I awoke with a start, fragments of my dream still tangled with my early morning consciousness. In the dream, I was traveling, but rather than being at the start of my travels or at my final destination, I was in transit. I had a plane to catch and, though I had left hours to get from one terminal to the next, my journey kept being waylaid and confused. The airplane terminals became long curving paths. There were somehow missed taxis along the way, and I was running at the end. In realizing that I had missed my connection I awoke, my heart pounding.
As COVID-19 rates are rising again and the Delta variant is spreading at dramatic rates in largely unvaccinated American states, partially vaccinated countries, and globally where access to vaccines has been poor, the fantasy of arriving at our “final destination” — the post-COVID-19 world — appears to be quickly slipping away.
It is not, however, just the wily variants or rising case counts that leave so many of us with a sense of vigilance and unease. It is also the lack of closure on the pain and difficulties of the past 17-plus months, which has in turn delayed collective healing and perpetuated our trauma.
For many, especially in Massachusetts, this summer has felt like an important refuge from the national and global surges of infection. We have quickly moved into the days of summer — some enjoying the fruits of vacation, increased employment, and finally being with ones we love.
However, for those who have experienced the trauma of losing a loved one, financial disrepair, food insecurity, lost earnings, lost learning, a renewed vulnerability to addiction, increased homelessness, violence at home, loneliness, and deepening depression and despair, these summer days have offered no refuge.
I recently saw a patient who, with his eyes downcast, said to me in a low voice, “Doc, this COVID ain’t never gonna be over.” Last year, his mother died from COVID-19 while in a nursing home in North Carolina. Remarkably, she was the only one who was infected. By the time he heard she was sick, my patient could do nothing — he could not travel to see her and didn’t get the chance to say goodbye. The regrets, lack of closure, and sadness overwhelm him every day. So despite being back at work, he is stuck in the grief of his loss.
Part of healing from trauma comes from stopping to mark what has been lost. In our hospital and city every year, we mark the moments of the Boston Marathon bombing — using those minutes of silence to recollect together the loss of lives, the terror of those moments, the way we all drew together. It is in sharing these moments of silence that we are able to collectively work toward our healing. As a country, we mark loss through statues, memorials, flags half staff. But in these transitory days of the pandemic when we must keep running forward into the unknown, there have been no collective moments of silence, no memorials built.
How do we heal our loss and trauma while the pandemic continues on? While there are no easy answers, clinicians, teachers, and policy makers have tools available to them. Trauma-informed care is an approach to people undergoing any kind of difficult event — past or present — that shifts the focus from “What is wrong with you?” to “What happened to you?” When we seek to understand the complete picture of someone’s life, we can begin the healing process. In health care, trauma-informed care has the potential to improve patient engagement, treatment adherence, and improve health outcomes. It also works to rebuild a foundation of trust, an invaluable gift in this time of increased distrust and acrimony in all directions.
Trauma-informed practices are also critical in the classroom setting. Anxiety and depression levels among children and teens are higher than ever in the wake of these many months of the pandemic. These unremitting mental health concerns will probably be coupled with an uptick in classroom behavioral disruption — a normal outcome of the “fight or flight” or stress response — especially for those children with fewer supports at home or in their community. Trauma-informed classrooms create spaces where children can cool or calm down, are dimly lit, use warm colors, and flexible seating. Teachers in these settings recognize that when a child acts out, it isn’t necessarily connected to anything that is happening in the classroom but rather attributable to a serious event that has happened in that child’s life. Indeed, a key role of schools is to create a sense of safety so that children can learn.
How can we build these practices into our future even when the world is so uncertain? The Campaign for Trauma-Informed Policy and Practice put together a road map for the first 100 days of Joe Biden’s presidency for building a trauma-informed country. And though we are far beyond the 100-day mark, we finally have a federal infrastructure to move forward on this platform. Additionally, the funds from the American Rescue Plan could be used to augment Massachusetts’ trauma-informed practices.
While we are building these programs, however, each of us has the opportunity now to pause, to recognize what each of us has been through, and to respond to our individual and collective trauma. Collectively commemorating our losses, even when the pandemic is not over, is a key to the path forward. In our grief, there is nothing wrong with us.
Dr. Katherine Gergen Barnett is vice chair of Primary Care Innovation and Transformation in the Department of Family Medicine at Boston Medical Center, clinical associate professor at the Boston University School of Medicine, and a fellow at the Boston University Institute for Health Systems Innovation and Policy.