In a recent post I mentioned that at the time of September 11th I was working as a nurse in the Pediatric ICU of a local hospital.  There was such a feeling of connection in the aftermath of our Nation’s worst terrorist attack in history.  There was a warmth that accompanied the shock, fear and devastation we were all feeling during that time.  Before long, that fear was exacerbated by an additional threat:  Anthrax attacks.

I didn’t know much about Anthrax, but during one of my overnight PICU shifts, a father was reportedly in our Emergency Room with an infant who was unable to breathe.  That baby was quickly transferred to our unit for intubation and treatment, not an uncommon occurrence durning my work in the PICU.  But this potential diagnosis was different.  I was told during the transmission of the nursing report that Dad worked at the US Post Office.  The ER team believed the sudden onset of symptoms in the infant may have been the result of secondary exposure to Anthrax, via Dad.

In the PICU we were always cautious about infection, and didn’t always know what germs and/or danger we ourselves were exposed to during the course of treatment.  The hands on care that we provided was up close and personal.  There was no social distancing when placing arterial lines, IVs and chest tubes.  We had to rely on gowns and gloves to protect ourselves.  That risk was also part of the job.

But as mentioned, this was different.  I didn’t know anything about this Anthrax threat, other than what I’d heard on the news which was so scary.  This baby needed immediate care and we were moving as fast as we could to draw up the weight-based medications that would make rapid intervention possible.  I was scared of the unknown.  I had my precious but vulnerable son Zach at home who at the time was only 2 years old.  His safety was always at the forefront of my mind.  I never wanted to risk bringing anything home to him, lest HE be secondarily exposed to something through me, that could kill him.

So with fear and focus brewing, we moved quickly.  We administered the necessary doses of the various medications employed when placing a breathing tube in the baby.  Our team performed like a well-oiled machine, moving quickly, intentionally and relatively quietly.  We were able to stabilize that infant as we had done so many times before on the unit.  Phew.

But no sooner did we seem to get the infant into stable condition, than I received a second admission request call from the ER nurse, saying this same family actually had a second infant, the identical twin of the one we were treating, who’d been brought in this time by Mom, with the same rapid onset of respiratory and other ominous symptoms.  They were rushing him up for intubation as well.

We repositioned in another bay, admitted the second of the two babies and got to work going through the exact same procedures, weight-based measurements and life saving interventions we’d just started to wrap up on his infant sibling.

I don’t recall what time I left the hospital that next day, but it was somewhere around 20 hours after I’d clocked in the night before.  This had been one of the most challenging and frightening shifts I’d ever worked.  We didn’t know what we were dealing with infection wise.  We didn’t know if we would be able to effectively reverse the damage done to either of these twins.  We just knew Dad and Mom were there in the wings, praying for their children, unable to breathe themselves.  Mercifully they eventually did fine and both infant boys were able to return home with their parents several weeks later.

I share this visceral experience that still makes my heart race over 20 years later, because it reminds me of the way we can muster up a seemingly appropriate response in a moment of stress, but still have to find time to process the experience later.  This is much like losing a loved one.  We can plan funerals, make phone calls, get the right clothes on and get everyone fed.  But we aren’t able to start the process of grieving until much later.

The other thing it brings to mind, is the world of difference that can exist between two losses.  In the example of the twins, although our clinical team was seeing them as quite alike, in terms of their size, condition and what needed to happen to save them, I bet their parents were seeing them separately.  These weren’t two very alike patients to their Mom and Dad.  These were their sons.  Two separate sons, who were both in the fight of their lives.

Our medical team was relieved when they recovered, because as clinicians we all knew that not every patient did.  Sometimes we would find out when we returned for a second shift, that the patient we’d cared for the night before wasn’t there anymore.  Not because they got better, but because they died.  Or “expired” as we would clinically memorialize it.  My 20 hours with these twins could have been heartbreaking and devastating.  But it wasn’t.  They survived.

But this has me thinking about the chasm of difference that exists between two different losses.  Again, as their nurse, I may have seen them as similar beings, with similar symptoms, treatments and families.  But I have a feeling if we’d lost either or both of the twins, their parents would not have seen these losses as similar.  They would have seen them as two separate and tragic deaths.  Thank God that wasn’t the case.

I think and write a lot about grief, and its complexities.  Losing just one important person in our lives is devastating.  But today I am talking specifically, about what happens when there are multiple deaths in our life, especially close together in time.  Like when one parent dies, and less than a year later, the other one dies.  Or when the unexpected death of a loved one, is followed almost immediately or within months, by a second tragic loss of another person that we are close to.

As loved ones supporting someone in grief, we may have a tendency to see two or more losses as part of a whole bigger tragedy.  Like when someone loses a family member, and six months later, another family member dies, or a friend is taken by surprise tragedy, it seems to sort of just start to piling up.  Maybe there was an accident or an acute illness that unsuspectingly took someone from us out of nowhere?  Meanwhile we haven’t even begun to process the initial loss that has broken our hearts.  This is a whole bigger tragedy, but the individual losses can be quite different.

Just as I described seeing treatment of the twin patients as part of the same work shift, we can often assume that others are grieving multiple losses as one big shit sandwich.  But I think we need to be more sensitive than that.  Yes, from a timing perspective, perhaps devastating deaths and losses happened close together.  But timing may be the only thing the events had in common.

I share this to caution us when trying to be compassionate with ourselves, and as we support others who are hurting.  Try not to assume that this is just one big crappy season.  It’s easy to see it that way.  But last Fall I attended two funerals for two brothers, just a couple of months apart, and they were anything but one big loss.  These men were distinctive and contributed to my life in much different ways.  I know firsthand, that no two losses are the same, and I just wanted to take a moment and remind all of us that just because something happened in close time proximity does not obviate the need for us to support each other in various ways, and in accordance with each specific loss.

As I’ve grown well into middle age, I realize that my peers are dying faster than they used to.  Sometimes it feels like friends and family members are dropping like flies.  Yet the only thing these deaths really share in common is when they occurred.  The remainder of the unique, exquisite and differing experiences of pain and loss, for each, require they’re own specific grief and processing for healing to begin.

In my experience, two deaths equal double the trouble.  And as much as we like to do things efficiently, we just can’t grieve in a “BOGO” style and expect to heal.  And we need to try to keep that in mind when supporting others who have suffered multiple losses.  Each are unique.  Each require compassion, time, love and understanding.

Even if you are the only one who realizes this, you can still bring comfort to yourself or a grieving loved one by acknowledging the individuality of multiple losses.  Noting the differences between them can be a caring first step in reminding yourself, or someone else that:

Wow, these losses are not the same… 

and I am here to support you through whatever is needed for each,

to the best of my ability, for as long as it takes to help me/you heal.”

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