My Plea to Complete the Rite of Passage of COVID

Using ritual to improve understanding and provide closure

Our healthcare system and our society have been at a crisis point since well before COVID. As an ER doctor, I have stood at that intersection for the past 15 years. I thought that COVID brought both the healthcare system and society at large to a breaking point that would force a reckoning; force us to face these crises head on. 

I was wrong. It turns out, I grossly underestimated our ability to deny our problems, to deny the suffering in our communities and to deny our own suffering. For all intents and purposes, COVID—as an entity separate from the variety of respiratory illnesses we have always managed—is over. Everything is back to “normal.” For the life of me, I can’t figure out how or why. More than 1.1 million Americans died, 250,000 children lost at least one parent, meaning  one in 300 people died and one in 300 children lost a parent. As many as 4 million people have long term disabilities. This doesn’t even begin to address the lost friendships, jobs, houses and trust in each other. As far as I can tell, we haven’t even collectively acknowledged what happened, much less grieved it. 

What is a rite of passage?

Though COVID isn’t the rite of passage any of us would have chosen, it is a rite of passage we all faced. At its simplest, every rite of passage has three phases:, separation, transition, and return. Separation is leaving the familiar. The cancellation of March Madness, the abandoned streets of large cities and my empty emergency department all felt unfamiliar. Many of the things I had placed my trust in to provide security for my family—like my job and my investments in the stock market—no longer seemed like the sure bet they had been only a week before. 

Transition is the trial, the testing, the journey. Everyone had a transition phase in COVID. Mine didn’t really start until after vaccines became available and I thought we had reached the beginning of the end. After that, dozens of patients I cared for died unnecessarily because they had chosen not to get vaccinated. I felt deep anger toward the unvaccinated people who didn’t die, but filled up my ER beyond the breaking point. It felt like each unvaccinated individual had made the conscious decision to make my life harder. Then the overwhelm set in. Our ER was asked to be a makeshift  pressure release valve for the whole community. When the ICU was too full, the patient stayed with us. When patients became too sick for our small hospital to care for them appropriately, the patient returned to us. When the clinic was too busy, the patient came to us. When someone was too agitated to go to jail, the patient came to us. Once they arrived, there were no hospital beds to send them to, so there they stayed—sometimes for days. One guy even threatened to kill me and my family. When I broke down crying after that, my own husband hadn’t had any idea how much I was struggling. If I’m honest, I don’t think I did either.

In many ways, I had it better than most. My spouse is a stay at home parent, so we didn’t have to scramble to find  child care. None of my friends or family died of COVID. Even so, the last three years turned my world upside down and I’d be surprised if yours didn’t, too. 

That leaves us at the return. In the return, we are welcomed back into our communities with what we’ve learned through our struggle and transformation, and we’re accepted into a new role. That sounds nice and peaceful. It may even sound like something you’ve already done. I am nearly certain you haven’t because within that is facing your grief in community with others, witnessing and being witnessed. Within the return is also sharing the lessons of these tumultuous times and how they have changed you; witnessing and being witnessed. The return also includes how that change transforms who you will be going forward and the gifts that will bring to your community; witnessing and being witnessed. 

How do we complete this rite of passage?

As an ER doctor, I feel a deep need to be witnessed in this way. I need those who know me to understand deeply what has happened to me over the past three years and recognize that COVID really happened. Right now, it feels like we are already trying to suppress that memory and pretend it did not.

So now, we must do something that makes many in healthcare, especially physicians, deeply uncomfortable: recognizing and sharing our emotions. How? Perhaps by gathering in circle with other healthcare providers. We must share and listen with open hearts. There are some feelings and thoughts that we can’t and shouldn’t share with the general public. There are some experiences that only we can understand. Following that, we must physically express the pent up anger, fear, sadness and shame. For those trying to express sadness, spending time under a tree or in the water can help them to connect to it. With anger, more active practices like hitting or chopping can help bring those emotions to the surface and release them. There are similar practices for fear and shame, which often involve mixes of the physical expressions of grief and anger. 

After that initial raw emotion has been expressed, we can return to the community at large and share our experiences together. Ideally, this sharing would be facilitated by an elder, who can pause their inner conversation to create space for vulnerable sharing. Simply listening with an open heart without trying to plan what one will say next can be incredibly healing. After this sharing and understanding, it is important to commemorate this rite of passage and what was lost through ritual. 

I imagine this ritual as a way to symbolize what was lost, show that we can hold our grief and loss together and honor what was lost so we can move forward. Each of us can bring a glass filled with water and rocks. Each rock would represent a person who died or was deeply affected by COVID that we carry around with us. The water represents the grief and all that was left behind related to death and everything else that was lost. We would pour these into a shared container, representing that we hold these losses together and the return of the bodies of these people who have died to the earth. After that, we can symbolize relighting our soul fires by igniting a candle. We can use these candles to contribute to the ignition of a larger fire, representing our shared transformation. 

Why this rite of passage matters

Our healthcare providers cannot survive pretending COVID didn’t happen. We swallowed our grief, fear, anger, overwhelm, and exhaustion for years and we are left with mounds of burnout and disillusionment. Hundreds of thousands of doctors and nurses have left healthcare in the past several years, and among those of us who stayed, many continue to feel like we are being asked to operate in “crisis mode” rather than feeling fully supported by our leaders and organizations. In order for us to continue to work in the field with our health intact, we need to be seen. We need to grieve, we need to be held and we need to be welcomed back as whole people—different from the ones who set off on this journey. Not addressing these feelings will leave us (including those who don’t work in healthcare) more numb, more alienated and even sicker than we are now. Our healthcare system and our society can’t let numb and alienated become the standard of care.