We are emerging from the hottest 2 days in the UK that have ever been recorded, with the mercury reaching over 40° C in some places and not much less in other parts of the country. The world is in a largely unprecedented state of change-politically, environmentally, and of course, from a health perspective, as we learn to live with the ‘new normal’.
We are in another, albeit milder, wave of the pandemic in the UK. Milder, because of the outstanding and swift response of science to the virus, and investment in prevention and mitigation of its worst effects on most people. The health service is nonetheless feeling the impact of COVID-related morbidity and the demographic we work with as community nurses is, as always, the worst affected.
It is perhaps not surprising that I have been thinking about grief, loss and change a lot recently. The subject of one of our articles this month is a personal account of anticipatory grief and bereavement.
Grief is an emotion that we can feel in response to any loss or change. There have been many losses during the pandemic: loss of routine, connections with others, ways of working, and of course, the deaths of patients, carers and loved ones-not always from the virus, but certainly overshadowed by it. We are all familiar with the work of Kubler Ross (1969) and her theory on the stages of grief that suggests that the process is linear and predictable: denial, anger, bargaining, depression and finally acceptance. However, anyone who has experienced grief will tell you that it is chaotic and disorganised and that we bounce between these stages, eventually reaching some sort of resolution, which may not be the one we had hoped for.
A more helpful way of looking at grief was posited by Murray-Parkes in the 1970s (Murray-Parkes, 1972). He described the initial stage as ‘shock and numbness’ after the loss, followed by ‘yearning and searching’, ‘disorganisation and despair’, and finally ‘reorganisation and recovery’. In a similar vein, Worden (2008) described the period of mourning following bereavement as first, ‘accepting the reality of the loss’, second ‘working through the pain of grief’, third ‘adjusting to an environment where the deceased is missing’ and finally, ‘finding an enduring connection with the deceased while embarking on a new life’.
It can be difficult to know how to support someone who has experienced significant loss, but it is this last point about finding an enduring connection with the deceased that is, I believe, key. Klass et al (1996) described it as ‘continuing bonds’ in his wonderful book subtitled ‘New understandings of grief’. He argued that we do not need to ‘recover’ from bereavement and move on, but we can develop a new, different, and precious relationship with the person who has died. He makes many suggestions about how this can be achieved, but let me offer a personal perspective on the continuing bonds my family and I have with my father-in-law who died during the pandemic.
John's photograph in a lovingly chosen frame sits on the piano, smiling at us while we live our lives. He watches me as I ineptly contort myself into yoga poses on the floor below, and I imagine he would be mildly amused. We have scattered his ashes on the three highest peaks in the UK and visit them regularly, treasuring memories of the many times we walked and camped together. We holiday in his birthplace each year with my mother-in-law and imagine what John would say and do as we visit places he loved and enjoy the beautiful country lanes of North Wales. We talk about him all the time, and sometimes talk to him as well.
My final reflection is based on the wonderful analogy of ‘Balls in a jar’ which is often used to understand grief. Imagine three jars of the same size containing balls that get progressively smaller. The ball symbolises diminishing grief over time … which is of course, nonsense. Anyone who has experienced grief will tell you that grief does not get any smaller, the ball doesn't start rattling in the jar: it cannot and should not. Eventually, however, with time, the jar gets larger and the grief is accommodated in an expanded world. A world with new connections, and people, and love and hope. My mother-in-law's expanded world includes Coco, a loveable little dog, who brings life and connection, as well as a little bit of mischief, which I think John would rather like.