Grieving From Afar

By Laura Ward

The COVID-19 pandemic has changed our lives in so many ways including the devastating impact on how we are able to mourn the death of our loved ones. When a death occurs, we have patterned ways of responding based on tradition, culture and religious beliefs. 

These responses are comforting for both the bereaved and for those providing support.  Soon after receiving word of a death, our support system mobilizes. People often begin showing up with food or flowers, jumping in to care for the children of the bereaved offering to run errands or help arrange a memorial event.   Cultural or religious beliefs provide ritualized ways to mourn which offer comfort in their significance and predictability.  These rituals mobilize community support for the mourners.   Muslim communities wash the body, wrap it in a piece of cloth and bury their dead quickly and in the presence of loved ones. This allows the soul to rest peacefully.  Christian and Jewish traditions call for close proximity with the dead in order for those left behind to confront their loss.  Events such as Repass, and Shiva allow survivors to find refuge in their communities.  In some cultures, those close to the bereaved will take turns sitting vigil with the family for days or even weeks after a death. 

During this health crisis, social distancing has made it so that people are unable to grieve their loved ones in traditional ways.  Without these rituals and the opportunity to be in the presence of the person who has died, see the casket and be around other people grieving the deceased, it can be harder for those grieving to make sense of the loss and eventually accept that their loved one has died.  Having traditions to follow and a set of rituals enables people to integrate the loss into their life.  Without this element of face-to-face support and left alone in quarantine, people experiencing losses may suffer more due to the isolation necessary for social distancing.  Social isolation has also been shown to prolong grief. 

In addition, we are in a stressful time, people are experiencing many losses beyond the death of a loved one ― including the loss of a job, savings, sense of identity and more. These additional stressors can get in the way of grieving normally, additionally those who would normally support the bereaved might be distracted by these stressors in their own lives and may be less emotionally available to provide support.  Also, people are overwhelmed with fears about contracting the virus or losing more loved ones to COVID-19. These all-consuming feelings may prevent people from acknowledging their grief, but it’s important to create space for it. Delaying grief is not healthy and can lead to long-term physical and psychological challenges. Instead of holding grief in, find new ways to go through the grieving process and say goodbye to your loved one within the limits of social distancing.

You don’t have to be alone.  It’s important to avoid withdrawing from friends in your grief even though we can’t support each other in person at this time.  The best thing we can do when we are grieving it to reach out as much as you can to family members through phone calls and video platforms.  Friends and family members can gather via chat conference to talk about their lost loved one, share memories or simply cry together and know they aren’t alone in their grief. Sending emails and letters to people in your network is another way to take part in a collective grieving process. I have often had clients speak about how meaningful it is to receive letters which include personal stories or experiences of their loved one that has died.  Some families or group of friends start group text chains to check-in or share memories or thoughts of the deceased.  The key is to talk to someone else about your feelings, rather than keep them bottled up. It’s important to find connection in whatever ways you can. Being intentional about the emotional bonds that are still present can provide some comfort, this is not the same as being able to have a hug or to sit together in close proximity but the virtual connections can be a way in which the emotional connections can be expressed where we are at now.  If you lack the motivation to follow through on connecting, try to book times for phone calls and video chats. Arrange these conversations as appointments you must keep. Agree on times with people in advance so you are more likely to follow through. Of course, choose to connect with people who provide healthy support, are responsive and flexible about your needs.  The amount of contact we need and want can vary on a daily basis and it’s helpful to connect with those who are understanding of this. 

Funerals and memorial services are valuable both on a practical to provide structure in that they give people tasks and a way of coming together to grieve.  They provide confirmation of the death though being able to view the body and grieve in community.  Physical touch through hugging our love ones is incredibly healing.  This coming together also empowers social support and connection, reassuring us that we are not alone in our loss.  Celebrating a loved one’s life in a public group setting with others is a very healing part of the grieving process, but social distancing and stay-at-home orders mean many families must delay memorial services for an unknown amount of time. The uncertainty of when they might be able to honor their loved one in this way is difficult and anxiety-provoking. Recognize that this is temporary and although there is a delay, these services can still take place and it is important that they do in order.  It can be helpful to think of these services as being delayed rather than cancelled. 

Depending on where you live and how you’ve been social distancing, you may be able to have a small service with immediate family, and there are ways to include others in the experience.  Many funeral homes are offering livestreaming of graveside services or larger, interactive virtual funerals.  Some allow immediate family the right to attend the burial process, while still following the CDC recommendation of no more than 10 people gathering in the same space. Mourners can still drive by in their vehicles in a parade, staying in their car while offering their respects.  Others have offered drive-thru windows with a video of the person on a monitor or in-person visitations with two people allowed in at a time and disinfecting between visitors.  One benefit of virtual funerals is that people who ordinarily might not be able to attend services, due to living far away, finances or even a discomfort with grieving in public, are now able to participate.  However, this process will not work for those who do not have or are uncomfortable with technology. It’s unclear when traditional funerals and grieving rituals will be an option in the future, but that doesn’t mean it’s impossible to process your grief and move forward in this uncertain time. Recognize your feelings of grief, loss and sadness as normal during this time. 

Identify and acknowledge any thoughts feelings that arise and let yourself move through them.  A wide range of feelings are normal during grief and it is often described as a roller coaster of emotions. Expressing whatever comes up can be helpful and writing out your feelings can be a therapeutic experience in times of grief. You can keep a private journal for your eyes only or even write a tribute to share with loved ones.  Some people find healing through writing a letter to the deceased.  Remember the times you spent together and share these memories with loved ones. Looking through photos can bring comfort, creating a photo slide show or music playlist can be another way of honoring and celebrating the relationship with your loved one.  Just like a written tribute, it can be shared now online or at a future memorial service.  Make a memory box, draw or scrapbook.  Engaging children and adolescents in these activities can also give them an avenue to process their grief. Consider other rituals that will allow you to express your grief now…light a candle, create some art in their memory, plant a tree or cook your loves one’s favorite meal. 

Generate a plan for coping.  Ask yourself how you usually take care of yourself during a difficult time and modify these to work in the current situation.  You can still do things like read, take a bath, go outside, eat healthy meals and nap.  You might find it useful to think about how your lost loved one would like you to respond in these circumstances. You can use this exercise to help generate coping strategies. Recognize that less activities in our lives make more time for thinking and feeling, this can be good and also overwhelming.  Distract yourself on occasion with activities you enjoy or try something new.  Moderate your news intake and be gentle with yourself around fear related to the pandemic. 

If more support is needed, reach out to the professionals.  Grief support is being offered online by many hospices and mental health professionals including Hospicare.  At Hospicare, we offer both individual and grief support in an online format.  There are social media groups for grief support as well as many online resources.  At hospicare.org/blog you can watch videos made by our interdisciplinary team with tips, resources and activities to cope with grief.  Connecting with online communities of grieving people help grievers feel less alone.  Talk to your doctor if you are experiencing physical symptoms of grief.  Grief is hard, it’s a different experience for everyone and there is no right way to grieve.  Practice self-compassion, allow yourself to have a good cry and take good care of your mind and body during this challenging time.

Grief During Covid-19

By Laura Ward

Grief is defined as a normal and natural response to loss.  At Hospicare, we provide bereavement support to those who are grieving the death of a loved one.  However, based on the current circumstances, we feel that it’s important to expand our discussion of grief to include the many different types of losses that people are experiencing right now as part of this pandemic

These could be major such as that of a job or financial means.  As a community, we are curtailing our social contacts due to the need for social distance.  This loss of physical connection with our loved ones is extremely difficult.  Gone are the simple social pleasures of meeting a friend or friends for dinner, coffee, a walk or at the dog park.  Social gatherings such as book club, game night, choir practice, group exercise classes and BBQ’s are off limits.  The theater, bowling alley and churches are all closed.  The wedding, trip, or family reunion we had planned has been cancelled.  Our children are grieving the loss of their social network, educational system, sports team, extracurricular activities and even that recital, performance, or big game that they had been working towards.  Our regular routine is disrupted, many of us are no longer able to head to work as usual and those who are working for essential businesses now must cope with added fear and risk.  The uncertainty of this time and the risk of illness brings its own anxiety and adds to our stress. 

Grief impacts us on many levels.  Physically, you might notice changes in sleep or appetite, fatigue, restlessness, headaches, body aches or episodes of crying or feeling numb.  Grief can be a roller coaster of emotions and these emotions can change quickly.  We might feel anxious, sad, angry, fearful, or more irritable.  Grief can feel like a heaviness we carry both physically and emotionally.  On a cognitive level, we might have difficulty concentrating (which can make working from home even more challenging), be indecisive, find ourselves preoccupied with worries, experience a sense of unreality or denial.  We might experience behavioral changes and find ourselves inpatient, forgetful, or looking for unhealthy ways to cope through overeating, too much screen time or numbing ourselves with drugs or alcohol.  Socially, we need more support when we are grieving, and these current circumstances can make it especially difficult to meet that need.  Some people isolate more during grief and lack the motivation and energy to make the extra effort needed to connect.   Spiritually, we might find ourselves searching for meaning or comfort during this time.  Some people find comfort in their faith or prayers, and others have spoken about the positive environmental impact.  For example, dolphins have been spotted for the first time in the canals of Venice and air quality has improved in China. It’s important to recognize how these grief reactions can impact our current functioning.  Our usual means of coping may also have changed whether it be our habits or reaching out socially, going to the gym or attending an art class.  We may need to explore how to recreate, expand and implement, new ways of coping during this pandemic to maintain our emotional and physical health. 

The experience of grief can also be both individual and unique.  It can be difficult when the people in your life are struggling with this current situation and the associated losses, but are expressing that struggle in very different ways.  One might assume that since we are all in this together, that we would be feeling similar ways.  Yet, our expressions of our grief may look so dissimilar that instead of feeling supported, we can be left feeling more alone.  Perhaps you are feeling sad and someone else is responding with complete denial or is minimizing the seriousness of the situation.  Or you might receive messages from other friends to “think positive” or “see the bigger picture” or laments about “silver linings.”  Neither one of you is wrong in how you are coping with the situation, but you may simply not be on the same page at the same time with the people in your life.  This can create tension, and leave people feeling more alone and without the comforting validation they would normally receive in these relationships.  Remember, that even though we might not understand another person’s emotional or mental response to this crisis, even if our own grief looks different, we are all grieving.  The greatest kindness we can offer is to support each other, and in order to do that we must suspend our judgements to allow for the range of emotions that those around us are experiencing.  More than ever, we need to take care of each other during this time and accept both our own and others experience with an open heart.  Check in frequently with the people in your life and with the people in your home.   

When we are overwhelmed with difficult emotions, it can be helpful to lean in, allowing yourself to move through the emotions that are rising.  Know that all emotions pass, change and evolve.  It’s important to make time to feel, and it can be helpful to set aside time just for this purpose.  Some people might find that journaling, meditating, or talking it through with a trusted friend to be a safe way to achieve this.  It’s important to allow our feelings to be expressed or we run the risk of the feelings building up which can negatively impact our health or overall functioning.  Sometimes we might realize that our worries or fears are dominating our mind.  If you feel like you’re in a rut with these thoughts rather than moving through, it can be helpful to disrupt this process by deep breathing, stepping outside or distracting ourselves.  Other ways to cope include creating a new routine, getting outside, trying something new, discovering joy in the moment, exploring new ways to connect, and getting in touch with gratitude.  Creating a new routine can be a source of comfort when we have lost our usual way of life.  A new routine can mean setting a regular time for waking, bedtime and healthy, balanced meals.  Getting dressed and ready for the day.  Introducing daily time to be outdoors, take a walk or even just sit on the porch.  If you are working from home, start and end at regular times and step away from screens for some portion of each day.  Connect with family by spending time together at home or through electronic means.  For instance, play games together online with a friend or set up a virtual coffee date.  Take time and space for yourself through a solitary walk, reading a book or putting together a puzzle.  Find joy in starting a new hobby or enjoying an old one.  Practice gratitude each day and when all else fails, extend kindness and compassion to yourself, this is a difficult time.   

Wellness in the time of COVID-19

BY LAURA WARD

Though you might feel somewhat powerless or limited in what you can do, there are ways you can offer support and take control of emotions. Below is a list of suggested activities that might help you during this difficult time (modified from handout created by Mount Holyoke University Counseling Service).  

Seek support: Continue telehealth visits with your current mental health provider (The Governor of NY has announced that all co-pays for telehealth are being waived!), reach out by phone or FaceTime to friends or family members. You can also reach out to us at (607) 272-0212.

Maintain a healthy routine: Stress can disrupt our daily routine, in turn causing more stress. It is important to maintain your regular schedule for sleep, eating, having fun, socializing (phone calls or FT), studying, and working etc. Creating a new routine will be necessary in the time of social distancing, but routines are helpful. If this is difficult to achieve by yourself, work with a friend – you can encourage each other in self-care. Click here for a list of some free sleep meditation apps https://positiveroutines.com/free-sleep-apps/ 

Exercise: Physical activity can boost your immune system, help you feel good about yourself, increase your energy levels, alleviate stress, and help with sleep. With gyms closed, take a walk, run or hike outside. Try online workouts. There are lots of free workouts online. My favorite for free yoga workouts on YouTube is “Yoga with Adriene”. Utilize apps like “Map Your Run” to share your workouts with friends, set goals together, etc. Here is a list of some recommended work out and fitness apps https://www.self.com/story/best-new-workout-apps 

Meditate: Find some time every day to do a bit of meditation. It helps you feel grounded and present. Try https://insighttimer.com/, the #1 free app for stress, anxiety and sleep.  

Be informed: Uncertainty or misinformation can increase worry and cause panic. You can stay informed through official, fact-checked channels (e.g. World Health Organization website).  

Pay attention to some positive news: Despite this difficult time, there is often some positive information in daily news. Decide whether the degree of your worry is consistent with reliable information (e.g.: incidence rate, death rate, current advancement of medicine etc.) I have been uplifted through reading stories about the way that people are helping each other during this crisis.  

But limit the information: Sometimes, too much information leads to overload and more stress. So please try to limit your exposure (such as <1 hour/day), and make sure your information sources are reliable. Avoid reading information on the topic before going to bed – this can make it more difficult to fall asleep.  

Think positively: Recall how you and your loved ones survived past hardships and crisis. Remind yourself that things are temporary and the current situation will pass. Please remember that no matter what happens in the future, you and your loved ones are striving to live day-by-day in the present. Change your perspective – consider the current time as an opportunity to show more care to yourself and your loved ones.  

Share your thoughts/feelings with others (in moderation): Talking about your thoughts and feelings can help alleviate stress. Others might share similar feelings and help you feel less alone.

 ● Check in with your loved ones (in moderation): If you are worried about your loved ones, please reach out to them when you feel comfortable and lend a listening ear. Loved ones are often concerned about us and we may think they are trying to protect us by not being fully truthful; try not to jump to conclusions about their health and well-being, and please understand that we cannot always control others’ behaviors or change their beliefs. It can be helpful to have a few friends that you check in with regularly, even a simple “How are you doing today” text can help us all feel more connected. I enjoy using the free app Marco Polo to send videos back and forth to loved ones.  

Learn to say “no”: Although sharing can be helpful, sometimes it is also important to say “no” when you are not comfortable with sharing or engaging in conversations on the topic. Just make sure you set your boundaries respectfully or leave conversations in an appropriate way.  

Engage in conversations and activities unrelated to the outbreak and allow yourself to have some fun: There is still life outside of the current crisis. Reading news and engaging in activities unrelated to the current outbreak is okay – it doesn’t mean that you don’t care or aren’t concerned. Get a puzzle going, read a book out loud with family, break out the board games. Be creative, for example plan a FaceTime movie night with with your kids and their friends, all watching the same movie and eating popcorn at their respective houses.  

Do some relaxation: Make sure to plan some relaxation or activities you enjoy into your daily schedule, such as deep breathing, spending time with friends (virtually), coloring, listening to music, taking a shower, taking a walk, etc.  

Let it out: Sometimes expressing your emotions can be helpful – try journaling or keeping a voice diary, or let yourself be upset for a while. Here is a meditation for lovingly exploring your emotions. https://insighttimer.com/iamrachelricketts/guided-meditations/lovingly-exploring-our-emotions?utm_source=crm&utm_medium=email&utm_campaign=Black%20History%20Month%20-%20Week%203%20newsletter&utm_content=Variant%201&_branch_match_id=759402562456716377

“I’m Grateful for the Many Ways Hospicare Serves Our Community”

“Facing the end of life takes courage, perhaps especially for the family members of patients,” says Pamela Goddard, Hospicare volunteer. “Facing that approaching loss is a difficult thing. But, we don’t have to face it alone. This is the real gift of hospice services—support for both patients and their family members at every step of the way. And, with support, we can find comfort and even beauty in coming to terms with end-of-life and the process of grief.”

Pamela helps offer that support and comfort to others by her involvement with Hospicare. She sings with Hospicare’s monthly Women Singin’ group and with Schola Cantorum, a smaller group that sings at the bedsides of patients. She also takes part in vigils, sitting beside dying patients who do not have friends or family who can be with them in their final hours. On June 10, she will co-facilitate “Gathering the Pieces” with Elaine Mansfield, a workshop for grievers that focuses on ritual, simple mindfulness meditation techniques and shared experience. Pamela will be focused mainly on leading the meditation portion of the workshop, building on her experience as the co-facilitator of a community mindfulness meditation group that meets once a month at the Nina K. Miller Hospicare Center in Ithaca.

All of these activities express her gratitude for Hospicare, she says. “I’m grateful for the comfort and relief that Hospicare brings to friends and their families. I’m grateful for the home Hospicare has provided our meditation group. I’m grateful for the many ways that Hospicare serves our community, and for the many ways the community serves Hospicare. This mutual, vital interconnection is a really beautiful thing.”

Pamela has had friends who have been cared for by Hospicare, and her mother-in-law also received hospice services in New York City, so she has experienced first hand the value of hospice for those who are terminally ill. “I’m a strong believer in the value of respectful palliative care at the end of life,” she says. “I’ve seen how people dear to me have been able to transition with dignity, each in their own way. The ability to make personal choices about how to die, to have some control over this crucial time of life—for the individual and also for family—and to have caring, professional support is such a gift.”

Volunteering with Hospicare has been deeply moving and also fun, Pamela says. “It may seem odd to use the word ‘fun,’ when talking about working with the dying and their families” she admits, “but there’s often humor and lightness in what we do.” Music especially plays a powerful part in her volunteer experience. “It is a heart expanding honor to bring peace, beauty, and even moments of joy, at the end through the power of music,” she says.

Find out more about the “Gathering the Pieces” workshop or about volunteering with Hospicare.

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Illuminations: a Time of Remembrance and Community

Each year, on an evening in early June, the gardens of the Nina K. Miller Hospicare Center on Ithaca’s South Hill glow with light. Visitors stroll our garden paths, which are lined with 300 luminarias, many dedicated to someone who has died. At the end of the evening a lighted canoe glides across our pond while trumpeters play “Taps,” and all who are in attendance pause to remember someone they love. This is Hospicare’s spring community memorial event: Illuminations.

This year’s Illuminations event will be held on Thursday, June 8. A reception and luminaria lighting begin at 7:30 p.m. A special program of remembrance starts at 8:00 p.m. Illuminations is held rain or shine. In case of inclement weather, the program moves indoors to the Hospicare Great Room. The event is open to the public. There is no cost to attend, although luminarias can be personalized for a suggested donation of $25. (Donations are greatly appreciated, but not required.)

If you are grieving the loss of someone you love, whether the death was recent or many years ago, and regardless of whether your loved one died on hospice services, we invite you to join us. Come experience the peace and beauty of the Hospicare gardens. Light a luminaria in memory or in honor of a loved one. Most importantly, share in the sense of community with others who are also grieving a loss.

If you would like to join us or make a contribution to have a luminaria lit in memory of someone you love, please RSVP online.

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Books Help Grieving Children & Teens

by Laura Ward, LMFT

As part of my work with grieving children and teens, I’m always looking for new ways to talk about grief that feel both safe and interesting. One of the ways to accomplish this is by reading books to children that explain death and grief. Some books, especially those for children, focus on telling a short, but relatable story about loss in its various forms and how it feels to experience this loss. These stories build empathy for self and others in an engaging and concrete way.

Children are concrete thinkers who struggle with understanding the abstract and philosophical questions that surround a death. Stories can help them understand death and grief as a normal part of life.

Books such as Lifetimes by Bryan Mellonie and Robert Ingpen, and The Fall of Freddie the Leaf: A Story for All Ages by Leo Buscaglia, explain death as a natural part of life in the same way that birth is a natural part of life. These books can help reduce fear around the topic of death.

Workbooks, or activity books, provide an avenue for children to open up in counseling in a safe and engaging way. They also provide activities which normalize grief and provide tools for coping with the related emotions and experiences. Amy Barret Lindholm and the children of The Dougy Center for Grieving Children authored After a Death: An Activity Book for Children, which I use with children fairly often.

Helping Teens

Teens can have an especially difficult time with grief. They are in the normal developmental phase of pulling away emotionally from the adults in their lives in order to establish their own identity. This can make it difficult for them to confide in the close adults in their lives. In addition, peers are now the main influence whose opinions matter. It can be difficult for teens to “lose face” by confiding in peers and showing the depth of their emotions openly. In addition, puberty increases the intensity of emotions, but without the benefit of a fully functioning frontal lobe to regulate responses.

Journaling is a great way for teens to process feelings and emotions while grieving and a good skill to have for the future.

Chill & Spill: A Place to Put It Down and Work It Out by Steffanie Lorig  provides a fun alternative to journaling that is specific to teens and their experience. The teen can choose to share some of what they have written with the counselor as a means to build connection.

Straight Talk about Death for Teenagers: How to Cope with Losing Someone You Love by Earl A. Grollman provides answers about what teens might expect in their grief, which doesn’t entail taking advice from the various adults in their life. The book is also brief but informative, which is a plus.

Weird is Normal When Teenagers Grieve by Jenny Lee Wheeler is also informative, but is written by a grieving teen. This is especially useful as grieving teens often feel alone and isolated in their grief from their peers. It goes a long way for teens to feel like there are other people their age who have navigated the strong emotions of grief and found a way through.

Each of these books is on our Hospicare Wish List since we like to have a supply available to hand out to families with young children who have lost a loved one or who have a family member receiving hospice services. Part of our work at Hospicare is to help patients’ families prepare for and understand what’s happening with their loved ones. Books like the ones listed here are important tools to help the youngest family members understand what’s happening.

 

Laura Ward is a bereavement counselor at Hospicare. She also organizes our Good Grief program to support grieving children and their parents/guardians.