Covid-19: The Shadow of Death

24 Apr 2020 Nick Garbutt    Last updated: 24 Apr 2020

Pic: Pixabay

Death is not the end. For the bereaved it marks the beginning of grief.

Grieving is as natural as death itself and different societies and cultures have evolved their own traditions around bringing solace to those left behind. These rituals are grounded in centuries of understanding of how we can re-build our lives from the devastation of loss.

The pandemic has ended all that for the moment – and not just for those who have fallen to the virus.

This is likely to lead to an upsurge in what is known as  complicated grief.

Healing after loss is a normal, natural process. It is very, very sad to lose someone you love. It causes intense pain which can often feel overwhelming. Different people react in different ways but it is common to feel guilt and or anger, shock and disbelief as well. It can disrupt your physical life too, interfering with sleep and eating for example. But although the person you love will never come back people eventually recover.

Sometimes, however,  these intense feelings that are often experienced in the early days of grieving don’t go away and stay with people for a long period of time. This can lead to people neglecting their own wellbeing, being filled with dread about the future, isolating themselves and obsessing over whether they are grieving in the right way.

To put this a little more scientifically complicated grief is defined as “being distinct from bereavement-related depression and anxiety, and to predict long-term functional impairments.”

The psychiatrists who coined that definition also devised an inventory of complicated grief which helps understand the symptoms based on a questionnaire.

There is clearly a heightened risk of bereaved people developing such symptoms at a time when the normal rituals around death are denied, the limited opportunities for the dying even to say goodbye to their loved ones, and the physical isolation that the grieving are forced to endure during a lockdown.

Sadly the risk is greater for relatives of those who pass away in Intensive Care Units.

 Complicated Grief After the Death of a Relative in ICU was published in 2015 in 41 ICUs in French hospitals. It was the first study of its kind.

It concluded: “Sadly, over half of these bereaved family members presented with complicated grief symptoms at 6 months, a proportion that persisted essentially unchanged for a total of 12 months.”

This is a staggering five-fold increase in the numbers suffering these levels of grief over deaths which occur elsewhere.  As more and more people were reaching the end of their lives in ICU before the pandemic, this paper highlights the need for especial support to people whose loved ones die in this setting.

The researchers also found: “Being present at time of death increased the risk of presenting complicated grief symptoms in our study. This finding may seem surprising, as relatives often express the wish to be with their loved one at the time of death and witnessing the death has been identified as a marker for good-quality end-of-life care. However, relatives may wish to witness the death then find the experience difficult to handle, at least in the ICU setting.”

It concluded: “Relatives who wish to be present at the time of death need compassionate support before, during and after this experience.”

“High-quality communication involves adequate information that death is imminent, to ensure that the family is aware of the reality of death and can say goodbye to the patient; another component of good communication is adequate support for relatives who wish to witness the death.”

Further to that it would seem that the compassionate solution both for patients and their relatives is that when a person is close to death they should be extubated (taken off the ventilator) and given palliative care so that they can pass away more peacefully with their loved ones, rather than being kept alive for a few more minutes, just because it is possible to do so.

In these times there will also be many deaths both from Covid-19 and other causes where relatives will not be able to see loved ones before they pass away to say what needs to be said, and their goodbyes. And then many will face grief in isolation.

To compound this, bereavement services are currently unable to offer support face-to-face.  Cruse Bereavement Services and others  offer support via helplines  and a compassionate, caring professional can do much to help in such times.

There is also a wealth of advice and support online on Cruse’s website around funerals during the pandemic, how we can help friends who have been bereaved, and how we might remember the dead in a fitting way, despite the constraints. It is high quality information and an important read for anyone who has friends, relatives or colleagues bereaved at this time.

Dealing with death during the pandemic is recognised as a major global issue, as per this piece  by the World Economic Forum.  And it challenges all of us, those who are grieving and those of us whose role is to show kindness, compassion and support to those who are.

But death happens daily from all sorts of causes and even before Covid-19 we didn’t deal with it well and, as a society,  we don’t give enough support to the bereaved.

That should change.

Nothing good will come from all this suffering. Yet it might remind us that death comes to us all. That it should not be a taboo. That nobody needs to grieve alone and the inevitability of the end of life is a shared inheritance.

In contemporary Western society, too many define a good life by the wealth that you have, the car that you drive, the home that you live in and your perceived status. We have been conditioned to build our ambitions around these things. Yet none of them matter in the last moments of life.

Death is as normal as birth, and just as mothers are right to plan for a good birth, so too are we right to make death the peaceful, moving and spiritual passage that it should be. Afterwards we need to give all the support and kindness we can to help those who have lost loved ones.

One of the most brutal impacts of the pandemic has been to make this so much harder to achieve.

It is important to highlight this now, and in the weeks and months to come when people might be in desperate need of support. The pandemic has wreaked havoc and as a result there are many causes quite rightly clamouring for attention, many needs to be met, many services to support.

But we must ensure that the needs of the bereaved are not forgotten and that bereavement services are properly funded so we can help those with complicated grief out from the shadow of death.


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