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Dying, grieving and the pandemic

Column box-Dr. Carl E. Balita-Entrepreneurs’ Footprints

Facebook has become an obituary. Many profile pictures have become candles, black ribbons, and black backgrounds for our own relatives, friends and acquaintances. In the past, Covid-19 was statistics we monitor. Now it is a horror movie we cannot dare watch anymore but couldn’t turn off either. The movie is interactive that the terror is knocking on the doors of many while others have it within the household already. The scare is real.  And the serial killer is on the loose.

Covid-19 is not synonymous to death. Low at 1.67 percent death rate among all cases, Covid-19 caused 13,435 Filipinos to die from it and 143,726 active cases (as of this writing) and growing. The people who succumb to death are beloved members of an extended family, treasured friends to many, valued members of a community and Filipinos who could be dreaming of a better Philippines in their dying moments. There is no consolation in comparing our statistics with the global norm, because these are still deaths. There is no victory in realizing it kills less as compared with other causes of deaths, because these are still deaths.  There is no relief in rationalizing that government is excellent and we are doing something to stop it, because these are still deaths. The fact is that many are dead, more are in critical condition, much more are grieving for their loss and everyone lives scared of an enemy that is so real.

Death is surely a part of life and not opposite it. It completes a cycle of life with a beginning and an end. But death from Covid-19 is a lonely death enduring painful symptoms—alone—and anticipating cremation, which turns your flesh to ashes to be brought home in an urn. Thank God there are compassionate medical frontliners who could at least hold their hands in empathy during those dying moments. But the dying must be as difficult as the grieving and bereavement experienced by the family that never will have the chance to care for the dying, to embrace the body to comfort and to console, or even to undergo the normal process of mourning and grieving. And by the way, many Covid-19 deaths were preventable and unnecessary.

Dying, grieving and bereavement go through human processes that are understood and explained by theorists.  This is not to intellectualize over and to romanticize the death and dying experiences of many but to explain and describe the phenomenon to bring greater meaning to this inevitable human experience.

A dying person undergoes a journey through denial, anger, bargaining, depression and acceptance as introduced by Kubler-Ross. Denial is the usual psychological defense to anything unpleasant with a response that communicates the message, “no, not me!”  A usual diagnosis of a dreaded disease or condition will lead the person, the family or even the medical professional to get a second opinion, take another confirmatory test or simply express doubt over the objective evidence that led to the diagnosis.  These behaviors are unconscious to resolve the anxiety and use denial, which is the safest available psychological defense, with prayerful hope that the findings is false and the “bad news” is not true. Once denial fails and the “bad news” is confirmed, anger state asks the question, “why me?” This relieves the tension from within—rationalizing over the person’s unworthiness to be in the situation. Anger is that emotional state of wanting to project the situation on blameable external factors soothing the psychological trauma within.  After the anger is exhausted, partial acceptance sets in through bargaining, where the person accepts the reality with wishful thinking and conditional resolve, saying, “yes me but…”. Here is where resolution of conflicts may need to be addressed ahead of the anticipated death.  Bargaining lightens the burden of death by fixing what may still be fixed and by creating a more ideal “pre-departure” setting. Realizing the limited time, in anticipation of death, the person becomes more passively responding with depression, which need not be the clinical state, but an emotional sadness to say, “Yes me, I want to be alone.” And this connects to acceptance where the person surrenders to the inevitable and will communicate, “I am ready, my time has come.”

The above theory explains and describes the psychological state of a person in a dying experience.

Grieving or bereavement is a person’s experience of and state of desolation resulting from a loss, not necessarily death.  But yes, this applies to the family members and friends who lost someone through death. It also follows a process. Engel’s model enumerates shock and disbelief, developing awareness, restitution, resolving the loss, idealization and outcome. Shock and disbelief is where there may be intellectual acceptance but emotional denial of the loss. Grief is much less traumatic cognitively than emotionally. Developing awareness is where there is consciousness of the reality of the loss. Here is why grieving is derailed in the absence of the cadaver to prove such death. Restitution is the part of mourning that includes rituals, which actually is not for the dead but for the living. This is the part that is deprived in Covid-19 deaths because the wake and other rituals are limited, if not prohibited.  Resolving the loss is through a focus on the thoughts about the deceased. Idealization represses all negative feelings toward the deceased. Here is why there is sympathy, and not empathy, for the dead because sympathy is subjective and empathy is objective. Every dead person is accorded good memories, or at least forgiven for the bad ones. And outcome stage happens when the psychological dependence on the deceased is reduced as interest in new relationships and experiences resumes.  And life goes on and moves forward.

Mourning is a socially conventional bereavement behavior after a death. We feel this from people around us these days.  And we cannot be grateful enough to celebrate of our own safety and life as we bear witness to the many lives others have lost. The grief cycle of shock, protest and disorganization brings us to the challenge of re-organizing lives forward. We all are mourning, grieving and bereaved, and if careless and unlucky could be dying, sooner or later.

Life ends in the same way, but indeed the difference is on how we live and how we will die. As one ends a life in this pandemic experience, those who are left behind should not fear beginning life anew, without those they may have  lost. This is because the dead are not dead in those they left behind, unless they are forgotten.  It is in the death of many that we value our lives more—and everything essential around it, which this pandemic has defined so well. The deaths become a reminder that they left us but they were not able to bring with them their material wealth but has left a legacy of how they lived their lives through the footprints they leave behind.

With prayers for the lives we have lost and the life we still are blessed to keep.

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