August 10, 2022

I went to a birthday party this past weekend. It was low key, mainly people of my generation (mid 50s to mid 60s) and a mix of folk who had known each other for decades and newer acquaintances. Once the usual topics of conversation such as entertainment and politics had been exhausted and we moved into the more personal, nearly everyone had the same story to tell. They were exhausted. Some were taking FMLA or other time off from work. Some were devising retirement plans. Some were trying to figure out how they were going to be able to keep up their usual professional pace without dropping in harness. This was an upper middle class professional bunch, working in health care, education, ministry, the not for profit world. And every single one was feeling the same.

I fit right in there with them. I’m running out of gas. I’m not quite to the coasting on fumes stage but it probably wouldn’t take too many further reversals to push me there. I’ve been thinking a whole lot about what’s causing this. I think just blaming the pandemic or the viciousness of our current political moment is too facile an answer. I think it’s something a bit deeper and a bit more primal. I think we’re dealing with an enormous amount of unrealized and sublimated societal grief. And if there’s one thing that I’ve learned from the last nearly forty years of my life in medicine and as a double widow, grief will always out. It may be transformed into other emotional states through circumstance or force of will but it will continue to rocket around your brain and your life until you acknowledge it and identify it and deal with it and grow around it until, while it remains a part of you, it is no longer the defining part.

What is grief? The dictionary defines it as ‘deep sorrow, especially that caused by someone’s death’. But, again, I think that’s a bit too simplistic because grief can happen in many circumstances that don’t involve death. One of my most acute episodes involved my finishing up thirteen years of higher education. I’d made it! I didn’t have to go to school or training any more! I was, to my knowledge, the first person in my medical school class to receive a faculty appointment at a major university. I had to grieve the loss of a linear way of living from educational milestone to educational milestone, neatly laid out like a treadmill and adapt to a life where there was no longer a road map. It took me about a year and a half to do that.

I think grief is what happens when the reality of our current circumstances differs from our imaginings and planning and expectations of what those circumstances should be. Death, of course, changes everything, especially the death of a spouse or other close companion. The mind can’t really conceive of the future without that other important person being a piece of what’s to come and if they are irrevocably removed, there’s a huge cognitive dissonance. But the same thing happens with more minor traumas and disappointments: the need to cancel a planned vacation, the inability to attend a social event or milestone celebration such as a wedding or graduation for someone important to our lives, the expectation that American society will rise to a challenge and act for good and instead, in many ways, does the opposite.

Two and a half years of pandemic has ripped well over a million Americans out of the social fabric from Covid through death. Each one of those missing people has left a social circle bereft with traditional mourning grief. Some people have only lost an acquaintance. Others have lost multiple family members. Hundreds of thousands of children have lost a custodial parent. Hundreds of thousands of aging parents have buried a child. But what of those who became seriously ill but did not die? I take care of a few of them. I have people with long Covid whose bodies were so ravaged that they will never resume normal activity again. They’re alive but grieving the trips they’ll never be able to take, the hobbies they’ll never be able to pursue, and their spouses and families are grieving the huge alterations in their own lives due to their loved one’s care needs. (I’ve been there – having a seriously ill person at home is no fun). Then there’s those who have recovered from acute Covid but who now have long Covid symptoms which are poorly understood and which no one really knows how to treat. They too grieve the loss of their past health and function and face an unknown future.

Then there’s the years of cancelled and postponed societal rituals. For me, this included the inability for my family to have a proper memorial after the death of my mother, the cancelled theatrical opportunities, the inability to make music as a choir, the lack of group dinners out, cast parties, or drinks with colleagues after a particularly stressful work day. Many of these things have started to return in a somewhat modified form but all of those missing events and interactions has each left a lingering trace on the grief pile and that must be felt and addressed. And those missing threads in life’s tapestry are causing all of us to become more detached from each other and part of the reason why so many of our social institutions – health care, education, cultural opportunities – seem so shaky.

Perhaps the biggest contributor is how the pandemic has laid bare the deep political and social divisions we have. I don’t care which side of the fence you’re on, every one of us is looking at the American political landscape, riven by distrust, if not downright hatred of the opposition, egged on by a media ecosystem that cares only about clicks and revenues which are best fed by maximum conflict, and wondering where is that ability we have always known in the past for Americans to all pull together for the common good in a crisis and will we ever have that again? That’s a huge loss of faith and certainty in how the world should be and when that’s added on top of the deaths and the disappointments, it’s a recipe for disaster.

I’ve learned about how to cope and lessen grief over time – and there’s really only two things that work: time and other people involved in your life. Antidepressants and other quick fix pharmaceuticals usually don’t help much. You have to develop the coping mechanisms and put in the time. What are mine? Well you’re reading one of them. These essays and the books that have come from them are perhaps my most obvious constructive response to my personal grief. I find that the actual patient care piece of my job and the time I spend face to face with patients where I can use my skills and my empathy and my ability to simply listen gives me renewal. The piece of my job that interfaces with administration and the system…. well that’s another story. I think this works because so many of my patients are now in their late 80s and 90s. They have living memories of a worse time: the Depression and World War II. They survived. They developed resilience and coping skills. Look up the elders in your life and listen to them. They can teach you a lot about how to deal with today.

I know I’m being a bit of a negative Nellie with this particular post, but I’ve learned through these writings that when a thought like this is rattling round my brain, best to get it out. I’ll sleep better and have a bit more energy tomorrow. Unlike today when I fell asleep on the couch in my voice teacher’s living room waiting for my lesson, despite the very loud scales from the lyric baritone coming through the wall. As I told my voice teacher, I was an intern. I can sleep through anything.