to swim (or maybe just keep our head above water) in this ocean? Some ubiquitously described tips that seemed to apply to this situation are:
- Allow yourself to feel what you feel and accept that others may be experiencing grief differently or not at all. This can be hard at work, especially if those feelings result in behaviors that may cross a professional line.
- Talk to someone you trust – this can be a friend, family member, colleague, physician, or therapist. Just the act of sharing how you are feeling can help you feel less alone.
- Take care of your physical health – get enough sleep, exercise, do things you enjoy, and spend time with people you love.
- When feeling overwhelmed, try to anchor yourself in the present. Take a few deep breaths and notice the things around you. Remind yourself that, in this moment, you are safe. Let go of what’s outside your control and focus on what you can influence.
- Find meaning and purpose – this is where we are often (but not always) truly lucky. We have the privilege of serving others through patient care, research, and education. We give back to our community in ways that matter, to individuals and to society. Try not to lose sight of that and remind yourself of the intrinsic rewards available to you. It is okay, and likely helpful, to hold grief and gratitude at the same time. I have included a great article by Arthur C. Brooks (under Good Reads) in this edition of the newsletter that may help with that if you are struggling to find a way.
- Be careful of triggers – too much news, scrolling on social media, or surrounding yourself with people that cause you distress is probably a bad idea. These can be difficult to avoid, and finding balance in your thinking can help. When worst-case scenarios highjack your thoughts, intentionally picture the best-case ones too. Neither should dominate your mind completely.
I have talked many times about the mental health resources we have available for faculty and staff, residents and fellows, and students. Please don’t hesitate to avail yourselves of them. Asking for help is a sign of strength, not weakness.
Finally, as we go about our daily work, remember that we never really know what someone else is going through. Grace, compassion, and caring are needed by us all. It can be hard to remember when we are grieving ourselves, so all we can do is try, prevent ourselves from comparing our losses, and ask forgiveness when we misstep. If you see someone hurting who seems to be struggling to swim, throw them a life preserver by checking in and listening with empathy.
Perhaps I am moving into acceptance, and I do genuinely believe that we will get through this together.
Take good care of yourselves – and of each other.