While it appears we are on the downhill slope of COVID-19’s integration into everyday life, burnout rates are rising, and organizational trust is taking a nose-dive. Aren’t we supposed to be in the post-disaster recovery phase? What is the bottleneck holding us back from moving toward our new horizon? On the surface, issues like operating losses, staffing shortages, and scarcity of supplies appear to be a few of the big contributors. Health care leaders are asking their troops to increase throughput, improve efficiency, and do more with less. There is pushback to these requests, morale is possibly at its lowest point ever, and the three A’s are rising: angst, anxiety, and anger. The pandemic has changed our lives at so many levels: occupationally, economically, and personally, and we remain grief-stricken.
The Zunin-Myers Phases of Disaster curve lists “working through grief” as an important aspect of post-disaster recovery. I believe this is where we are jammed. Sometimes, we are deadlocked pushing back and forth against one another. In other cases, we are inwardly immobilized, ready to pop in an instant like a shaken bottle of soda if another change or request comes at us from above. Incomplete grief runs hand in hand with burnout by consuming our energy, shortening our bandwidth, and leaving a trail of inefficiency, depersonalization, and cynicism in its wake.
So what is the next step? We must pause for grief recovery. Let’s face it, even the most highly trained purveyors of health care have not learned to do grief well. We might even debate the definition of grief: Doesn’t someone have to die for me to feel the emotion of grief? The answer is “no.” Throughout life, we experience many psycho-social transitions; some are easy to do, some are bittersweet, and others continue to make us mourn. Not only do each of us lament personal adverse childhood events, but medical training and daily practice continue to layer on grief.
These layers of grief mount up to become the tip of the burnout iceberg growing visibly above the water line. And how are we managing this colossus? We are currently equipping ourselves with tiny ice picks to chip away at the gathering distress. A resiliency tool here, an EMR short-cut there. Beneath all of this, grief continues to solidify, pulling us downward. We must begin to complete this cycle of grieving.
It might be hard to swallow our physician pride and park our egos to begin this journey of grief recovery, but this is where coaches, mental health professionals, and grief counselors can come to our aid. The perceived stigma associated with the “helper needing help” persona might also limit our willingness to be vulnerable. So, at minimum, I gently encourage you to begin your grief recovery by writing a letter to the Pandemic. In The Grief Recovery Handbook, John James and Russell Friedman describe how to write a 5-step Grief Recovery Completion Letter©:
- Begin by reviewing your relationship with the event that has created a sense of loss.
- Apologize for your role in possibly creating some of your own distress, even by simply being present at this time in history.
- Forgive the pandemic for its transgressions against you.
- Complete any unstated communications you might have related to this experience.
- Finally, bid it farewell. You have come through a disaster, and clearing the grief is fundamental to moving on. Please join me in writing this letter.
I have been reviewing our relationship, and there are some things I need to share: I apologize for allowing you to derail my well-being. Mitigating stress is now a daily focus for me. I apologize for my anger toward you, which preoccupied me more than it ever could you. I have learned to better manage my responses where anger may have been previously triggered. I apologize for fearfully withdrawing from life at times which undermined my connection with family and friends. You are what you are.
I forgive you for being a disruption in my life. I forgive you for the exhausting mounds of information and misinformation that accompanied you. There were so many details, decisions, and messages to sift through each day it was mentally overwhelming. Although adapting to change is less painful, I am still more easily tired when my load becomes heavy with decision-making. I have learned to pace myself better. I forgive you for the stress the decision-makers created for all of us, whether they were right or wrong or somewhere in between in their mandates.
I want you to know I am stronger because of you. I set better boundaries in my life now, and I am grateful you did not rob my dearest ones or me of life.
Consider sharing your letter with a friend or colleague and inviting them to write their own. I would be honored to receive a copy as well. We are indeed in this recovery together.
Susan MacLellan-Tobert is a pediatric cardiologist and can be reached at Health Edge Coaching.