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MGH Global OB-GYN Newsletter

December 2020

Massachusetts General Hospital                    Vincent Program in Global OB/GYN


 “Life has never seemed so precious”

 
In the fifth century Before the Common Era, Aeschylus wrote: “God, whose law it is that he who learns must suffer. And even in our sleep, pain that cannot forget, falls drop by drop upon the heart, and in our own despair, against our will, comes wisdom by the awful grace of God.”
 
In this time of pandemic, our collective learning has come from global, communal, and personal loss. We have been stretched between the kindness of individual acts of love and courage and the cruelty of separation, quarantine, and loneliness. In this issue, Chaplain Donna Blagdan takes us through these moments from her lens as a chaplain at Massachusetts General Hospital.
 
There are many challenges and roadblocks to mourning those who have died directly or indirectly from the devastation of COVID-19. On the one hand, our rituals of grieving, which include gathering together, have been disrupted or forbidden and on the other hand, so much death can numb the soul. We can have trouble finding meaning and vision, and lose our deeply personal and individual ways through the journey of life. Poet Mary Oliver asks: “Doesn't everything die at last, and too soon? / Tell me, what is it you plan to do / with your one wild and precious life?”*
 
It is through remembering and honoring those lost that we learn and maintain our humanity. Wisdom and self-insight are first steps in healing and repairing our world. -- Annekathryn Goodman, MD, MPH, MA
 
Dr. Goodman is the Director of Strength & Serenity MGH Global Initiative to End Gender-Based Violence and Chaplain for the Trauma Critical Care Team, National Disaster Medical System.
 
* From Mary Oliver Poem 133: The Summer Day 

Notes from the Field


Folding Death Into Life

By Donna Blagdan, BCC
 

This dewdrop world
Is but a dewdrop world
And yet, and yet…
*Issa, 18th century haiku master


MGH Chapel
Each ribbon reflects an inpatient treated for COVID-19 --
teal honoring those who recovered and silver honoring those who died.
 

As of this writing, 325,000 individuals have died from COVID-19 in the United States. In an article in PNAS, the authors estimate that for every death, there are nine people bereaved. That means that 2.9 million people have been directly affected by a loss of a loved one during this pandemic. Worldwide, that number is many times higher.
 
That’s a lot of grief. It’s worse than it sounds, because much of this grief is complicated – even more intense, prolonged and debilitating than usual. Loved ones, for the most part, have not been able to be with the dying. Public rituals have been largely shut down, and with so many deaths happening in institutions, communities are less attuned to the loss. The sheer number of losses makes us numb, further isolating those who are impacted. Resources are limited and rarely directed to the bereaved. Many dismiss the deaths, “because most of them are old and sick anyway.” And yet, and yet.
 
Beyond the deaths from the virus, there have been many other forms of loss (and change): loss of normalcy, change in work responsibilities and location, isolation from families (especially poignant during the holidays), loss of physical touch. Each of us has our own list of losses, some mundane and some profound. All very real.
 
As chaplains, we have tended to patients who have been (are) alone, and to staff members who have been stretched almost to breaking. All of us work to manage our own grief while we care for others. We all carry stories, so many of them. The first patient to die from COVID-19 in the state: offering prayer by phone on the other side of the glass window of the ICU. The husband who lost his wife of 54 years and yet couldn’t remain at her side after she had a sudden stroke: “We were just having breakfast this morning!” The nurse who cried because she couldn’t hug her toddler when she came home from work. The elderly mother with COVID who found out her daughter died from the disease. The psychological impact of seeing rooms filled with prone patients.
 
How will we, individually and collectively, begin to heal from 2020? William Worden identified four tasks of grief: (1) accept the reality of the loss; (2) process the pain of grief; (3) adjust to a world without the deceased; and (4) find an enduring connection with the deceased while embarking on a new life. Recently, the MGH chapel was filled with 700 battery-operated candles, and the Spiritual Care Department welcomed everyone to light a candle while reflecting on loss during COVID. The hope was to invite us all to “accept the reality of the loss” just by simple acknowledgement. By the end of the week, 500 candles were lit. It was a powerful reminder that we are not alone in our grief.
 
For many of us, our loftiest hope might be to “return to normalcy.” But perhaps there are deeper opportunities. In the wake of a devastating experience, some people report a ‘‘growing sense of themselves’’ in which they feel healthier and more able. These individuals adapt to the reality that death could occur at any time and begin to live more intentionally and deliberately, reassign priorities, develop closeness with others, and recognize that life is finite. In a recent New York Times article, BJ Miller wrote,
 
The pandemic is a personal and global disaster, but it is also a moment to look at the big picture of life. Earlier this week I had a patient lean into her computer’s camera and whisper to me that she appreciates what the pandemic is doing for her: She has been living through the final stages of cancer for a while, only now her friends are more able to relate to her uncertainties, and that empathy is a balm. (12/18/20)
 
It will be hard to find a silver lining for this calamitous year, but it is important, for our own healing and the healing of our communities, to develop and deepen our internal resources. I was talking to a friend last night who finds himself continually in a state of “super grumpiness.” His antidote? He combs through stories on a Go Fund Me site and gives money to strangers. “I do it for myself. I feel better,” he said. In the MGH Spiritual Care Department, we know that the best cure for our own foul mood is to visit a patient on one of our floors. Activating our innate compassion can be an energizing, not depleting, response to suffering. Remembering what called me to this work in the first place is one of my greatest resources, yet I have to pause and reflect in order use it. I’m perplexed when I hear people use the phrase “compassion fatigue” because I think it’s an oxymoron, and in fact leads people away from  sustenance.  Real compassion floods us with warmth and opens our hearts.
 
My hope is that parts of us that were dormant before COVID will wake up. I have already heard this from others. One of my patients, facing a terminal illness, reflected that “life has never seemed so precious.” As we look back on 2020, I hope we can find an enduring connection with all that has been lost while embarking on a new life with new meaning. As BJ Miller said in the article, “The cumulative effect is shock fatigue or numbness, but instead of turning away, we need to fold death into our lives. We really have only two choices: to share life with death or to be robbed by death.”
 
May you be happy, healthy, and peaceful in 2021.
 
Rev. Donna Blagdan is the Spiritual Care Provider for inpatient oncology at MGH. She is board certified through the Association of Professional Chaplains and is ordained as a lay minister in the Zen Buddhist tradition. Before joining MGH, Donna was a palliative care chaplain at the University of North Carolina Medical Center.