by Charlene Thurston, RN, ANP,Hospice Director,from the Fall 2001 Hospice Currents Newsletter
It’s difficult to imagine writing a Hospice newsletter during these troubled times without focusing a portion of it on the deeply penetrating effects of grief, loss, anxiety, and fear which the terrors of these past weeks have inflicted upon us all. Therefore, beyond updating you on Hospice activities, we felt it important to provide our readers with information about how grief and other emotional symptoms might continue to unfold, and when to be concerned and seek professional assistance.

When a loss occurs or disaster strikes, all of the reactions which will occur will not surface at once at the time of the event, but rather continue to manifest themselves over a period of days, weeks, months, and, for some, even years. As our defense mechanisms of shock, disbelief, and denial decrease, the numbness that may keep us from feeling the full effect of the event diminishes, and, as we come to truly realize what has happened, our emotional reactions increase.We all process grief and stress differently, though there are many aspects that are quite universal. Some people felt an overwhelming impact of distress immediately and in the days following the attack. Others felt more numb and distanced from it during that time, but began to fully take it in in the days or weeks later. If it weren’t for the threat of further terrorism, for most people who weren’t closely connected to the attack, the stress reactions associated with 9/11 will have begun to diminish somewhat by now. For others, however, especially for those who are more vulnerable due to other current stressors, previous life experiences, or already existing anxiety, depression, or other disorders, significant symptoms may be continuing or even increasing. It s very important for us all to be aware of this phenomenon, to be patient and compassionate with ourselves and others, and to seek or suggest help when disruptive symptoms don t diminish.

To assist you with recognizing symptoms of concern, I ve included the following information from the excellent guidelines available from the National Mental Health Association.

In the days and weeks following a traumatic event, it is normal to have difficulty managing your feelings. Some common reactions include: disbelief and shock; fear and anxiety; headaches; stomach problems; difficulty concentrating and making decisions; apathy; emotional numbness; irritability; anger; depression; sadness; loss of appetite or overeating; crying for no reason; overuse of alcohol or other drugs.

Suggestions for reducing stress and trauma reactions include: talking with others and expressing your feelings to friends, relatives, doctors, counselors, clergy, etc.; eating healthy foods, getting plenty of rest, & exercising; spending time with family and friends; limiting your exposure to news and images of the tragedy; participating in activities that you find relaxing and soothing; getting back to your usual routine.

When feelings do not diminish as the weeks go on, or, when distress is so severe that it interferes with your ability to function, it may be important for you to seek professional help. Signs that help may be needed include: nightmares; re-occurring thoughts about the event; avoidance of thoughts, conversation, people, or places that remind you of the event; having trouble falling asleep or staying asleep; feeling jumpy; being overly concerned about safety; feeling guilty, worthless, or hopeless; not taking pleasure in activities usually enjoyed; having a sense of foreshortened future; having thoughts about death or suicide. Acute and/or post-traumatic stress disorders, substance abuse and addictions, depression and anxiety disorders, and domestic abuse are mental health issues that can develop or intensify after traumatic events.

If you feel that more information or support would be helpful, please consider contacting doctors, nurses, mental health counselors, clergy, and any of the health and human service organizations on the island. Also, I encourage you to call or visit the website of the National Mental Health Association ( (800-969-6642), or the many other websites available, which offer information and support. NMHA has other guidelines as well as those included above, including how to help children, how to help employees, etc. In all crises, we are presented with opportunities as well as danger. In this crisis, as in others, we have the opportunity to remember and honor our values and to cherish whom and what we hold dear. Unfortunately, we will all have to deal with sadnesses at times throughout our lives. Our hope will be to survive, recover, and even grow and become richer for having endured such experiences.

Funded by the Palliative & Supportive Care of Nantucket Foundation, the Palliative & Supportive Care Program is operated as a department of the Nantucket Cottage Hospital, which is an affiliate of Massachusetts General Hospital, and a member of Partners HealthCare. Palliative & Supportive Care of Nantucket is a specialized health care program dedicated to providing excellent physical, psychological, social, and spiritual care to persons with life-threatening illness and their families.

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