The Many Faces of Grief in Healthcare

In this resonant episode of The Symptom Media Podcast: Bridging the Divide in Mental Health, host Dr. Lindi van Niekerk is joined by grief clinicians Danielle Glorioso, LCSW, and Amanda VerWys, ACSW, to examine a constant, yet unseen companion in healthcare: grief. Opening up about their own personal bereavement and sharing their clinical experience, Danielle and Amanda take on common myths and help us define the difference between grief and mourning. Through this conversation we’ll explore the myriad ways grief can arise, not only from a loss, but identity shifts, moral distress, and systemic failures.

Most importantly, their experience offers tangible practices for clinicians and institutions: psychoeducation, peer support, gentle self-disclosure, and simple embodied routines to help integrate rather than suppress grief. This is a call for all of us to remember that only together can we reduce isolation and stigma, and build cultures where everyone, including the caregiver, can heal.

This podcast is brought to you by Symptom Media - Mental Health Education & Training

For more information about the resources shared in this episode you can visit:

• Danielle Glorioso’s Grief Therapy Site  
• Columbia University Center for Prolonged Grief
• UC San Diego Stein Institute for Research on Aging
• UCSD'S Health & Physician Wellness Infrastructure

To learn more about Symptom Media and its mental health resource library visit: https://symptommedia.com/

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Transcript

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everyone and welcome back to the Symptom Media Podcast, Bridging the Divide in Mental Health. I'm your host, Dr. Lindy Faneke, and I'm grateful you've joined us for this meaningful and deeply personal conversation. Our mission here is simple but vital, to bridge the divide between the clinical and the experiential. By fostering dialogue between research, practice and lived experience, we hope to cultivate empathy and meaningful change in how we approach the challenges of our work and our lives. To listen to other episodes in this series and to learn more about SymptomMedia's mental health resources, please visit SymptomMedia.com. In this episode, we turn our attention to a topic that affects every health professional, and yet it is often relegated to the margins, grief. Whether it's the death of a patient, the loss of a colleague, or personal bereavement, grief is a constant, if quiet, presence in clinical practice. How do we acknowledge and integrate grief while continuing to care? How do we process recurrent loss without dulling our capacity to show up? My guests for this episode bring both expertise and lived experience to this essential conversation. Danielle Glorioso is a licensed social worker and executive director for the Center for Healthy Aging and the Stein Institute for Research on Aging at the University of California, San Diego. After losing her brother to suicide in 2006, she has dedicated her clinical practice to grief and loss. Amanda Fervais is an associate clinical social worker and grief therapist. She entered this field after her younger brother died in 2018 and since then Amanda has supported clients dealing with similar situations. In conversation with Danielle and Amanda, we'll explore the many layers of grief in healthcare and what it truly means to journey through grief. Let's dive in. Danielle and Amanda, thank you so much for joining today. I'm excited for the conversation because I just feel like what you both will bring to the conversation is not just head knowledge, very much a journey that you've walked through and something that I'll personally benefit from and I'm sure lots of people listening. So we're speaking about grief today, something that none of us can escape and it's a response to an irreversible loss. Yet some people think that grief is just intense sadness. I'd love it for both of you to to share your own experiences with grief. That's why I know you come with us, not just with all the academic knowledge and your experience as therapists or social workers in this area, but also that this is a very personal journey that you've walked. And if you're willing to share that with us, that would be great. As a grief therapist, I have chosen to be very open with my experience in grief and why I'm called to do this work. And so my story is, and it still is emotional, 19 years later, I still get very emotional when I share the story. ah I lost my brother Brian to suicide 19 years ago. And at the time I was in graduate school. trying to figure out what I wanted to do and what I wanted my area of focus to be. And I very suddenly and unexpectedly lost my brother. And so after that, I became very interested in suicide loss. So I became very interested in suicide loss and working with other people who had lost somebody. As a way to sort of hold space for my own grief and understand my own grief, I was drawn to be around other people who had also shared in a similar loss. And so since that point, I have been very focused on working with clients who have had a suicide loss. I've run a monthly support group for well over 14 years so that I can also connect with other suicide loss survivors. So my story is one that is deeply personal, but transitioned into something that was also professional. And thank you for bringing the two together. think that's really beautiful. Amanda, how about for you? In mine, seven years ago, I lost my little brother uh also to suicide and his journey was brought to that point. And so through that process sort of got acquainted with spaces of social work, spaces of therapy and the power of these tools to be able to provide really important space for folks in the most disorienting, uh putting it lightly, uh experience of a sudden. in the case of a suicide loss and in case of my particular loss was very sudden and very complicated. So you have grief and then you also had stuff that comes with um what we would say is complicated components. maybe grief that's hard to talk about because it sort of comes with extra stuff. In my case, I was pivoting out of a different career professionally at the time. And so that pivot was informed by my brother's journey and his process of improving his mental health, as well as some other spaces of recovery that I had become more aware of. And so I lost him before I was able to start grad school. But it also meant that I was able to access grief support in follow up to his death. I wasn't aware that grief therapy was a thing prior, but man man, was it super helpful for me. And I attribute a lot of how I've been able to move through my grief process and integrating that grief to having that support and being able to have space to talk about stuff that we all encounter at some point, but this was the first time for me. I've also led some support groups as well and helped folks get language to this really disorienting space of grieving. And even just providing that shared language, even if it's not long-term grief therapy that they're looking for, having those connections and having a space to put their grief throughout their day has been really, really a huge privilege to get to stand on one side of a table or a screen and make that space available for folks. Because I know how important it was for me. Thank you, Amanda, for sharing that. I think both of you just sharing this is already creating space for others who's listening to this as well. Amanda, you said earlier that grief is not a problem to be solved. And I know, Danielle, you also believe this. It's not a pathology to be fixed. And that's kind of hard if you're in the health world, because we're so used to fixing and solving and curing and treating. But the process of walking through grief looks different. And so how did kind of your own journey shape your understanding of what grief is like, Danielle. So I think that going through your own grief journey is one that... is quite educational because before I lost my brother, really truly didn't understand the magnitude of grief and loss. I had known people who had lost somebody they loved and I had had empathy and compassion for them, but nothing prepared me for the magnitude and intensity and devastation that came from my own loss. And the way that I think about my own loss sort of reflecting back is that I would probably say that I was a high functioning avoider, which meant that I was pushing down my grief. focused on, I was in grad school, I had two small children, I was working full time. Like I was keeping busy. But actually what I was doing is I was just running. I was just trying to find every way to avoid what was going on underneath. What I've learned in that journey is that grief waits for us. And what happens when it waits is that it grows, right? It becomes more and more difficult to manage. And so I remember my sort of wake up call. was probably about seven years after I lost my brother. And I didn't even realize it, but I had lost quite a bit of weight because I wasn't able to eat and sort of sleep and function right. But I was doing everything else. was doing all my tasks and on top of the things, but my mental health had been slipping. And my boss at the time said to me, are you okay? I've noticed you've lost a little bit of weight. Are you okay? And that, believe it or not, that was my wake up call. They're like, oh no, actually I'm not okay. And so it was that moment when I started to change gears and recognize, okay, it's time to focus on me. It's time to address this grief underneath. What you said reminds me of a children's book I recently read about grief and they've got this beautiful illustration of this big teddy bear that keeps getting bigger and bigger and comes out at night and kind of sits on the kid's chest and this like big bear that just keeps being there until you start hugging it and tending to it and caring for it and it sounds similar to your journey. yeah, I like that. Amanda, what was the moment for you when you realized you're not okay and was that a similar experience to what Daniel just described where you were just trying to keep going and being okay or was that different for you? So for me, it was pretty immediately after losing him, also very high functioning. And once we moved through some of the business of grief side of things, so funerals, services, things like that, settling all the logistical pieces that follow a death, I found myself just having extra brain fog, these things that were just like, I'm trying to operate at the same level that I was before. I took my... I was thankful my employer at the time gave me a week or two off, which was such a gift and also was not the fullest time away either. And I found coming back, was like, feel really, like something is either, for me, felt like internal, almost like there were clouds. I was able to move through, it wasn't stopping me from doing tasks, but it just felt like I wasn't recognizing what was going on for myself. And so I had already been connected to support. though not specifically around grief. And it was really helpful to more intentionally go, hey, is this something we can look at? Again, it just reminds me that as much as grief is something we're all going to experience, if we're connected to other people, which we all are at some point in our lives, and yet it really took some intentional work on my part to get connected to those resources. And I think you both illustrate so well the thumbprint of grief that looks different for everyone and even that's a really good takeaway that it can show up differently and it can become aware of it in a different way as well. Daniel, what are the dimensions of grief? The obvious but also maybe some of the subtle dimensions of grief. So when we think about grief and loss, the truth is if we live long enough, all of us will experience some form of loss. And so what we want to think about really is what's happening in the body when we lose someone we love dear, right? So if we think about it from the perspective of an attachment figure, so we are hardwired as individuals to seek proximity to others. And so when we have strong attachment figures in our life, it creates this internal homeostasis for us so that even if they're not near and close to us, We can still go out and explore the world and sort of come back to that secure haven, our base, because our internal world is sort of at this like nice homeostasis. And then when we lose a significant attachment figure, our whole internal physiology becomes upside down. And so when we think about what happens to us, when we have a loss, our whole internal world becomes disrupted. And so our ability to eat, sleep, think, concentrate. grief brain becomes an issue. So all of these things start happening that we might not even understand because perhaps we've not had a loss before. We don't understand that there's so much more happening internally as we are trying to adapt and re-regulate to this new reality without our loved one in it. So we might have difficulty sort of with our own identity. So who we are in this world without our loved one. What does life look like now without our loved one? What are these new intense emotions that come up? Anger, sadness, loss, guilt, blame, shame, and then also just like the disruption that happens in our everyday life. So it is so multifaceted. And what I like to share with people is that grief is like a thumbprint. There are no two that are exactly alike. But there are similarities in some experience that we share in grief and loss. It sounds very much as you describe it, like it's almost a, it's not just the loss of a person, but a loss of that internal sense of safety that we also have and something that, like you say, if we live long enough, we'll all experience, but we don't really get prepared for that very well. Amanda, could you maybe tell us a little bit, what is the difference between just mourning and grief? I think often those two are also confused and could you share more about that? Yeah, absolutely. The distinction that we can draw is sort of that mourning is this sort of process that holds within it the grief, all the different dimensions that Danielle was touching on. So it sort of carries us through, you know, the different dimensions of grief, the different facets of our unique grief thumbprint. So for example, during a mourning process, one might start with that acute grief where you're struggling with sleep or eating or your physical body is being so deeply impacted. which we'll sometimes refer to as acute grief. So the really significant frequent teariness, you know, kind of what we think of when we think of somebody immediately following a loss when they're experiencing that grief, not to say that it's limited to that. And again, everyone's is very unique. But as we move through the mourning process, the hope is that you continue to find different ways to learn how to hold the grief and that we can get to a place where somebody has what we would say is integrated grief. So... The idea is, you know, the mourning process is sort of this container that your grief is within. And there is a point where maybe our clients or folks will find that, you know, the mourning process maybe concludes or you find yourself sort of coming through that process. Whereas grief is not something that we are solving for or trying to cure. The hope is that, you you can kind of move from that acute, really significantly painful to one that allows you to move forward holding that grief. helping people kind of get to that more integrated place where the grief is sort of part of your daily experience, but not in a way where it's that very visceral or what we think of when we think of somebody in immediate grieving or new grief. I'd like to turn our attention to exploring grief within healthcare, both at an individual level that health workers may face, but also at a systems level. And so Danielle, I'd like to ask you, like, I mean, as health workers, we just witnessed such profound loss every day, whether it's our patients dying, whether it's our own experiences like you've had. What are some of the other gates of grief that exist? So death is a very common and well-known one. but there's other ways in which people can experience grief or that grief can enter our lives. And could you share a little bit about how that could be? Oh, yeah. So when we think about grief, it's like, it's so challenging because it's more than just one thing, right? So it could be the loss of anything we hold dear, right? So it could be the loss of relationships. It could be the loss of an idea of something that matters to us, a loss of a disconnection to our ethical values. And when we think about what health care workers go through, right, in terms of grief and sort of all of the challenges that they face on a daily basis, you even think about as therapists. you know, we are facing and listening to and bearing witness to people's most intense suffering every single time we meet with them. And the vast majority of healthcare workers, they're on the front lines. Let's just say they're social workers or they're physicians. They are dealing with life or death every single day. They are dealing with a patient's disappointment. They're dealing with a patient's loss. They're dealing with an angry family. They're dealing with all kinds of things on a regular basis and in a very intense high level, regularly. Now, not all healthcare workers are in the most intense settings, but still by and large, healthcare workers, caregivers, are going to be facing really complex, challenging circumstances regularly, which includes human suffering. You think about having to bear witness to human suffering. regularly. And then also all of the challenges that come with the human suffering, right? Let's just say that the system is not set up to properly help the patient you want to help. So then there's the challenge that's related to not being able to give your patient the things they need. And so the grief and frustration that might come along with that. So there really are so many levels that healthcare workers are facing. And I think that we got to see a sense of what it's like for healthcare workers during COVID-19. Like that's when it first started to become aware to the general public what healthcare workers go through. But the truth is they were going through challenging times long before that. And now COVID-19, the pandemic is resolved, but healthcare workers are still facing very challenging, difficult things on a daily basis. Amanda, in your practice as a social worker, mean, how do you or have you experienced this, the loss that Danielle describes? mean, just the, do you cope with bearing witness to people suffering every day and the effect of that? It's a daily practice. think I've been lucky enough to have support from on a systemic level through those that I get to work with, like Danielle, that are really proactive about helping me, helping to remind myself that I am a human person as much as my clients and the folks that I get to work with are also human people. And we all, you know, as much as we can find those spaces, least even like let the air out of the balloon a little bit, that pressure builder. has been really helpful. It doesn't solve it. It's not a quick fix by any stretch. But yeah, when I think of clients who are struggling or clients who are going through their own grief, or when I've encountered situations where there's been a loss within the folks that I've worked with, right? And so then I'm coming at it with my own grief and supporting family and supporting system. And so I think just trying to be as clear as possible about what might be going on for me. and then trying to have those opportunities to reach out for support. So often in grief work, we'll think about sort of there's the power of the individual space, working with a grief therapist is an example of the support group or a space where somebody can say, hey, I don't even know what this is, but I just feel heavy today. Or I found myself kind of really feeling the weight of today's work day, right? Like, and how do we help just even add language to that? continues to be something that's helpful for me. Even just saying the thing out loud might allow the pressure to diminish just a small, small amount. I think you touched on the most important thing that health workers are humans and that is the thing we all seem to forget all the time and from so many of the conversations we've had with whether they've been doctors or nurses, the realization that comes for everyone when they realize, I'm more than just the nurse, more than just the doctor, I'm allowed to have feelings and I do have feelings and that they matter as well. And I think just that awareness and that permission is such an important first step to allowing yourself even to experience the grief that... may have been under the surface for such a long time. Danielle, mean, grief wears many faces and you've already said how high functioning you were and you uh were in coping still with your grief and that's the same as so many other health workers. So how would they recognize that they may be experiencing grief if it is a lot more subtle, maybe from the loss of identity or other reasons for loss beyond just death? Yeah, I think this is such an important question because like we've talked about a lot today, it's not one size fits all. And so it really is going to be person dependent. But I think it really starts with some of the things that Amanda was talking about, which is sort of like systemic approach to support. So whether that be some sort of a peer support program for healthcare providers where they can sort of. get together and name things and talk about their experiences and maybe share their vulnerabilities. I think that just that part, right, can help open our mind to perhaps what I might be struggling with, but didn't have the words to name, but also in a setting where we're reducing the loneliness and isolation that comes from all the intense emotions that might be coming up as a result of our career path. And as caregivers, and many are probably empaths, and people who were called to do work that cares for others, it's often at the expense of ourselves and our own feelings and emotions. And so what we need to do is like, we need to push it down and we need to sort of focus on other things. And so by having a space where we can come together and create language and open up, because it used to be many years ago, and I think it's shifting a little bit. used to be that there was some... shame or maybe even stigma around healthcare providers needing resources, needing support or not doing well with all of the different things that come up as part of the job. creating programs where we can encourage people to get help to get. support where maybe they can learn about the feelings that they're experiencing and name it and figure it out. Is it grief? Is it identity crisis? Because who am I beyond this white coat? Who am I outside of my role here? And then also finding ways to process it. And so about a year ago, I very unexpectedly lost my father and he was in ICU. And at the time, because I do the work I do, I was really noticing the healthcare workers that were on ICU because what's happening in the ICU setting is really intense activities all day. Okay, so I was dealing with the active death and dying of my father and all of these workers were there to support us during this really intense experience. Like for me, it was so intense and I was wondering, what is it like for them to be bearing witness to my intensity and then have seven other rooms on that unit? where they are also dealing with the same intensity. And then that night, the nurse said goodbye and they'll be back in the morning and they were gonna take off my father from life support. And I remember thinking, what is it like for that nurse to go home to their family after carrying this like really intense day and know in the morning they're gonna be helping to usher my father out? and what that might be like for them to know that this is what they're going to be facing. And then also all the other rooms that they'll be facing too. Are they getting the right support that they need? Do they have a place to be able to talk about it? What is it like for them to see that on a daily basis, that suffering? And are they in a space where they can be supported amongst their peers as well? But I think that like learning how to feel, like what I talk about with my clients is to touch the feelings, all four corners of the feelings that we're having. and then totally put it away and get a break from it. So if it's that nurse that left us and knew that they were gonna have to come back to this in the morning, can they totally touch what they were feeling on that drive home? And then when they get home, put it away, right? Just notice it, just observe what is it? What am I feeling? What am I noticing? What am I thinking? How is this for me? And then put it away and to be able to sort of like transition into the next. thing. It's so valuable what you're sharing. I mean, I've had experiences being 24 years old in South Africa as a young physician on the wards and dealing with five deaths in one evening. And just never having had the language of how do you say to five families, one after the other in a row, that they've lost their loved one, let alone to think about how I'm feeling about it. And so much of our ability to cope in healthcare is about shutting down. our own feelings. And so I think, as you both mentioned, the ability for us to put language around that, whatever that may be, would be such a helpful first step. Amanda, I want to ask you, like, I mean, in Western society, especially, we really have a phobia of dealing with talking about death and dying. Like we've just said, no one puts language around it. And so we either approach our experiences by numbing it. So complete anesthesia or amnesia, we just forget that they've ever experienced. And Danielle so nicely said about touching your feelings. And what have you seen are the consequences when we don't do that? When we don't name our feelings, give them some space, both professionally and personally, if we don't process the grief or the feelings we have. Oh my goodness. I feel like the consequences are as unique as the individual grief journeys, but none are any less significant. So my mind first goes to for individuals, right? Where we see, you know, maybe increased levels of burnout or, you know, in some cases there might be an over indexing on work or eating or, you know, drinking or, mean, there's a myriad of ways in which people will cope or do their best to try and cope. you know, within the healthcare field, as much as I can imagine folks are, you know, service oriented, there's a lot of schooling. There's a lot of work that goes into becoming somebody who's wearing a white coat or operating a machine or engaging with these families in the ICU. And so that's a lot of effort and pursuit. And so it's quite possible that those are the same things folks lean on when they're disoriented by grief or they're disoriented by suffering. When we look at, you know, on a larger scale, the consequences of it or that we continue to act as though grief is not a thing or that death is something that we have to avoid at all costs. so grief is something we need to avoid at all costs, you know, but grief as Danielle said, right, like it's still there. And so so what do we do with that when when you have big messages or little messages saying, hey, you know, avoid avoid death, avoid loss, avoid grief at all costs, right? Do everything we're going to even tell you how great you're doing if you're if you're not crying. following the loss of a person. It's continuing to deny the reality of what is. And I think when we collectively continue to do that, it doesn't, it's not positive in any way. When we talk about grief, it's the sense of like shifting it away from something that needs to be cured or that grief ends or that there's sort of this, you know, moment in which you will not grief. But I really like to think of whether it is grief of a person or grief of an identity around an identity or a life transition. you know, folks who are retiring, it may not always be around something, you know, really significantly quote unquote negative, right? Like it could be, well, I'm an empty nester now, but my kids are doing really well, but I'm, I'm still experiencing grief. And so, you know, inviting people into this, this idea that grief is maybe actually evidence of a lot of love and a lot of care. If we didn't care about our people or the things that we're doing with our lives or our job in the case of retirement or our kids in the case of being an empty nester, right? Like if there wasn't that care and that support and that relational depth to a person or an idea of ourselves, then there wouldn't be grief. So my hope is that we can continue to even shift how we think about grief as it being evidence of something beautiful and deep and important and something we wanna maintain. Like I don't wanna move away from the love I have for my brother. He's been gone from this earth for seven years, but I still love him a whole lot. And so of course that grief is going to come with me. And so that's, think, or the hope is that you can be in that integrated space rather than pushing it away or saying, no, I'm just, I'm only happy, or I've dealt with my hard thing and now I'm moving on to something else. like to, I mean, pick up on this idea that you mentioned that it's this linear journey and that there's a time where it begins and ends and that's so much about how we think about grief or how we were educated. Let me say that that's how I was educated. My one lecture maybe I had about death and dying at medical school was there's the five stages and you move through the one, two, three and then you're done. And Danielle, I know you said you once had quite an unexpected or maybe totally experienced response from one of your fellow colleagues kind of six months after the death of your brother and who thought you should be over it. What was that response that you got and what insight did it maybe give you about how we as the health community think about grief? Yeah, this was fascinating to me because at the time the colleague that I'm thinking about was my boss, a wonderful person. I think very highly of him. And he also was a psychiatrist. And as a psychiatrist, you see a lot of suicide loss and you see a lot of anxiety and depression. And yet there was still this complete lack of understanding about what the grief process might look like for someone. And so what happened was it was my brother's birthday. I went into work. And at the time I did not have a grief therapist. So I had no idea that his birthday might be really, really hard for me, that it might be really activating and overwhelming. And I might experience. some real intense emotions. got to work and I was like, whoa, I can't, I can't do this. I was so overcome by my own grief. And now as a grief therapist, I'm quite aware that for the rest of my life, his birthday will probably be really hard. And that's normal and expected, and it's totally okay. And I won't go to work ever again on his birthday. But on this date, I emailed my supervisor and I said, you know what, I'm going to leave early because it's my brother's birthday and it's just too much for me. And in the kindest way, he said to me, wow, I would have thought that you would be better by now and be over it. I'm sorry to hear it's a hard day. Go ahead and go home. And it was so fascinating because here's somebody that I know is kind and cares about me. And yet at the same time was just completely unaware of what to say and what to do. And so I use this as an example, not because I want to put this person on blast, but because it's important to understand. that grief is like we've all been saying today, grief is not something to be resolved and it's not something to be sort of tucked away or to get over. And when we use words like that, I thought you'd be over it by now. What we're doing is a sort of putting on some sort of judgment or understanding about grief that is not accurate. Because now what I know is that I will always struggle on his birthday, normal, expected. It's 19 years later and still when I say that I have lost my brother to suicide, I still tear up and cry a bit. Normal and expected and totally okay. Like I am okay with crying about it when I say it because the reality is not a fun one. And so in my journey of sort of understanding my own grief and becoming a grief therapist, the psycho education and the understanding of what grief is and the understanding of how to manage it has totally helped equip me. to be able to deal with my own intense emotions when they come up on his birthday or on the anniversary of his loss. Now it's still deeply painful and really difficult. And I also understand that and expect it and don't judge myself for it or don't think I should be anywhere else other than whatever comes up today and what I feel is what's normal, natural, expected. It's sort of rethinking that whole piece around what... moving through grief is and what feeling grief is and adapting to grief is. Daniel, I I want to maybe just carry on from that what you've just said where it says it's this lifelong journey. And one of the quotes I recently read was by Oscar Wilde that said, where there's sorrow, there's holy ground as well. And that seems profound. And so how does one walk through this road of grief, of having it become more a companion or a constant conversation that can still shape how we live, connect and care? How has that looked like for you? Okay, so what I would say is a key piece to the work that I do as a grief therapist is absolutely the work that I do for myself as a griever. The psychoeducation that comes with understanding grief. Because again, for many of us, we experience a really intense loss. There is nothing that can prepare us for it, nothing. It is so intense and overwhelming that if I were to try to put it to words, it would not do it justice. It is the equivalent of having a bomb go off in your life and being expected to walk around like everything is normal when you are living in wreckage. And it is going to take a long time before like grass will even start to grow in that wreckage, let alone being able to build something that feels like a life worth living. amongst that wreckage. And so for me, it was helping myself to understand my grief and manage it, which also meant feeling it. And so many of us, therapists included, don't like feeling uncomfortable, intense feelings. Maybe we don't have the tools, maybe we don't have the words, and maybe we would rather like push that down or move away from it because it's really inconvenient. Painful feelings for many of us can feel inconvenient. And so what I have had to learn is tools to be able to feel the intense feelings that come with it. And this can be applied to anything else I go through in my life, because feelings are really important cues to us, right? Like when we stop fighting intense feelings and we just start getting curious about them, we can learn a lot about ourselves. What is coming up right now? What does this mean? And then sort of, again, that piece of like touching it and putting away. When I first lost my brother, I was just putting it away. putting it away, putting it away, running, running, running. And I think that like whatever coping mechanisms you have before the loss tend to be what you will double and triple down on after the loss. So if you tend to be somebody that uses a glass of wine to cope when things are stressful, you might have a glass or two of wine after the loss to cope with that stress. Or if you tend to be somebody that shops to cope with your... difficult times, you might be somebody that's going to shop a lot after the loss, right? Because we don't tend to develop these amazing new coping mechanisms in the midst of a loss. And for me, difficult feelings were something that like, I don't like to feel so because they would distract me from being productive. And so in all aspects of my life, including the loss of my brother, what I have learned is like how to feel the feelings. and I'm still standing. And now that I'm feeling my feelings about all things, I am far more tethered to my world and my life. Amanda, what does that look like for you? How do you give yourself the permission to still experience those feelings of grief and like Danielle explained, she'll never work on a brother's birthday. Have there been any things like practices that you've had to adopt for yourself as well to give you the space for your feelings and to just be with your grief? you know, as somebody who tends to be a planner, tends to be a little bit type A, some we would call like over-functioning in a lot of ways, like my coping prior to and following my loss was to just like, I'm going to start a graduate program and I'm going to keep, I'm going to stay doing that. I'm going to continue to do that. I'm going to do really well. So I think for me, it's felt like a quieter experience. And again, it's so individual. But the power of just being able to say like, don't know how I'm going to feel on his birthday, or I don't know how I'm going to feel on the anniversary of his loss. And giving myself that margin to not know, to not have the plan or the answer. Some years I've really wanted to be thinking about other things and have quiet moments. Some years it's like, I just want to eat all of his favorite foods and think about him. And so encouraging folks to maybe not always feel like they have to have a plan or know exactly what they're going to do because It may shift and change. It changes. It can change so quickly. As a griever, there was a part of me that thought, okay, maybe the first birthday is going to be really hard or the first anniversary or the first Christmas, but then like the second and third and fourth, you know, in the years since are somehow going to feel just a lot better. And so again, it's helping to manage expectations and to also, you know, acknowledge that those are real and that it may be different, you know, in moments that catch me off guard, because there's those two, right? Those moments when you're driving and you might pass a place that reminds you of a person or a song comes on the radio that just is like so connected to that person. So I think as we try to provide the psycho-ed and create space where it's okay to say, I, the song came on the radio and I sobbed in my car. Those things are okay. Sometimes I'll say, you know, it looks like more of a plate of spaghetti uh for grief instead of like this linear up into the right, like straight line, because you might, find yourself diving back into other things and feelings that you might have had before might come up and it's all part of the process. It's all part of the process. What you both are saying really resonates and I think one of the hardest things as a health worker is being okay with the unknown. Because so much of what we've trained to do is to know, to predict, to plan, to think of every possibility that could arise. so letting go and just experiencing I think is a hard thing because it feels like letting go of control. And I can attest to my own journey of having a miscarriage and then coming out of that totally rationalizing everything, planning how it should be. how I would react, how I can manage feelings, how I can do it all until I couldn't. And it was, like you said, Amanda, this wonderful plate of spaghetti that's in front of me that needs unwinding. And it's not as straightforward as what my mind wanted to rationalize. And so Danielle, with that said, you work so much with health workers. I know you've had many health workers, you've been your clients as well. And especially for personalities like ours, how do you provide them with the support that they need? And how do you help people be okay with the sense of letting go and... and just observing or experiencing what they're feeling. Yeah, well, thank you for sharing your own experience with this. think I appreciate that because it helps lend this whole idea that many healthcare workers do, which is the difference between our intellectual mind and our emotional mind. And my guess is like probably your whole life, you have used your intellectual mind to solve problems. And so because that was sort of your coping was like, okay, I'm going to solve the problem. When you went through your own experience, like that was your go-to coping. I'm going to think my way through this. experience. And so that is not an unusual trait. for many healthcare workers. And so what I talk about a lot with my friends who are healthcare workers and also with clients is the idea that like we want to help bring together the intellectual mind with the emotional mind. I'll say to many doctors that I work with, like, I don't want you to think your way through this right now. Right now, let's bring it down. Let's bring it down to the emotional mind. Let's feel your way through it for a second and try that. And that can be really hard, right? Because number one, maybe we're not used to it. Number two, maybe it's a little scary, not too comfortable. thinking our way through it is they've been doing it for their whole life, their whole career. The emotional mind is a really tough place to start doing. And so what I did with one of my clients, and this worked beautifully with him, is his doctor told him to go to therapy because he wanted to see his physician, his own physician. And his physician said, you know, you're having all these health problems. I think that you need to see a therapist. And so he didn't believe in therapy, but he said, okay, if my doctor's saying it, I'm a doctor, I'm going to go to therapy. And so we started this thing, we called it 10 minutes a day. And the idea was he had a really long drive home every day commute from work. And when he got home, he felt this need to show his family that he was just fine. So there really wasn't any room. was like be on all day at work, drive home and be on at home. I think the drive home was like 45 minutes. He had to just feel his feelings for 10 minutes of it. And at first he could only do two minutes. And then he would be like, okay, I tried my two minutes and I'd say, what was it like? We would talk about it before, you know what he was doing is 10 minutes and his health totally turned around. His doctor said like his, some of his levels came down. He had had, I think it was IBS and that had resolved. And so all of this work and like feeling feelings, he said he never did it his entire life. He couldn't, he couldn't bring it back to like, maybe when he was five or six, he felt some feelings. It had been that long. So the idea of like even doing two minutes. was really tough. And so this sort of back and forth of coming up with these little strategies to invite feelings in and to practice it. And then totally like the minute he got home, like put those feelings away and show up for your family the way you feel the need to show up. And so there are lots of different ways that we can sort of help people go from, I'm gonna think my way through it to let me try feeling my way through it. And also thinking too, let's try both because I've done a lot of great things with thinking my way through problems. It's effective. Let's also try doing both at the same time, sort of back and forth so that these two are in alignment. The intellectual mind and the emotional mind can sort of come in alignment with one another. Yeah, and giving some space and time for that emotional mind to be developed is not something we've had often as health workers. And so this seems like a really valuable process, I think, just for everyday life, irrespective of what one's walking through at a time. Amanda, how do we support each other? How do we support if a colleague is experiencing a loss? What role can compassion and attunement play? And what are the things we should avoid not saying to people? You already alluded. to it earlier of not getting over it, but going through it. What is a helpful response that we can give to other people around us that may be suffering and experiencing grief at this time? That's a really helpful question. think, you know, having conversations like this, I think is hugely, hugely helpful. So I just want to name that we all struggle in this area. And so sometimes folks will want to support in the perfect way, or there can just be a lot of difficulty around this topic. so acknowledging that that can still be a work in progress in the support group spaces in particular. And this is also in some of my individual sessions I'll hear. you know, specific language around grief maybe has been spoken to us. Again, it's all so well-intentioned. Most often, you know, it's very rare that I have somebody who somebody is being intentionally unkind around their grief, right? And even as Danielle alluded to with her story, was like, this person is intending to be nothing but supportive. And yet themes that come up a lot for me that well-intentioned language that I've heard from folks, ones that continue to... create some agita for people or emotions of, ugh, I know you're trying to help, but it just really doesn't feel helpful. I don't want to hear that, right? The get over it is language that can be really harmful and variations of get over it. For some people, moving on is a totally fine way that they're able to articulate part of their grief process. And for others, moving on might feel like we're using my experience, right? Like moving on would be that I have moved on from my relationship with my brother. And so that can feel kind of... alienating for people or placing expectation on. um Others might be intended to be kind, but things like, well, everything happens for a reason. You will grow through this. Trying to find the positive light on someone's grief experience. When I think of my own experience or somebody who's been sick for a very long time, that one can come up a lot if there's been a lot of suffering leading up into somebody's. passing, that one might come up a lot. Wanting to put a silver lining on it, and though it may be true, it's not for us as supporters to maybe make that statement, which again, really positively intended 99.9 % of the times. By and large, want the, the griever is the one who gets to decide if there's a silver lining that they're willing to name and speak to. And I think if we can pause just for a moment prior to saying that, more positively received is. Things around, know, I'm just, really sorry for what you're going through, or I'm, you know, acknowledging the emotions you might have, or I'm here. I'd love to bring you a meal. I know some folks struggle around the like, how can I help? That language can be challenging for some folks. I recognize that for a lot of people, this can be a minefield. And so I know so often folks want to know like, what is the right thing to say or the perfect thing to say? Most often, it's just letting them know they're not alone. And you acknowledge the reality of what they're going through with an I'm sorry or something to that effect. And as best as we can, trying not to slap a silver lining on it or they're in a better place. uh Again, it's acknowledging that for those of us wanting to provide support, there's probably some internal discomfort we have of being near someone who's grieving and not having something to say that can fix it. The intention is almost always really, really good. But yeah, my encouragement would be to just kind of maybe pause for a minute, breathe, check yourself and say, okay, what is it that I really want this person to know? I want them to know that they're cared for by me and I want them to know that I'm here. I mean, I think just that line of I'm here seems very truthful and just the best that we can do. And I think we struggle as again, as health workers, as a society of not doing because just saying I'm here and I'm not saying anything, I'm not fixing you, I'm not curing you makes us feel very helpless. And so practicing that ability to just be there for someone else without doing anything. I think that's a real muscle that we can all can strengthen as well. So not to add a silver lining to things that shouldn't be. you've educated me well, but please feel free to correct me. I do though, I ask you, I wanna go back to the quote I read that said, where there's sorrow, there's holy ground. And I do think again, as a modern day society, we try and shy away from any feelings of sadness, sorrow, grief, because we've put a perceived negativity around those emotions. But yet they also open up something inside of us. uh build capacity within us, enable something new to grow. And so I do want to ask both of you whether, I mean, it's been 19 years for you, Danielle, it's been seven years for you, Amanda, have you seen that there's any gift or anything new that's arisen inside of you because of this experience you've had with your brother's grief that is valuable, that has treasure to it? I'm so glad you're asking it in this way. When you think about any life challenge we've gone through, right? Whether it's grief or it's a breakup or it's adapting to something that's really difficult, right? It's so painful in the moment, but there can be gifts that can come out of any life circumstance, right? And so for certain, when I'm working with a client, I would not use a silver lining approach like Amanda said. But what I do try to think about in terms of my own grief experience and also my clients is this idea of post-traumatic growth. I'm not sure if it's something that you are all familiar with, but it's sort of this idea this positive psychological changes can occur as a result of struggling with something highly challenging. In my situation, there is no doubt that I have had tremendous post-traumatic growth as a result of the loss of my brother. It was by far the hardest thing I've ever been through in my life and probably, I hope, the hardest thing I ever will go through in my life. Let's end it there. And yet, through the course of that, I've been able to use my loss and use my brother's life and use his story. as a way to help empower and facilitate adaptation in some of the most painful circumstances of someone's life with all of my clients. So when you think about that great honor that I have now as a result of my own suffering and as a result of my brother's life, I get to help people navigate through the most painful and treacherous journey of their life and help them give them some hope in that journey because when we're in the midst of a grief journey, It can feel like it's never ending and it's always gonna be this way. Because in that moment, that is exactly what's happening. And what I can do is I can shine a little bit of light on that and help guide people through that journey. And every single support group I run, I am finding a way to pay honor to my brother's life. And I'm finding a way to pay honor to my own pain and suffering as a way that I can use to connect to others who are going through something quite similar. It's such a nuanced thing. It like totally taps this part of me that I think really resonates. And it's so the hope that we have for any of our clients going through it. You know, I know I mentioned the silver lining thing is being like, please don't be the one to say it. Like let the griever be the one to say when those things have happened. But yes, losing my brother was the most significant kind of life tilter for me. And so, you know, I think if anyone had told me when I lost him that... There was going to be depth and richness and beauty. And there's just been so much that his life and his death has given me and that my grief with him and the relationship that has continued for me since he's passed has given me. If they told me that initially, I would have been like, go kick rocks. There's no way, you know, oh there's no, there's no way anything good can come from this. And I think when you, when you're able to move through the process in a way that is touching all of all the four corners of your grief, right? You're learning how to integrate it day to day, working with clients. It's a very tangible way that I've integrated the learning and the progress and the education and the certifications and all of those things get to come together in a really beautiful way that is deeply, deeply meaningful for me and to get to pay the service that I received forward in terms of walking alongside my clients as they navigate the space, whether it's immediately following a loss or in some cases, many years since the person has passed. It's such a gift and it's such a privilege and you know I certainly wouldn't be doing this work were it not for having lost him. And at the same time I'm so keenly aware that I had to be the one in my individual process and my unique thumbprint to get to this place where I can feel that depth and that richness and that... the sacred ground, right, that holy ground that the quote kind of speaks to, right? If somebody had told me at any interval, that is mine to come to, that is not for someone to tell me. And so I think in these spaces with clients, we get to sort of provide that hope and provide that light without it falling into that category of like shoving someone into acknowledging good from the most difficult thing they may be ever faced. Just hearing each of your stories, I mean, it's so powerful and brings a lot of healing just, I think, for other people being able to hear the journey you've walked through and your experience of it currently. And so I wonder what advice would you have for health workers who, when we go to the hospital, we put on the white coats or the nurses' outfits or whatever it is we wear and it becomes like our emotional armor. and behind that emotional armor we hide our own feelings, we hide the shame that we have from struggling with grief and then we get trapped in profound loneliness and we see that with health workers experiencing burnout, depression, there's so many mental health challenges among health workers these days. What advice would you have for how we can... step out of that emotional armor to do a little bit of what you both do so beautifully, to share our own experiences in a way that it could maybe foster some deeper connection, whether with our colleagues, with our patients. How do we do that in the way that you both do it so beautifully? Well, this is such a This is such a big question and it's so layered. There's so many different ways that I think that we can approach it. So sort of like from a systemic place, you know, one of the things that I've been really proud of is that at the University of California, San Diego, we have a program called HERE, which is a program that's designed to do exactly this. It's to foster support for healthcare workers. I think that we might be the only location in the United States that does this. And really the idea is to sort of create this world of support for healthcare workers. And so there's so many different things that they offer as part of the HEAL program, which is the HEALer Education Assessment and Referral Program. And I share this because you don't have to do exactly what HEAL is doing, but they have some key things that can really make a difference if implemented systemically. So the idea that maybe... confidential support referrals to mental health care so that you don't have to feel vulnerable in front of your peers if you don't want to, emotional processing debriefs after a workplace crisis or stressor, or maybe something called Swartz Rounds, which is a structured multidisciplinary forum within healthcare centers where both clinical and non-clinical people can gather to talk about their emotions and thoughts around a certain topic. These types of things can foster supportive, compassionate work environment, job satisfaction, interaction, interdisciplinary communication, which is so important. I mean, there's so many different ways that we can approach this. And I think like anything, everybody is unique. So it's not going to be a one size fits all. Maybe somebody would prefer that anonymous referral for mental health care because they don't want to talk about it. They don't want to let that armor down professionally because maybe they're in a leadership role and they can't, but also maybe leading with vulnerability and compassion. So creating work environments where you can debrief about a difficult situation and maybe lead by example. sharing that I've been struggling with this one thing, or creating an environment where it's okay to share about these things. I mean, we can make these changes to create a world in which healthcare workers can be better supported in their team. And then also being sure that perhaps outside of that, family members know how life can be difficult or other people are aware that like, you know, maybe I need some debrief time outside of work also to manage. Amanda, how do you do it on a more individual level? Like you mentioned, you self-disclose in the support groups that you run in some way. How do you do that in a gentle way that doesn't put the attention on you, but still gives others just the ability to know that you understand their experience? I mentioned, in this space, there's something so powerful about knowing that there's mutuality in the experience. So knowing that somebody's not just coming at it from their thinking brain or their intellectual, whether it's me or a healthcare worker, right? There's so much education certification investment, thinking, thinking, thinking, theory. Often I've shared that I've experienced loss. Often I'll say that I've experienced a loss to suicide, that I've experienced other kinds of losses as well. There's stigma around some of these things as much as I wish there wasn't. And so in the case of, you know, sharing that I've experienced loss to suicide, right? Like that might create a little bit of an, oh, okay, we can talk about those things. There's a little bit more safety here to talk about those things and kind of bring it into the light and bring it out of this potentially isolating space. And in the case that there may be some stigma included in some of what they may be experiencing that, you know, complicated losses doesn't scare me. Now I hear from both of you the need for that individual vulnerability and then also for a system to be vulnerable and open and saying we're creating spaces for people and it needs the two strategies I think together to break down the stigma that so much of this holds within the workplace and still for people. And so as we nearing to a close, I just want to circle back to we spoke earlier and Danielle you mentioned. the COVID-19 pandemic and the effect that had. And I read this interesting paper by Sarah Byrd and her colleagues. They did a scoping review on the grief experienced by health workers, both because of bereavement from the loss of their patients, but then also the deep loss of their professional identity when they realized the system that they've put so much in wasn't there to support them. And so holding all this grief is hard, I think, in the health system. And it may integrate or soften over time, but it still stays present. It never gets forgotten. As both of you said, your grief is never. quite gone, it's always there. And so around the world, we have seen how communities remember, whether it's the Rwandan genocide or some of the conflict in Colombia, those communities make a point of remembering their grief as a way of reaching their own healing. And so again, I'd just love to ask you both, how does this act of remembering help us heal some of that deep grief? that the medical community or the health community has experienced because of COVID. And do you think there is a duty for us to remember or do we just brush it aside and move on? Like when we think about the pandemic, sort of the sense that we're over it, right? We've moved on from the pandemic. We're not all actively wearing masks anymore. When you have something that significant, short answer again, not trying to be too prescriptive, but my recommendation would be to find ways that acknowledge what they've been through and maybe what specific components of the pandemic specifically, the moments that created the grief or the experiences of grief for them. Collectively, we use kind of that mid-March date as sort of the date the pandemic started. So there might be sort of articles written or you might notice some date-specific milestone. moments, but that may not be the thing that connects to an individual healthcare worker's grief, right? It might be more associated with an individual experience that took place during the pandemic in an individual client space where some people really would value examples of, you're lighting a candle, you're writing a letter, you're reflecting, right? You're connecting to that individual. And so my encouragement would be to think through, you know, for an individual worker or a group of healthcare workers, what might be that? What might be the timing that feels connected to your grief experience? And then what sort of practices might feel like the fit? We do paddle outs a lot here in California for folks when they've passed away, right? So that's a method of remembering. And there's just so many different ones that you can engage in. So finding one that feels like genuine and authentic to you. Maybe it's taking the time to go to a place that gave respite during the pandemic or a space where there was a happy memory with family during, the midst of the tornado that was and can still be COVID-19. I would just add to that, that when we think about the work that we do as grief therapists, we want to help our clients focus on remembering the good and the bad, the reality of what was. And so we certainly want to encourage people to be able to face what is. And so if that is a coming together to sort of collectively face, not bury what we all went through in the pandemic, especially healthcare workers on the frontline, not bury it, but to sort of acknowledge and face what was and how difficult it was. And we think about like culture. I don't know that we always do the best job in this country sort of helping people come together. But one example that comes to mind is 9-11. Every year on September 11th, there is a sort of coming together of our country in remembrance of what took place that very difficult day for this country. There is generally like a moment of silence and there's acknowledgement of the day and there is a ceremony that happens every year. And I would say that many people in this country would find that relevant and helpful. And so, well, I am not suggesting that you do the same thing and the same scale for the pandemic, but there are examples of things that can be helpful and sort of facing together as a community what is and what we survived through and then putting it away. Thank you for that. And I think that not forgetting the experience that so many health workers had and finding those ways for them to remember would be such a helpful way to to move through that if that's the right language. Maybe then a final question to you to both of you. We've spoken today, you've given shared so many helpful strategies, both from acknowledging your grief, giving your feelings the space to be felt how to be with each other and then this importance of remembering. Do either of you have any final words of wisdom to health workers who may be in a journey of grief at any stage? Well, I would start with reminding everybody, including healthcare workers, that none of us have superhuman capes that we wear. We're all human, trying to do the absolute best that we can. And to remember that we do not grieve well alone. So whatever that might mean to us, so whether it's bearing witness to somebody else's pain and allowing them an opportunity to share how they're doing and not fix it, or it's sharing your own pain, suffering, grief as a recognition that all of us do better. when we have an outlet to share our grief and our suffering. So keep in mind that we do not grieve well alone. that and just underline that grief is something we all experience and the fact that you're grieving means you're human and it means that there are things that matter a lot to you and when those things change, right, grief can come. And so to need support is human as much as experiencing the grief is human. Thank you, Danielle. Thank you, Amanda. think that's a perfect ending to remember that we are human and our grief. Grief is human and that we need each other around us. Thank you so much for this conversation. Yeah, thank you for your time. Thank you for taking the time to join us for this discussion. To learn more about our guests and to access the resources mentioned, please visit the Symptom Media podcast page at symptommedia.com. We look forward to having you with us again for our next important conversation.