ICU for the Soul
Some things bear repeating
Some things bear repeating… again.12
****
Grief points to the true north of what matters most. It is love magnified. You do not grieve what you do not love. Grief is the deepest form of love we can know. Like a never-ending marathon for the soul, grief stresses our entire being, challenging us to grow, to endure, ultimately expanding our capacity to love.
It is one thing to discover a safe place to mourn. The privacy of a dark room or parked car has served me on many occasions. In our death-defying society, acknowledgment of grief is now nearly completely hidden from view. Ritual is minimized in favor of communal encouragement to “move on” “get over it” and return to “normal.” We no longer wear black veils or armbands to let our neighbors know we are ambling tilted through the haze. Instead, we walk oblivious among the invisible bereaved.
The thing is, grief only happens in the context of relationship. So, it follows that mourning is a shared social experience. Being seen is essential for healing.
Before I became a hospice and palliative care physician, expressing grief openly was confined to my grief group for fear of being deemed unprofessional, or worse. Based on some researchers’ definition of "complicated grief", six months after a loss, the presence of persistent “negative emotions” warrants further evaluation and treatment. Which means these scientists believe I and others like me, with “… chronically elevated levels of yearning are cause for clinical concern.”
Yet, if we give permission to voice the shared experience of loss, we relieve the feeling of being alone in our grief, even though our grief is always uniquely our own.
****
Though Sonia knows she will soon become a widow, this is not what is on her mind when she asks me to sign some paperwork enabling her to take a leave of absence when the time comes.
I ask her how long she would like.
"My work only allows three days for a spouse."
Whether the result of hypocrisy or a blind spot, it is striking the ease with which our society doles out support to prepare for marriage yet skimps on the time necessary to heal from separation. From the moment we adopt the anticipatory term of fiancé until we transform into spouse, we are encouraged to linger in our new reality. Many pour time, energy and money into enjoying a honeymoon to celebrate and solidify the new way of being in the world as a married couple. But what of divorce or widowhood? Three days seems a bit lopsided when trying to reconstruct a life after one's soul has undergone an amputation.
"Do not, for one moment, let anyone tell you how long you are allowed to grieve. It is impossible to know when and if you will feel ready and capable of resuming work in a specified amount of time," I say.
She stares at me for a long while before her chin begins to tremble. I reach out my arms, and she lets me hold her, allowing herself to cry.
"Really, doc?"
"Really," I say.
"I'd like to offer you another way to hold your grief, so you can give yourself full permission to grieve ... by way of a metaphor."
Sonia releases my hold and readies herself by sitting down and scooching back into her couch. She reaches for a small notebook with her left hand and balances it on her lap while holding a yellow pencil in her right.
"Imagine you've just been in a serious car accident." I speak slowly, moving to sit next to her as I emphasize the word serious. "Even if adrenaline allows you to clear the wreckage and crawl to safety, you quickly realize you have a seriously broken leg."
Sonia nods. Her pencil still poised.
"As soon as you look at your newly twisted leg, you are like, Oh whoa! I need help. You don't relate to it like, What's wrong with me? Why can't I walk? Or I just need to try harder? No!" I continue with more animation and force in my voice, "You know you have a seriously broken leg, and you need help."
Sonia's eyes widen.
"So, the first thing you do is give yourself permission to not move. You know you are injured, and willing your leg back together isn't going to work."
Sonia gives a slight nod.
"The second thing that happens is that people come to your aid. Sirens announce help is on the way. Teams of specialists as well as good Samaritans even show up. They are all here to offer support because they can see you are in need."
"Yes," Sonia says with a relief that has the word linger in the space between us.
"And because this is a serious accident, you are quickly taken to the hospital where more specialists can provide intensive support in the intensive care unit. You don't deflect or re-interpret your need like something is wrong that you alone should be able to fix. You know you have a seriously broken leg! You are in the ICU! This is what it takes to heal from a life-threatening injury!"
Sonia cracks a smile for the first time.
"And guess what?" I change my tone of voice to become more emphatic with a hint of sarcasm. "No one is telling you to just 'get over' your broken leg. Not even you! If you ran marathons before the accident, you wouldn't expect yourself to be registering for the next race anytime soon. You know better! And the world around you knows better, too."
The shine of Sonia's teeth shows me she gets it. Completely.
"While you are in the hospital, the thought of returning to work right now does not cross your mind. And no one in your work expects you to because YOU ARE SERIOUSLY INJURED IN THE ICU! Even the federal government recognizes this and provides job protection benefits called the Family Medical Leave Act for up to 12 weeks. Or disability in the event longer time for healing is needed."
Sonia's head tilts to her left as she ponders.
"And the really cool thing is yet to come. You don't just tolerate the extra support. You and the world around you expect it. Having a cast, crutches, eventually even a temporary placard for your car that allows you to park in the best spaces for free, become essential to your healing. They also act as cues to everyone around you that you are not yet recovered. Anyone seeing you in a cast and crutches wouldn't ask, 'So, when you gonna run your next marathon?' Rather, you have universal permission with tangible reminders that you are in a state of healing, and those around you support you in your recovery, for however long it is going to take."
Sonia now sees where this metaphor is going. She sets down her notebook and pencil, then closes her eyes and nods slowly.
I soften my voice to continue, "You allow yourself to work with all the specialists who are coming to help you learn to walk again. You and they expect it will be uncomfortable. You welcome whatever support can help ease the discomfort and empower you to heal. A lot of the time you are frustrated, humbled and scared. Even still, it's all anticipated. Expected. Normal."
Sonia's eyes stay closed.
"Even when your cast finally comes off and you appear healed, you have been practicing learning how to live with a healing broken leg. You and everyone around you knows you have been through a life-changing ordeal." I slow my words to emphasize their importance. "No one pretends like it didn't happen. Like it is risking life and limb to ask you how you are. People ask and you answer."
I wait for Sonia to make eye contact before continuing.
"On days when you can answer 'I'm feeling great,' people cheer you on. On days you say, 'I'm hurting' (especially on rainy days), no one cowers away or rolls their eyes at you in disbelief. They know, they have seen, what you have been experiencing. It was a visible, life-threatening injury. And with it comes empathy."
Sonia's head lowers. Her shoulders give a quick shudder as she brings one hand to cover her eyes.
"Sonia?" I pause to make sure she is ready to hear me. She nods. "Your soul has been seriously injured."
Sonia's head continues to nod.
"Your husband's death will be like the life-threatening car crash, and your soul ... your soul will have just been ejected from your body. This is more than a road rash you are preparing for...."
Sonia raises her head as she allows a tear to dangle from her cheek.
We hold each other's gaze.
"Grief," I speak more softly still, "is like a seriously broken leg. It, too, can heal well if offered proper support. You may even find, after months if not years of diligent physical therapy and practice, that one day you catch yourself wondering, which leg did I break?" I offer a gentle smile as I continue, "You know, though, that even if the limp is subtle or at times forgotten, your leg is never the same." I tilt my head to the side before saying, "The soul is no different. When supported in healing, the soul's ability to grieve is a reflection of our ability to love."
Sonia takes a deep breath and then allows herself to cry.
****
Like so many with whom I have shared this metaphor, once grief is made visible, it makes it possible to give permission to grieve, for however long. This is the first step toward healing.
When the first wave of the COVID-19 pandemic hit, unique healing spaces for the critically ill were created out of necessity and virtually out of thin air. Cafeterias, parking lots and operating rooms were just a few of the non-traditional settings transformed to support life on the edge.
COVID-19 shined a light on so many painful and inspiring truths about how we can treat our neighbors and ourselves. Grief is one of the universal injuries magnified by the pandemic. And its illumination demands that we create the equivalent comprehensive, intensive care support, as we've developed for the most complicated cases of COVID-19.
It is time we create an I See You for the soul.
That repetition was intentional… because it makes me giggle… because it’s necessary… because (for those who’ve read along for a long time, you know my my favorite “because”…sing it with me…) because I can…. Why necessary? Because I still cannot seem to footnote a title (or a footnote for that matter. If I could, I would have linked this sentence to this:)