Our Current Reality and the 6th Stage of Grief: Meaning
To clarify, I am not a therapist. I am also not a doctor. I am an executive coach who supports doctors in their leadership development. Much of that support comes in the form of leveraging my neuroscience-based training to help them understand the ways the human brain gets hijacked when we are tossed about in things like uncertainty. I have used these tactics for years supporting physicians amidst their everyday complexities of navigating the thorny overgrown path of a broken health care system. These tactics are being leveraged in new ways today as I coach them through the multiple triggers experienced during this pandemic.
I have been asked by friends and clients what I find helpful to process the myriad spectrum of experiences I am reading and hearing about: from identifying plans for leading other leaders through multi-layered blankets of ambiguity, all the way to helping physicians adapt stress-relieving tools helpful in pre-Covid days to this new world of chaotic ICUs when they aren’t sure when they will be able to pee. It is an absolute honor to walk with them in this space and I am so grateful to be trusted to help them craft a way forward. I am also struggling as many other helpers who are helping the helpers - we want so badly to make their pain disappear, but we can’t. So, what am I using to process all of this emotion? I am using what I have always used: meaning.
You’ve likely heard of Elisabeth Kübler-Ross and her work on the Stages of Grief that began back in the late 60’s. I learned about her five stages (denial, anger, bargaining, depression, acceptance) when I was an 18 year old x-ray school student, reading required texts like hers titled, On Death and Dying. Super cheery read for my first semester in college; while my buddies were up at CU learning how to party, I was working 7 am shifts at Presbyterian/St. Luke’s hospital, in freshly pressed whites learning how to do things like insert barium enema tips into patients’ rectums. Fun! However, that read was startlingly helpful to me. Our program director chose this part of our curriculum in an attempt to help us process the emotions of patients we would be encountering in our clinical careers, while they encountered us providing diagnostic services for them. Her intent wasn’t lost on me, as I found the book to be helpful for that purpose as an 18 year old squirt finding herself in some seriously adult circumstances. I also found it to be incredibly helpful, personally. Having lost my dad quite suddenly to a massive heart attack just 3 years prior, with no model to understand the shock and horror of what my devastated family was going through, this book was incredibly enlightening. I was able to step back into my experience during that awful time and label things I was feeling to begin the process of finding closure.
When looking at the Kübler-Ross model, we can also find ways to label what we are going through with this pandemic situation. We are all suffering the loss of the old way; albeit temporarily, or permanently, one has zero certainty as of today. Anytime we encounter change, we also encounter grief. Some grief is short-lived and quickly processed to the other side, while some is not. It can take years to get to a place of acceptance depending upon where each of us are in our very personal grieving process at any given moment.
These days, I find that I vacillate between two areas: feelings of worry about these physicians I love being exposed to huge viral loads, and feelings of hope for the new world on the other side of this crisis. I do feel crazy many days as I sweep back and forth between a very dark space and the cheery, high-levity Janelle I tend to gravitate toward. I am watching myself on one day in the morning feeling the stage of anger about how much harder it is for doctors to be dealing with this pandemic amidst the well-established epidemic of physician burnout requiring them to be put in harm’s way, all without the required personal protective equipment to keep them safe. That same day, in the afternoon, I find myself moving beyond acceptance of this situation we can’t change, and dreaming about what the future may hold for all of them, and all of us. David Kessler who co-authored a book with Kübler-Ross later identified a 6th stage of grief: meaning. This is the stage that helps us move toward something that looks like hope, along with some sense of closure.
At some point, quite possibly years later down the road, we are often able to attribute meaning to losses experienced. Some find growth, character development, and resilience (insert your favorite Kelly Clarkson break-up song here), while others realize the value of gratefulness for all they currently have left in the wake of loss. I know I appreciated the hell out of my mom as well as all the golden wisdom in the leadership lessons my dad taught me when I was just 15. Had he died when I was in my 20’s or 30’s, I might not have remembered all he shared with me during his last year alive in a new position as the president of a small town bank. In addition to having an amazing leadership mentor in my memory banks, I received my professional calling from my dad’s death. My winding career path led me to specialize in coaching physicians 25 years after seeing my dad’s visibly distraught doctor standing at the back of the church while we walked out of the funeral. The vision of that lovely man’s teary face never left me, nor did his suffering over not being able to save his patient who cored on his exam table in the middle of a sentence, just 10 minutes after receiving a normal EKG. I somehow ended up working alongside doctors my entire adult career and am now in a position to lighten their loads with my current toolbox. If that’s not meaning derived from immense grief, I don’t know what is.
We will all get to the time when we are ready to cross the five stages of grief and land on this sixth stage where we will identify personal meaning from this crisis. Based on what I am seeing a mere three weeks into the entry of the global fight here in the US, many are already heading there with positive points related to things like:
a higher appreciation and respect for teachers
although some are struggling with full-time parenting while working from home, many have noted this virus’s resulting quarantine has produced an undeniable focus on family time
more companies allowing working from home indefinitely due to proof of concept along with physical space cost reductions to help companies get back on track financially
it has not gone unnoticed that mass shootings at public gatherings and schools have all but disappeared since social distancing measures went into effect
Here is what I am observing on the swing of being hopeful and dreaming about the future of healthcare and physician burn-out, in our not so distant post-pandemic future:
Physicians long held back by administrative tasks required of them have felt far less joy in their work given this drastically limits their ability to make meaningful connections with their patients; it also results in far fewer opportunities to make meaningful connections with their family members after work considering how much “pajama time” they spend catching up on charting every night when they would ideally be resting, engaging in fun hobbies that provide stress relief, and being present with loved ones.
The urgency behind the pandemic has resulted in regulations being lifted in the interest of time. The Centers for Medicare and Medicaid Services (CMS) is allowing patients to be prioritized over paperwork! One has to wonder why couldn’t this movement extend into the future of healthcare delivery once the need for immediate care passes?
Multiple efficiencies and effectiveness have been touted in the practice of telemedicine, yet most systems struggled with gaining traction due to patients preferring the tried and true, traditional face-to-face visit. Let’s be real; if we humans don’t have to change our ways, we ain’t gonna. And given the focus on providing the highest possible satisfaction to health consumers to avoid receiving solvency threatening ratings, there was no effective way to push this change forward pre-Covid.
Thanks to this highly underutilized yet already implemented solution of virtual visits in place for several forward thinking health care providers, over the last few weeks we could have a nice chat with a physician about our concerning Covid-like symptoms without having to enter their germy waiting area or exam room. Not to mention, we were often told coming in wasn’t an option to limit the spread of the virus, so we didn’t have a choice even if we wanted to see our doctor in person.
Now, so many of us have not only experienced a virtual visit and how nifty it was, we are also not so afraid of the unknown because we have been there and done that. There are now so many early adopters plus early majority folks on this innovation bell curve, we can only hope the tipping point is a done deal. Not to mention, thanks to loosening previous regulations, providers can now address more issues in telemedicine visits and receive reimbursement for the service they are providing. NICE!
Many physicians have felt like nobody cares about their welfare for years. Suicide rates are some of the highest of any industry and amidst many screaming loudly for change at a national level, very little progress has been made to lighten the administrative loads and lessen this horrific outcome for doctors, many of which are now taking their own lives while still in medical school. The lackadaisical messaging and delay from the federal government to invoke its power to demand companies mass produce personal protective equipment (PPE) doesn’t do anything but provide confirmation of this understandable bias. It would indeed appear that the government doesn’t care enough about our physicians and other healthcare workers to prioritize getting them what they need to protect themselves from the same fate so many other providers have experienced.
Regardless of what is or is not happening at the federal level, even with a complete void of a unifying leadership message, the country has responded in dizzying numbers to provide PPE for health care workers everywhere. More manufacturing companies than can be mentioned, local school teachers, and just about anyone else with a 3D printer have dropped their previous areas of focus to mass produce gowns, N95 masks, plastic framework, and shields to provide effective barriers between the aerosolized viral loads emitted from severely ill patients and our health care workers. Even our own brewery was approached by a large healthcare company here in Denver to find a way to mass produce medical-grade hand sanitizer for them, which we are now ready to do after a frenzied few days of frantic learning and leaning on a village of helpers in the community.
Regardless of whether or not the masses are able to deliver the amount of PPE and hand sanitizer needed over the next month or two, the message has been made for all to hear, loud and clear: WE SEE YOU. WE NOW KNOW YOU. WE WANT TO PROTECT YOU. THANK YOU FOR RISKING YOUR LIVES FOR US.
Due to the high cost of medical school coupled with a simple Google search teaching emerging, young, science-loving potential future doctors to stay away from medicine, many fears have been raised about a physician shortage in decades to come. There are so many barriers to entry, what would motivate young adults to persevere through the rigorous pursuit of a medical degree?
Given the current focus on healthcare workers across the globe and their heroic measures, expect to see a rise in interest and demand for physician and nursing educational opportunities everywhere. Although the inherent dangers of this calling have been readily expressed, the intrinsic motivation for humans to serve the greater good will prevail.
Healthcare is also just about the only field where one has undeniable job security in this current pandemic economy.
In these times of fear and grieving of all that we are losing, there is much to be gained in finding our meaning…when we are ready. That sixth stage of grieving will be there, waiting for us all, when it is time to move beyond those initial five stages and cross the threshold into whatever our new post-pandemic world will be.