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The coronavirus pandemic differs from those catastrophes in various ways. But it brings stressors of its own. Especially for those worried about vulnerable elders, it brings a level of anticipatory grief, the form that appears when the death of a loved one appears inevitable. It also comes amid a sudden economic crisis and skyrocketing unemployment; the disconnection of people from their families, friends, and their usual routines; and the recognition that some of those routines will be permanently disrupted.
In her 1939 short story Pale Horse, Pale Rider, the writer Katherine Anne Porter describes the protagonist, Miranda, as she falls in love with a soldier named Adam while also falling ill with the 1918 influenza. Amid their fear of the disease, the pair also grieve their old way of life. “All the theatres and nearly all the shops and restaurants are closed,” Adam laments, “and the streets have been full of funerals all day and ambulances all night.” Only when Miranda recovers herself can she fully appreciate the world she and her lover have lost. And when she learns, by letter, that her lover has died from the disease, she descends into the darker depths of prolonged grief.
“At once he was there beside her, invisible but urgently present, a ghost more alive than she was, the last intolerable cheat of her heart; for knowing it was false she still clung to the lie, the unpardonable lie of her bitter desire.”
The Diagnostic and Statistical Manual of Mental Disorders defines prolonged grief disorder as grief symptoms persisting for six months or longer after a loss, along with separation distress, impaired social or occupational functioning, and the presence of symptoms such as confusion, shock, bitterness, and difficulty moving forward with life. As the public sits in anxiety and in isolation, policy makers seeking to cope with the current crisis must also begin to plan for the demands on mental-health services, specifically for grief and bereavement, in the near term and beyond.
As a physician who is also the child of two physicians, I worry in particular about the grief experienced by the health-care providers who are making good on their ethical duty to serve those suffering from the coronavirus. After the 2004 tsunami, prolonged grief disorder was found in one in 10 hospital workers surveyed. In the current crisis, medical providers—including my mother, an anesthesiologist who performs intubations—are at personal risk. Even those who survive COVID-19 or do not contract it in the first place may lose valued friends and colleagues, amid the deaths of other health-care workers who have had to work without adequate protective gear.
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In the hospital, doctors and patients alike have reasons to grieve. Doctors grieve the loss of a patient who has died. Patients, once a disease is diagnosed, grieve the loss of their health. Medical trainees grieve their former idealistic self as they become inured to a system that, ironically, often places little value on their own well-being.