There was no last in-person goodbye. There was no funeral to attend.

When Carleen Brenneis learned that a close friend had lost her mother to COVID-19, she wanted to show her support and share her grief. She joined more than two dozen people who wore masks and carefully socially distanced outside the family’s home. They lit candles they brought, and one by one they placed them on the doorstep. Someone played Amazing Grace.

“I won’t forget that,” says Carleen. “It really helped everybody.”

The director of Covenant Health’s Palliative Institute knows first-hand how the pandemic has affected our ability to mourn a lost life.

“I have four friends who have lost a parent, and only one was able to be with their parent and have a funeral. They died during COVID, so you couldn’t visit them. Two died of COVID.

The restrictions established to ensure public safety during COVID-19 have had a significant impact on traditional ways of openly grieving. Family members have been unable to hold the hand of a loved one or say a final goodbye at the bedside. Funerals have moved from intimate gatherings of remembrance to online ceremonies bereft of physical connection or quiet moments of closeness. Grieving the death of a loved one with others has been suspended for many who await the day they can gather with fellow mourners and meaningfully process their loss.

The possibility that a silent pandemic of grief is coming has been voiced by experts, and Carleen says it’s something we should prepare for.

“I do believe it will happen. You won’t see it in everybody. This is your ‘Do you remember when?’ year,” says Carleen, a registered nurse. “The amount of grief that has not been absorbed or acknowledged — and it will be different for every person — it’s a heaviness that people haven’t experienced before. Some people will deal with it well, and others will struggle.”

For some, such as those living and working in long-term care environments, loss has been amplified throughout COVID-19. 

At the Edmonton General Continuing Care Centre, staff were devastated by last year’s COVID-19 outbreak that claimed more than 30 lives. Theodora Agoawike, resident care manager on one of the units, says staff form close bonds with those in their care.

“For us, they become family,” says Theodora. “Anything that hurts them, hurts us too.”

And that hurt is still part of their lives.

“The pandemic is still with us,” says Theodora. “We have not really mourned our people. We haven’t really had that time. It has not been easy. For most of us, we go to the washroom, we cry, we wash our face and we come out because we still need to care for our people.”

And there are those who face loss in the workplace and their home life. Even if the loss isn’t specifically caused by COVID-19, the pandemic has affected how we grieve. Geraldine MacInnis, a resident care manager at the Edmonton General, lost several residents to the outbreak, and her mother died from cancer in January.

“I have not been able to go back to Nova Scotia to do her burial yet,” says Geraldine. “It’s had a major impact on me personally and in my work life, but I can’t crumble. I need to be here for my team and for our residents and their families.”

The pandemic’s toll and the waves of grief in its wake are ongoing, says Dr. Cheryl Nekolaichuk, a registered psychologist with Covenant Health’s Palliative Institute and a professor in the Department of Oncology with the University of Alberta’s Faculty of Medicine and Dentistry. 

“We’ve never really witnessed this before. We’re not quite sure what impact this is having on people, not just the immediate loss on a family but also on the community, and community can be described in lots of different ways, such as a continuing care centre,” says Cheryl. “I think there will be a surge in the need for supports.”

Cheryl says the loss of human touch and face-to-face support we see at traditional — and important — rituals such as funerals and memorials is “a huge loss.” But what hasn’t changed is the need to grieve. 

People need to be aware that there is no right or wrong way to grieve. People who suppress a loss will not escape it. “It will eventually find a way to work into your life even though you’re trying hard not to face it or trying to put it aside,” says Cheryl. “It is really critical that we all find our own way to grieve a loss.” Long-term effects may include alcohol or drug abuse, trouble with relationships or problems at work, she explains.

All losses, in terms of how the person can be mourned, are impacted by the pandemic, agree the two experts. At the Edmonton General, memorial tables have been halted by the pandemic due to safety concerns. Normally, a resident who dies would be honoured with a framed picture, flowers and candles, providing a space for residents and staff to remember.  

Diane Berge’s 92-year-old mother, Theresa Schiller, died from Alzheimer’s disease and other complex health issues on February 15. As her mother neared the end of her life, Diane was able to visit as much as she wanted, an eased restriction during the pandemic. 

“It was really good that we could come as much as we wanted. The staff were so good about that,” recalls Diane.

And when her mother died in the middle of the night, she was not by herself, even though Diane had gone home to sleep. 

“We went to rest knowing she was being cared for in a loving, respectful, dignified manner. That was a wonderful feeling of comfort for me. I knew they had really cared for her.”

Diane says she’s not sure when restrictions will ease so that she can hold a mass for her mother and a sister who died in October from cancer. While that aspect of traditional mourning is on hold, she says her loss was made easier knowing her mother was surrounded with warmth and compassion from her care team.

“Everyone met all her needs, arranging spiritual care along with every need being met,“ she says. “Their kindness and compassion were unmeasurable.”

Note: The many layers of grief occurring during COVID-19 partially drove the theme for the Palliative Institute’s virtual conference this year titled My Grief — Your Grief — Our Grief: Grieving Together in Times of Loss. Registration opens in June for the conference, which takes place Oct. 25.