5 minute read

The initial panic about the coronavirus has long passed. Sadness and grief from Covid losses is settling in on clinical settings, including behavioral health. In my small psychotherapy practice, I’ve heard about one client tragedy after another: The adult daughter who feels stricken because hospital policy wouldn’t allow her to be at the ICU bedside of her mother with Parkinson’s disease as she was dying from Covid. The elderly wife who survived Covid but then watched her husband with Alzheimer’s disease succumb to it at home. The middle-aged wife whose engineer husband was suddenly laid off. I feel a bleak heaviness oftentimes as I listen to these bereaved people that darkens my thoughts and mood for days afterwards.

In my other work as a healthcare consultant working with practice and agency managers in several states, I’ve heard similar experiences. Clients are suffering because of their fears, isolation, job losses, and, occasionally, family deaths. Because of their inherent compassion, the physicians, nurses, therapists, technicians and other helping professionals who work with them absorb their grief and suffer as well. Because they are devoted to the well-being of their staunch clinical colleagues, the managers feel the pang of loss, too.

Trauma is the clinical issue that rightfully gets the headlines nowadays. There are many frontline workers who have seen and will see terrible things during this pandemic that will haunt them for years to come. Depending on who they are and how they cope with their traumatic experiences, they may become stronger or damaged people All will bear scars.

But it is grief—that deep, broad undercurrent of sadness and sometimes regret that wends through our lives in response to loss—that will be the more prevalent emotional reaction for clients and clinicians. The fact that it is normal—normative, actually–doesn’t detract from its importance or its power, though. Unexpressed or unattended grief tends to cause later psychological and perhaps physical problems. We clinicians know this and usually try to help clients mobilize their support networks and faith communities to better face grief. We need to do the same for ourselves to deal with the cumulative, acquired grief we carry home with us from the hospital, nursing home and clinic after many emotionally riven clinical encounters.

In the ‘90s, I read the work of family therapist Evan Imber-Black about using both tradition-prescribed rituals, such as funerals and wakes, and newly created ones, such as dockside remembrances and the scattering of ashes, to help clients come together in healing moments of emotional expression and communion. I began thinking about how some of her ideas about rituals could be applied to the family medicine practice where I worked as a behavioral health faculty member for a family medicine residency program to assist our patients and staff. We weren’t dealing with a pandemic then–only the usual deaths from heart failure, uncontrolled diabetes and the occasional drug overdoses of a typical primary care practice. But I’d seen family medicine residents and medical assistants react with tearfulness or withdrawal whenever a patient passed whom they’d strived to care for and deeply cared about.

I imagined a three-part model for helping my practice and others to better cope with loss:

The first part is preparatory. The practice or agency leadership needs to buck the prevailing culture of “suck it up” that still exists in some medical and other healthcare sectors to publicly acknowledge the toll grief takes on staff members’ psyches and professional functioning. The practice should have regular education sessions and available resources for emotionally dealing with death.

Part two consists of the interventions taken in the immediate aftermath of loss—the bulletin boards with clipped obituaries, the group debriefings, the encouragement to join with the family members of the patient or client to mourn. Among the most moving aspects of my family medicine days were the many times I stood shoulder-to-shoulder with my clinical team members in the church pews at the funeral of one of our complex patients we’d been deeply invested in helping.

Grief will be the more prevalent emotional reaction for clients and clinicians

Part three is to create a regular memorial ritual or event, such as the candle-lighting events that cancer centers have twice yearly to bring families together who’ve lost loved ones to cancer. These are public ways to demonstrate that the people we’ve lost aren’t forgotten and that neither their presence in our lives nor our grief for them dies.

That’s where the poinsettias from this article’s title come in. The dark green plants with the bright red flowers so visible in many households at Christmastime became the focus of a simple ritual our family medicine practice created and used for years. All year long, we kept a running list of the patients who had died since the previous holiday season. Then we had the treating clinicians for those patients deliver poinsettias we’d purchased to the homes of their surviving family members with an accompanying condolence card that read: “We know the holiday season can be difficult for families who’ve lost loved ones the year before. We just want you to know we remember your loved one and you at this time.”

For many of the family members who received these surprise visits and the poinsettias, this was almost unbelievable. Some were choked with emotion when they called the office the next day to give thanks. Some wrote their own notes back to us, saying things like, “I didn’t think anyone would remember our Eugene. Thank you so much for remembering.”

For the clinicians, it was a reminder that what we do in healthcare is not just preserving health but fostering our loving bonds to one another. In those moments of standing in the household doorway with a festive plant in their arms and joining with the families in their grief, the physicians and therapists were spurred to reflect—sometimes awkwardly, sometimes with their own strong feelings–on their capacities for touching others with plain kindness.

The poinsettia tradition, as happens to most rituals, eventually became a rote exercise and ceased after more than 15 years. The need for human connection around grief—over Covid or any other devastating loss—remains to be met by new rituals for these new sad times.