I was unprepared for how Kathy’s death would affect my coworkers and me. Kathy, our administrative assistant, was someone everyone knew and interacted with each day. Sadly, she died suddenly while at work. We all felt the loss of Kathy with the added layer of being reminded of her death each day at work.

Because of this incident, we were hyper-aware when someone wasn’t feeling well and would even say to each other, “No one else is allowed to die!” A psychiatrist on the unit explained to us that after people experience something awful like we had, then the possibility of it happening again becomes scarier because you’ve been through it once already; something that was unimaginable becomes a real possibility. He helped us see our underlying anxiety as part of the grieving process.

Most of us are familiar with the 5 stages of grief introduced by Dr. Elisabeth Kubler-Ross in 1969: Denial, Anger, Bargaining, Depression, Acceptance. We often talk about those grieving as being in one of those stages, as if they are linear and to be checked off as a sign that we have grieved appropriately. As more research is done about grief, an understanding is developing that there may be more than 5 stages. David Kessler, a renowned grief specialist, suggests a sixth stage: finding meaning after loss. Claire Bidwell Smith, LCPC, suggests another stage that would either replace bargaining or fit between bargaining and depression: Anxiety.

After Kathy died, my coworkers and I experienced anxiety: we worried that someone else would die while working on the unit and that we would feel more pain from another loss. We had some of the physical symptoms of anxiety, such as increased heart rate, tense muscles. There were cognitive symptoms among us, such as fear of death, fear of being unable to cope, painful memories and images, preparing in our minds for another threat. Also evident were behavioral symptoms of trying to avoid the situation again by evaluating all the safety measures and procedures, needing to have escape plans, and feeling the need for safety and reassurance. Emotional symptoms were there as well, such as feeling scared, nervous, tense, on edge, jumpy, frustrated.

In the news, we hear about catastrophic occurrences, such as the tragedy of the condo complex collapsing in Florida, homes and people lost to hurricanes, and all the people who have died from COVID-19. While listening, I can imagine how much anxiety the survivors are experiencing in their grief. When we experience loss of any kind, we most likely experience the stage of anxiety. Anxiety in grief is normal but it can become unbearable, which might result in ways that we try controlling ourselves, others, and our environment. Instead of trying to manage our anxiety through control, there are healthier ways that won’t adversely affect others and ourselves.

  • Remove all expectations for yourself about how long to grieve, being able to do everything you did before the loss, or how much you are allowed to cry or if you need to cry. Try to be more kind, compassionate, and flexible with yourself
  • Let others help you so that you can rest, cry, remember, talk about it, do other things. There isn’t a time limit on having someone help you as you need do those things repeatedly
  • Try to relax by focusing on your breath. Place one hand on your stomach and another on your chest. Breathe in and out so that your stomach moves against your hand, and if needed, try to slow down your breathing with longer inhales and exhales
  • Try to relax by getting enough sleep and mindfully eating. Also engage in relaxing activities, such as taking a stroll in a peaceful environment, taking baths or showers, getting a massage, listening to music, gently rubbing lotion on your body, listening to a sleep story to help you fall asleep
  • Practice mindfulness – be fully present in whatever you are doing, noticing every little detail with all your senses. As your thoughts drift to the past of what happened or the future of “what if….”, gently nudge them back to the here and now without harshness or judgment
  • Think about how the loved ones lost had purpose, loved others, and try to find meaning in honoring them in the same way they lived
  • Write your grief story, including the what ifs and if onlys, the circumstances and contributing factors leading up to the loss. Include loving memories about your loved one if you have some. If not, then include what you wish you had with that person
  • Take inventory of how you still have control, even in the smallest ways
  • Pause daily to appreciate something that has nothing to do with the loss
  • Find a therapist who specializes in loss and grief
  • Stay connected to support people — spend time with them in quiet ways or an activity or conversation. Whatever you do does not need to be about your loss and grief every time, and is probably best if it’s not, but it is helpful to talk about your thoughts and emotions with them sometimes
  • If you don’t have support people, find some through a grief support or therapy group. Our thoughts and feelings need to be shared verbally when grieving and it can be most helpful to share with and listen to others who are also grieving
  • Plan meaningful ways to honor holidays and anniversaries. Plan for more self-care on those days too

Lastly, grieving is something we will do for the rest of our lives; there is no end date to grieving because we will always feel the loss, but we will grow around our grief. With time, both the internal grieving and outward mourning move on to different stages. How you feel right now will change over time. In the meantime, the suggestions above will help you manage each day.

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