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Grief has not changed during COVID-19, but the rituals of grieving have.

The long-term effects of those changes will be more evident in the months and years ahead.

How we grieve as we lose a family member to a terminal illness like cancer can help us contrast the differences between what used to be and what happens now in the midst of a pandemic.

Not all cancers end in death, but when a kind of cancer has defeated every treatment, the family begins an experience of anticipatory grief.

Actually, it often begins when hopeful doctors start to nuance their treatment suggestions as they try to help the patient and the family realize there is an end to treatments ahead.

So, anticipatory grief often begins.

For most cancer patients, family was around to help and support not only the patient but also each other.

Pastors came by, friends visited and the family facing the prospects of a deep loss were buoyed by the select community who were both familiar and supportive to them.

My father was one of the first patients in home hospice in 1982. There have been great changes since that time, but what has not changed is the sense of community, the bonds of friendship, of love and fellowship to the patient as he or she moved to the end of his or her life.

The hospice experience brought care and support to our family as we moved toward the loss at the center of our affection. The hospice healthcare team was also able to experience pride in the way they helped our family during the upcoming loss of a loved one.

This likely describes the experience of most people whose loved ones have entered hospice care in the final stages of their life.

Anticipatory grief set in motion what would often happen after death, but COVID-19 has changed much of this grieving process.

It is important to recognize that the COVID diagnosis is not a death sentence, as new treatments are saving more lives. Yet, people are still dying at alarming rates.

Patients who are diagnosed with COVID are most often isolated in ICUs or on COVID floors with restricted visitations for obvious reasons. Even those with other illnesses have restrictions on visitors.

So, family support is limited, which is more difficult for the patient, the healthcare team and the family. While some families have found creative ways to stay in contact, isolation is still severe.

Many COVID patients are surrounded only by their healthcare team in their final moments.

The weight of the loss for the family and the healthcare team is huge. Watching people die with COVID again and again is a “Groundhog Day” for healthcare workers, with no reprieve to process grief.

In talking with the orthopedic surgeon who will replace my shoulder, I mentioned that, as a therapist, I was concerned that healthcare workers might be facing the kind of trauma we have seen with our military. His response was, “You are not wrong.”

COVID-19 has dictated what can and cannot be done. Visitations, funerals, memorials, gravesides and other rituals have all been subject to regulation. Yet, the trauma of COVID-19 and a COVID death started earlier.

My mom died from COVID-19 but not with COVID. Her nursing home locked down and, at 95 years of age, all visitors, routines and patient to patient activities were curtailed.

Some family was finally able to visit through the window in Mom’s room. The last week of her life, my brother and sister-in-law were allowed in twice, but Mom was sleeping, rarely waking and less oriented to her surroundings.

She died on a Saturday morning without family present. This was not the way our family historically cared for each other, but there was no choice.

So, how can we walk with the grieving during these extraordinary days of loss?

Here are four simple things that can be done to remind the grieving person or family of their larger community care and support. These are all actions we would have taken pre-COVID, but now they require more advanced planning and modifications.

  1. Attend a service of remembrance if your community allows it and if you feel like you can do so safely.

If you cannot attend, sending a small floral spray, potted plant or other item is another way to remind the family of your love and concern when it is not safe to be in a larger group.

  1. Call ahead and stop by the house when fewer people are around to communicate your love and support in person.

You could simply offer a brief word of support or drop off helpful products such as a pound of coffee, a sleeve of Styrofoam cups, a bag of ice or a meal. In and of themselves, these are just things, but they are more than that – they are reminders of the care, concern and prayers of friends and community.

Be sure to remind the person and the family of your concern and prayers and, if there is a small group, voice a brief prayer for the family while you are there. In this time of social distancing, even the briefest encounter with others can make a profound difference.

That said, I hope it goes without saying at this point that with any in-person visits, please follow all of the public health guidelines – wear your mask, maintain six feet of distance, remain outdoors and keep your visit brief for safety’s safe.

  1. Stay in touch on a regular basis.

This is one of the best things you can do. It takes a year to just get a sense of what we have lost, and only then can we begin to grieve.

We have to walk around the calendar through holidays, birthdays, anniversaries and special occasions before we get a sense of how much we have lost.

Grief does not run its course in three months, so neither should our efforts to provide support. I am not suggesting you commit to reach out weekly, but it is important to space your contacts out over time just to see how they are doing.

  1. Remind the person or family that, whatever experience they are having in their grief, “it is normal.”

Always remember that. They are not losing their mind! For believers, I believe it is simply God giving us what we need to move on.

Working with the grieving for decades, grief is unique to each person. In fact, in one book of diagnoses that I use in my practice there is an ongoing comment which says, “unless happening in the course of a grief.”

Wash your hands, wear your double mask for others, mind the gap, be kind and do not grow weary in being safe.

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