Community Psychiatry’s Dr. Magavi was featured in Healthline discussing ways to cope after losing loved ones. 

By: Cathy Cassata | February 9, 2021

Bob and Bano Carlos were married 53 years when they both died from COVID-19.

According to their daughter, Tracey Carlos, they were inseparable.

“As important as my brother and I were to them, they were everything to each other,” she told Healthline.

During a phone call on March 14, 2020, Carlos learned that her mom had a fever and that her father wasn’t feeling well.

“They lived in a retirement community in Florida and assumed COVID was in the West Coast and hadn’t reached the East Coast yet. Florida was downplaying it at the time, and so they continued to live their life,” Carlos said.

Both of Carlos’ parents tested positive for COVID-19, and both were intubated in the intensive care unit (ICU) on March 20.

Because her mother lived with myelodysplastic syndrome (MDS), Carlos knew the chances of her surviving COVID-19 were unlikely.

She died on March 25 at 73 years old.

Carlos lives in Olympia, Washington, and wasn’t able to travel to Florida to be near her mother before she passed. However, Carlos did get there in time for her father’s last days.

“Dad lasted 30 days in the ICU, and we fully expected him to recover. He had COPD, but he practically forgot he had it because it [was managed] and wasn’t a major part of his life,” Carlos said.

Bob died on April 24 at 75 years old.

“It’s so hard to lose them both, but [the only] relief — and that’s hard to say — is that we didn’t have to tell Dad that Mom passed away,” Carlos said.

The toll of multiple losses

Losing more than one family member in a short time frame is considered a concurrent crisis, said Therese A. Rando, PhD, psychologist and owner of the Institute for the Study and Treatment of Loss.

“When the second person dies, the individual is still dealing with the loss of the first person,” Rando told Healthline.

This type of loss can lead to grief overload, or cumulative grief.

“We know this happens with both subsequential and nonsubsequential loss. Say two people die in an accident or fire. Your grief and mourning for Person A is complicated by the fact that you also have the burden of the grief and mourning for Person B, and that stresses you, adds to the traumatization, and reduces your support system,” Rando said.

Reviewing your relationship with the deceased is part of healthy mourning, she added.

“We go over it and think about the good, bad, happy, and sad times. Doing this is more challenging when you are reviewing Person A and that inherently means dealing with the loss of Person B, because they are also involved in that story you are reviewing,” she said.

Grief overload is a high risk factor for having complications with mourning.

While people who lose multiple loved ones will still experience the stages of grief — denial, anger, bargaining, depression, and acceptance — Dr. Leela Magavi, psychiatrist and regional medical director for Community Psychiatry, said the severity of the pain may be amplified.

“When individuals are overwhelmed with multiple losses, they are more likely to remain in the stage of denial for longer periods of time,” she told Healthline.

Magavi said they may engage in avoidant behavior by consuming alcohol or using substances to numb their pain.

“I have evaluated many children and adults who begin to stress and binge eat to alleviate their emotional pain,” she said.

The pressure to grieve both losses at once or equally can also add to the complexity of the situation.

“Each loss warrants time, reflection, and healing. If the individual had a complicated relationship with someone who passed, they may feel more guilty about this loss than the other due to their conflicting feelings,” Magavi said.

Conversely, she said they may feel shame and guilt if they don’t feel as saddened by one loss compared to the other.

“I remind individuals that there is no correct way to grieve,” Magavi said.

For Carlos, grief sometimes means mourning both of her parents together as well as separately.

“I used to talk to my mom every Saturday and I’ll find myself thinking, ‘Oh, I can’t wait to tell her this’ and then I realize I can’t tell her. And my dad had a job that involved him being a pirate at Disney World, so anything to do with pirates makes me stop and think of him,” she said.

Despite the notion that losing both parents is the natural order of life, Rando said research shows there are fundamental shifts that people make in the aftermath of losing their parents.

“When it’s a parent and you have a good relationship with them, you are incredibly impacted. Your parents know you from day one and you share such an incredible history. Losing them is a devastation of parts of the original family unit,” she said.

While the loss of both parents is complex, there are ways to cope. Below are some to consider.

1. Know you have unique challenges

Death during the pandemic, whether related to COVID-19 or not, can take more time to grieve due to shock, said Rando.

“I’ve done a lot of work on COVID death, and we see what we consider to be delayed grief for people. They haven’t had time to grieve because they have to focus energy on home-schooling kids, finding a job, keeping a business running, etc.,” she said.

Traumatization can cause post-traumatic stress disorder (PTSD) and anxiety.

“Try healthy anxiety management strategies like breathing, building things in life to offset distress, and self-care,” Rando said.

2. Feel all the feelings

Magavi advises her clients to name their feelings out loud by describing what they’re feeling emotionally and throughout their body.

“They can make a log of their emotions and identify any triggering factors, which exacerbated their condition, as well as alleviating factors, which helped them feel better. This activity helps us learn more about what we feel, why we feel, and what we can do to combat helplessness and take control during this time of uncertainty,” she said.

For Carlos, anger and self-blame are her biggest emotions to work through.

“I’m angry at leadership for not informing the public about the seriousness of COVID, and at my parents because after their deaths I became aware that they were getting together with friends in their retirement community,” Carlos said.

She’s learned to let go of some of the anger.

“This is bigger than any of us. I get angry when I see people without masks and not social distancing, but we are all human and we all mess up,” she said.

3. Memorialize in some way

Because traditional ways of memorializing a deceased loved one are restricted during the pandemic, finding closure can be more difficult.

“I didn’t have anything for my parents because we had them cremated, which was the only option at that time. One [parent] we picked up in a car port because we couldn’t go inside the building, and the other was mailed to us. There was no respect to it. It was just ‘Here you go, sorry, we can’t do it any other way,’” Carlos said.

Recounting memorable moments, looking through photographs, partaking in the loved one’s favorite activity, or writing a letter are ways to memorialize, said Magavi.

“My mom was very crafty, and I have a lot of her crafts, so when I’m working on them, I think of her. She also made jewelry, and so when I wear it, I think of her,” Carlos said.

She also participates in online memorials for others who have passed during this time.

“A lot of people are experiencing a lack of ritual that helps us cope, so find your ritual. Seek out things. Watch the COVID memorial on YouTube,” Carlos said.

4. Advocate on their behalf

Turning sadness and anger into spreading awareness about COVID-19 became Carlos’ greatest way of dealing with her loss.

“I wasn’t seeing much in the news about people who passed, and being someone who does a lot of advocacy work, I know how important putting a face to it is, so that became my focus,” she said.

Carlos posted her story on her social media channels and shared it with local newspapers.

“I had people tell me they weren’t taking COVID seriously — not even wearing masks — until they read my posts. That’s almost been a relief for me. Yes, my parents are gone, but who didn’t die because they read my posts?” Carlos said.

When someone believes that the death of a loved one could have been prevented, Rando said turning rage and powerlessness into advocacy can be healthy.

“That’s what started the Amber Alert,” she said. “This type of [advocacy] is a big element in healing, and while the difficulty in contending with [the notion that the death was preventable] can become a real stumbling block, at the same token, it can turn into advocacy for other people or political involvement.”

5. Grieve with others

While it’s more difficult to grieve with family and friends in person during the pandemic, connecting over the phone or online can still provide support.

“Grieving with family and friends may aid those who fear tackling their emotions on their own. I encourage individuals to own their grief and to avoid altering their grieving process to match societal or familial expectations,” Magavi said.

Carlos finds comfort in sharing her loss with her brother.

“I’d convinced myself that my brother told me things [about my parents’ death] that he never did, and talking some of that through with him helps,” she said.

6. Get therapy

Seeing a therapist helped Carlos deal with difficult emotions.

“She assured me it was OK to be angry, and I needed to hear that from somebody. There were things I told her that I couldn’t tell my brother, and it was great to have someone else to talk to,” Carlos said.

People often reach out to Carlos to ask how she’s dealing with such loss.

“When I talk to people, they often tell me that anger and guilt is most debilitating, and the last thing I want is for people to live with that forever. Therapy can help,” Carlos said.

7. Move on, not without

When multiple losses occur, Rando said assumptions, expectations, and beliefs about life are changed, and the living have to find ways to reconcile these.

“Some people turn to God and some turn away from God. Some get involved in political advocacy, some get angry,” she said.

In Carlos’ case, Rando said that over time, Carlos will figure out how to move in the world without her parents.

“That doesn’t mean she has to lose a sense of connection to them. She can remember them in healthy ways: in stories she tells, at Sunday dinners, or at a memorial mass,” Rando said.

“There are ways in our faith, culture, or way of being to have noncorporeal connections with people we love and lost as long as they’re life-affirming and help to move us forward,” she said.

Click here to read the entire article on Healthline.

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