05/25/2010 05:12 am ET Updated Nov 17, 2011

Hospice and Healing

Healing in Haiti

When people think of hospice, what comes to mind for many is the vague image of a frail, elderly loved one passing the last days of life after a long illness. They don't want to think about what the end of life means--until they have to.

As the Director of the Hospice Care program at the Visiting Nurse Service of New York (VNSNY), I'm reminded every day that there is a need to get the word out about hospice care and the benefits it brings to patients and their families. We hope this blog will spark your interest and become a place for you to share your thoughts, images, questions, fears and ideas about the end of life. This first offering looks at end of life care from a cultural perspective and considers how individuals and entire communities process sudden and traumatic grief and loss. We hope you'll find it helpful and join in the conversation.

The world is still reeling from the news that catastrophic earthquakes devastated Haiti on January 12th and Chile on February 27th. Millions of images of death and destruction have been broadcast on TV, over the Internet and in newspapers and magazines. No matter where you live, the tragic loss of life resulting from just a few seconds of nature at its most extreme has touched you, your family and your community.

For most of us, these troubling images of death will eventually fade from our minds and the shock will subside. We'll not forget exactly, but we'll go back to our jobs and our daily routines, as indeed, many of us already have. Not so for many members of American's Haitian and Chilean communities. Haitian American Marie France, a nurse with VNSNY Hospice Care, has seen the world as she knew it completely collapse. "My dream is gone," Marie said between tears. "My dream to go back ... what is left now ...there is nothing left to go back to."

Marie lost four family members in the Haiti earthquake, two aunts and two cousins. Her brother who lives outside Port au Prince refuses to sleep in his house overnight for fear of dying in his sleep as his home collapses around him. Every day Marie calls her friends and family and "every day there's news of another lost child or friend--still. Every single day you hear this news. You feel in pain, your friends are crying and you don't know when it will end."

Fear and anger accompany sudden traumatic devastation like Marie has experienced as well. For years, she has been sending money home to friends in need, and in 2009 she even started a small retail business to help a few friends gain independence. Before the earthquake, it was just beginning to thrive. She knows dozens of hard working people who have lost their jobs or seen their businesses crumble in the debris. Marie still makes payments on a family home that has vanished. Her investments are lost. Yet "we have to go on," she says, "we just continue living our lives."

Earthquakes, tornadoes, suicide, acts of violence in domestic or crime situations are all examples of sudden and tragic losses leading to traumatic grief. While grief following the death of a loved one is nearly always intense, the grief that follows sudden traumatic death is often:

• OVERWHELMING to those who are left behind to cope and mourn
• DISABLING because it is so complicated and prolonged
• Accompanied by enormous feelings of ANGER, GUILT, AND CONFUSION
• SHATTERING to the relationships, attachments and connections that define us
• INTENSIFIED by rage, thoughts of retaliation, and feelings of victimization

Anguish about the circumstances of such a death, as well as intrusive thoughts and images, can overpower the ability of those grieving to feel they can cope and go on with their lives. Besides feeling traumatized, they often also feel numb and hopeless in the face of these loses.

Processing grief is something Marie France is good at. For years, she's worked with families to help them understand and let go. She knows the value of getting professional help, and she's one of the best at giving it. After the earthquake, we worked with Marie to make sure that she had time away from work to cope and process her feelings. Like many who experience grief, she was feeling very down and tired. She recalls being very forgetful. "I would open my mouth to speak, and I just couldn't remember. It took me 40 minutes one day to find the address of one of my friends. I just kept walking up and down the street until I finally found the right number on the house. On a street that I know well, it took me 40 minutes!"

Clearly there is no simple way to resolve the painful mourning, which characterizes traumatic grief, but grief experts do suggest several ways to get help, often used together:

1. Counseling to support the griever and other family members
2. Education about the nature of grief and trauma
3. Medication to help with anxiety and/or depression
4. Support through self-help groups
5. Reading about how others have coped with such losses
6. Extended time to come to with terms with the loss
7. Specialized treatments that focus on post-traumatic stress symptoms
8. Exercise and other activities to provide relaxation
9. Nutritious meals and extra rest to maximize coping
10. Spiritual reflection and support

At VNSNY we have more than 145 employees like Marie who have been directly affected by the Haiti earthquake; people with family members living a continent away for whom they can do very little, if anything at all. They feel powerless, afraid, angry and lost. For our employees in this situation, many of whom work in Haitian American neighborhoods, we have arranged a support group where co-workers can come together to process their loss and find a path back to a "new normal."

Rev. Vincent Corso, Manager of VNSNY Hospice Spiritual Care & Bereavement Services, the group's organizer, noticed this week that there was "lots of pain still and a great deal of uncertainty regarding loved ones' health and well-being." The group shared poems and personal readings that focused on coping and getting through the day. "The incredible uneasiness people expressed about how the future will turn out is palpable," Rev. Corso said.

For a list of resources available to those who are grieving visit:

While many in the Haitian American communities here in New York have found ways to support one another, still others are struggling. As part of the human community of caring, each of us has an opportunity to help those in need through life transitions. In this sense, we can all be hospice workers and extend a hand to our neighbors.

What cultural coping strategies have you heard about or experienced? How has your life been affected by sudden and traumatic grief or devastation? We hope you will share your stories, solutions and questions here, and we look forward to touching base again soon.

Helpful Resources:

American Psychological Association
Tips for recovering from disasters and other traumatic events

Bereavement Support