key: cord-0059045-t3mgwnwa
authors: Piccolino, Sophia Tsesmelis
title: On the Front Lines of the Fight Against the COVID-19 Pandemic: Meaning-Making and Shared Trauma
date: 2020-09-29
journal: Shared Trauma, Shared Resilience During a Pandemic
DOI: 10.1007/978-3-030-61442-3_4
sha: 8546f9e844d215328a59c64df94613f1f258cf9e
doc_id: 59045
cord_uid: t3mgwnwa

The COVID-19 pandemic has become known as the greatest crisis of our lifetime, bringing about psychological, physical, and social distress to us individually, collectively, nationally, and globally. Social workers are skilled in supporting complex trauma, pain, and loss, yet doing so while simultaneously suffering from the same distress is not common practice. Social workers in health care have been uniquely and gravely impacted by this pandemic, often on the front lines, confronted face-to-face with the trauma of COVID-19, all the while supporting patients, colleagues, healthcare staff, families, and friends in parallel through their own suffering. The reflections that follow are a culmination of living through the COVID-19 pandemic as a social work leader in a New York City (NYC) hospital, with NYC being the first national epicenter of this pandemic. The existential distress of this shared trauma drives us to search for sources of meaning and hope through the pain and suffering.

natural disaster, while its seeming incontrollable and endless attack signals a unique trauma incomparable to others in our lifetime. The long-term effects of the impact of COVID-19 on our nation and the world will be for later writings and future reflections, research, and exploration. Presently, I write to share the experiences in the here and now, living and surviving through COVID. The suffering through COVID has pressed for exploring sources of hope, strength, comfort, and peace. Inquiries around meaning and purpose in suffering leave me wondering what I hold onto during difficult times and what do those around me hold on to.

The search for meaning and hope has been central to my work as a clinical social worker. I have experienced pain, suffering, and loss, searching and holding onto hope and meaning through the lens of oncology and palliative care. Searching for meaning has helped me persevere in the field of oncology and palliative care and given me fuel to understand that above all else, we are all human, in need of love, kindness, and hope. Whether it is hope for cure, hope for the end of suffering, hope to see loved ones a final time, or a hope for a peaceful departure from this world, through the pain and suffering, hope has felt tangible. Undoubtedly, these concepts have been at the forefront of my mind through what many are referring to as the collective trauma of the COVID-19 pandemic. Navigating this societal upheaval as a social work manager in a large urban medical center in New York City has been arduous. Certainly, collective trauma, despite its name, creates varying degrees of psychological and emotional distress across individuals and communities. It is not the individual suffering and loss but the very breakdown of the fabric of our communities and society that may inevitably lead to the effects of COVID-19 being a collective trauma (Hirschberger 2018) .

In a moment's time, cancer can change everything about what we know our life to be. Cancer brings about psychologically distressing issues related to feelings of loss, especially around certainty in life and finances, changes in self-identity, body image, issues and changes around sexuality/fertility, loss of meaning and purpose, unstable emotions, and fears and thoughts about mortality (Holland 2002) . These psychologically distressing issues among many others may be present at one or several stages of the cancer trajectory: diagnosis, treatment, recurrence, survivorship, and end of life (Grassi et al. 2017) . In my clinical experience in oncology and palliative care, issues around existential distress, meaning, purpose, and spirituality have resonated throughout the myriad of distressing stages that patients and I have faced.

In a moment's time, COVID-19 changed everything about what we knew our life to be. For some cancer patients, the pandemic brought about a greater acceptance of their cancer diagnosis, as their experience of isolation and alienation from others was minimized and their distress became normalized by family, friends, and the community. The distress of illness, infection, isolation, financial worry, job insecurity and loss, and mortality have become communal struggles. In some instances, social workers have shared a stronger level of connection and understanding to their patient's distress than ever before. In other instances, social workers' own fears, anxieties, and stressors around the pandemic led to greater boundaries and less emotional availability for patients. As I individually and we collectively in our communities, nationally, and globally face the COVID-19 pandemic, I cannot help but think of the impact of the existential distress and search for meaning in the suffering, loss, and pain. I walk through this pandemic as a clinical social work supervisor, my years in direct care having left scars of suffering, memories of love and hope, and humbling lessons of gratitude. As a supervisor, I walk along my team, and I walk along our patients, along my family and friends, as we face the suffering and loss uniquely and collectively.

Loss, trauma, and tragedy have pressed me to question my understanding of life, my perceptions of suffering, and how to find hope professionally and personally. I have looked for a way to redefine the pain and find some peace amidst the chaos. The work of Viktor Frankl comes to the forefront, a psychiatrist, neurologist, and Holocaust survivor whose work was on the basis that life can have meaning even in the most difficult circumstances and under the greatest suffering (Frankl 1946) , following his own suffering in concentration camps during the Holocaust and the loss of his family members. Frankl brought to the surface that we cannot escape suffering and loss of life and not only can we find meaning in suffering, it also can, in fact, allow for suffering to be more bearable and enable an individual to be more resilient, having profound insight. As Frankl (1946) suggests, we have the power to choose how we respond to our most challenging situations and control how we react in the face of adversity. In fact, that power is a human responsibility.

Finding meaning through the crises of this pandemic and searching for understanding of the suffering and uncertainty and its rippling effect in our community and our nation have created the holding space I have needed, grounding me, allowing for a calm in the storm, the space to dissipate the feelings of uncertainty, anger, anxiety, and fear. Searching for meaning and purpose in suffering is not the cliché of a "silver lining" -finding the positive within a negative. Four months after the onset of the New York "pause," 4 months following COVID-19 spreading through our nation, more than 30,000 New Yorkers and 140,000 Americans have lost their life (Centers for Disease Control and Prevention 2020). These facts are not the positive within the negative. They are the devastating truth of the pain and loss. Suffering is an inescapable part of life. Within it we can choose a path to find meaning despite the pain, trauma, and loss. Facing adversity does not elicit growth in us; the active attempt to choose how we respond is where that transpires.

Being in a leadership role throughout this crisis has felt like the culmination of great privilege and strain. The tasks of balancing the well-being and needs of our social workers and supporting patients, healthcare staff, and the institution through a pandemic that has brought unmeasurable strain on our healthcare system and essential workers have been stormy uncharted waters. Decisions, rules, regulations, and systematic needs are in constant clash, seemingly impossible to bring the safety and relief that all social workers needed and expected, as they faced the same crisis, often with fears, anxieties, gratitude, worries, and hope along the way. I walked alongside with them processing my role in supporting them, while faced with supporting my family, providing security and safety to my children, and fighting physically through being infected with the virus itself. I longed for ways to create a safe and secure holding environment (Winnicott 1960) for my supervisees, for my children, and for my family, a holding environment to create space for conflicting feelings around the social work role within an institution occupied by infection, fear, sickness, and loss of life. I wondered if we could find a way to continue to best support our patients, provide care to our hospital and our team members, create a safe emotional and physical space for our staff, preserve our role as medical social workers, and uphold the values of the social work profession.

The social work profession has a crucial role in the COVID-19 crisis to provide psychosocial support to individuals struggling with the emotional and psychological impact of this pandemic, while uniquely in tune to social determinants of health to help address the pandemic's disproportionate negative impact on racial and ethnic minorities and individuals of lower socioeconomic status. For social workers and other healthcare professionals, there is dual exposure to the coronavirus pandemic, both in their personal lives and in bearing witness to their clients' and patients' experiences. Supervisors, social workers, patients, clients, parents, spouses, and children are all walking in parallel, coping and managing a shared trauma (Tosone et al. 2003) .

A prevalent theme that has arisen is the role of an essential worker amidst the COVID-19 crisis and how social workers define ourselves professionally and within our institutions. To be an essential worker may mean you have been on the front line, exposed, in closer proximity to the virus, at greater risk for your own health (United States Department of Labor 2020). It may mean you have had the responsibility to protect, help, and save in a more visible way. It may mean you have had the privilege to leave your home, to have greater social connection to others, and to feel less isolated. It may mean you have had job security, salary increases, or hazard pay. For some professions and workers, there has been no choice in the category they have been placed; as a social worker, within a large hospital system, the question of who constitutes an essential worker was more significant than I could have envisioned. In essence, do I have the physical safety and security to work remote in my role, as I navigate the emotional and psychological burden of supporting our patients through a mutual crisis that I simultaneously am navigating? Do I have the clearance and authority to be present in the hospital, to provide critical in-person support to patients at the end of their life and to clinical team members battling through long shifts and fear and fatigue as they fight for our patients and their own survival?

We did not expect what happened. We were not prepared. Our nation, our cities, our communities, our neighbors, our families, and ourselves, we were not prepared for the societal upheaval, the extreme suffering and loss, the fear and uncertainly, the politics that would persist and exacerbate the crisis, and the division and mistrust. Take a moment to pause and consider your thoughts, feelings, reactions, and fears and the culmination of how you have responded to this pandemic personally and professionally, from your closest family and friends to unknown individuals walking 6 feet apart from you. Could you have predicted how you have reacted to the upheaval and the dismantling of the fabric of our society, to the loss and suffering, and does it align with your world thinking, history of loss, and prior exposure to suffering and trauma? Can you find meaning and purpose in this suffering, and have you been able to do so before? Its significance is understanding the role of meaning, transcendence, and resilience in existential distress.

The COVID-19 pandemic has brought waves of psychological, physical, and social distress to our nation and the world. In the social work role within health care, our close proximity to the suffering and distress of this crisis through our own struggles has been unique and challenging. Social workers are familiar with responding and supporting people in distress and doing so with humility. This shared trauma is unscripted, but together, through reflecting on our experiences, sharing our knowledge, and learning from one another, we can create greater understanding for this trauma.

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