Growth amid 'ambiguous loss': How the pandemic has changed us

[MUSIC PLAYING] CATHY WURZER: It's 12:19 here in Minnesota Now. This hour, we're looking back at the three years since our lives were upended by COVID-19. The pandemic has significantly changed our health care institutions and the people who work there. The all hands on deck response to the virus put stress on doctors and nurses and other medical professionals like many had never seen before, and it changed the lives of health care professionals. Let's hear from one of them.

KAY: My name is Kay. I started at the very beginning of the pandemic as an ICU nurse. And now, I am not sure what I'm going to be doing, but it is unfortunately not going to be nursing anymore. At the very, very beginning of the pandemic, I think that patients were looking towards nurses more for guidance versus just doing what the doctor says.

And so I think the patients really understood that they were really cared for by nurses, and we were the ones that were making the difference. So I think at first, at least, that was endearing. I would say the mental strain from a job such as an ICU nurse just-- a lot of it had to do with anxiety. Just staffing levels, materials that became readily apparent we're not going to have what we needed, anxiety over making sure that I'm not missing a single thing because it's very, very detailed work.

And then just there's a lot of depression. I guess seeing people, especially at the very, very beginning of the pandemic when people were just dying in front of our eyes. We couldn't do anything. There wasn't anything at the time. And then also their families and friends and other support people.

And then also there is just the alarms and the buzzers-- there's so many of them. You go home sometimes, and it was a common experience to still hear some of the ringing and the dings at night-- not just with me, but with others as well.

So I took a leave of absence starting last June. I love helping people, and I loved caring for them. And it sucks seeing them so sick, but it was great being able to help people get better. So I am losing a lot by leaving, but I think that it's taken a lot, too, from me, and so I'm trying to be even headed about it. But it is a passion, and it's not one that I will probably ever really give up.

CATHY WURZER: That was Kay. She wasn't comfortable giving her full name because of the nature of her story.

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And there are many stories like Kay's, folks who have endured extraordinarily difficult circumstances during this pandemic and lost something or someone dear to them. Without any sense of closure, that can be hard to deal with. University of Minnesota Professor Emeritus Pauline Boss is an expert in family stress. She coined the term "ambiguous loss" back in the 1970s. Now, these are losses that leave people without a clear understanding of the why behind the loss, nor does it offer much emotional closure.

Ambiguous loss describes the kind of unresolvable grief many of us feel or have felt during the pandemic. Dr. Boss wrote a book about this during the height of the pandemic. It's called The Myth of Closure, Ambiguous Loss in a Time of Pandemic and Change. And I'm so honored that Dr. Pauline Boss is back with us. Good to hear your voice again.

PAULINE BOSS: My pleasure, my pleasure.

CATHY WURZER: Dr. Boss, it's safe to say nearly everyone sometime in their lives experiences loss. That's the human condition. From breaking up with a partner to having a parent with Alzheimer's, you'll lose a job, kids leaving home-- but are those examples of ambiguous loss?

PAULINE BOSS: Yes, they are. And they're the more ordinary ones that we don't realize our stressing us at the time. I'm not talking about mental illness, I'm talking about anxiety and stress because things they're not going our way. And ambiguous losses are an example of that. When someone in your life disappears, but they haven't died-- they're still around, like a breakup. That's very stressful sometimes because there's no clear ending to the relationship. The person is still around.

But what we're seeing worldwide now is in Ukraine or Turkey with the earthquake, Ukraine with the war-- people are going missing. And they're going missing here too with floods and mudslides and so on, so people don't know if they're dead or alive. They have no body to bury, so it's a very stressful example, and the pandemic was one as well.

CATHY WURZER: Can you explain-- more than, I think, 14,000 Minnesotans, almost 15,000 have died from COVID over the past three years. I mean, that is a literal physical loss to cope with. And for those who are going through that loss, it is very difficult even today because they really haven't been able to fully mourn those individuals. How do we deal with that?

PAULINE BOSS: Well, the research right now shows that the main thing regarding grieving a death is to find meaning in it. And of course, it was meaning less during the pandemic. People died without you being at their bedside, and there couldn't be any funerals. And so it was a weird time. It was uncanny and not usual. And so our usual rituals of comfort were not allowed, were not feasible.

And so I think what we have to do is find meaning in a new way, and that is probably have the rituals still today, even if they're three years late and even if they're small. And sometimes, that's more meaningful, but there needs to be some kind of ritual with not just one person. It needs to have a few people around for it to be a ritual that has comfort in it from social connection.

So I remember we had a gathering of five people for my husband at the year anniversary of his death, and that was very comforting. And ordinarily, it would have been hundreds of people, but not this time. The main thing is to have some kind of ritual of remembrance, whether it's small or large, and whether it's late-- doesn't matter. But it should happen.

CATHY WURZER: We reached out on social media to hear from people about what they've lost and gained over the past three years of the pandemic, and I want to play a minute of this story for you right now. So let's listen.

PAULINE BOSS: OK.

HANNAH TOUTGE: My name is Hannah Toutge. I'm 23 years old. I live in Minneapolis, Minnesota, with my partner and our cat. I graduated from college in December of 2019, and then I came out in 2022. Graduating and then immediately jumping into a global shutdown pandemic sort of forced alone time and sort of being holed up in my room at my parent's house, thinking a lot about what I could want for the future, post pandemic, if there will ever really be a post pandemic time.

I don't know. It made me realize like who I really am. Honestly, a lot of it was TikTok. I think TikTok had a pretty big uptick in users at the start of the pandemic because everybody is at home and turning to their phones or tablets. So I downloaded TikTok for the first time March 2020, and seeing people from all over the world and how they were handling this massive transition we were all sort of going through.

And I think I kind of drifted onto queer TikTok. I found people who had similar stories to mine. We had inklings and suspicions of our identities at a young age and then maybe went through a time when we had to be a little bit more repressed-- which was college for me. And then in this time of looking maybe more intentionally for human connection, we realized, oh, these are my people, and this is who I am. This is where I belong.

I moved in with my partner, my girlfriend, and we bought a house together. I feel more authentic and more connected than ever before, which is wild to say as we're coming out of three years of disconnect and separation and don't hug people, don't shake people's hands. I feel more connected to people around me than I ever have, really.

CATHY WURZER: Well, bravo, Hannah. Dr. Boss, I'm wondering. Hannah obviously used the pandemic to find herself, which is a good example of maybe exercising the resiliency muscles that many of us have. Would you agree?

PAULINE BOSS: I agree. She's an exemplary example of resilience. What I wrote was the pandemic was the both a terrible time and a time of growth. We need to start thinking in both and terms, the contradictions. It was a terrible time, and it was a time of learning new things, even small things that gave us back some control when we were in an environment we couldn't control, like baking bread, and so on.

And this young woman found many ways to find control and human contact, even if it was virtual. So I think what we need to do is look back at what we lost-- loss of faith in the world as a safe place, loss of feeling safe on an elevator, for example, and many other things.

But what we gained was learning to do things in a new way, learning that we could be flexible if we were forced to. And many of us were flexible and learned a new way to do things, so there's a plus and a minus to the terrible thing we went through.

CATHY WURZER: How do you help people who remain emotionally fragile? There seems to be a lot of that here as we move out of the most darkest days of the pandemic.

PAULINE BOSS: Good question. I don't agree with what they're saying is that we're having an epidemic of mental health failure. No, we're not. We're having an epidemic of anxiety and high stress still, and that's a normal reaction to an abnormal situation, which we've had for the last three years.

And so what we need to do is find out who the minority of people who truly have mental health issues and need help, and the rest of us need to find human community. We need to increase our social contact and get back to having lunch or going bowling or whatever is popular right now and go to our social events because human connection is, in fact, the cure for sadness and normal anxiety.

And the people who have intense sadness that is depression or anxiety that's immobilizing, they do need professional help, but let's not paint that brush for everybody. Many people, like the young lady we just heard, are stronger for having gone through this, for having survived. Pat yourself on the back if you're still standing after these three years.

CATHY WURZER: Pauline Boss, you are a treasure. Thanks for your time.

PAULINE BOSS: Thank you, Cathy. Good program.

CATHY WURZER: Thank you. Pauline Boss is Professor Emeritus at the University of Minnesota Department of Family Social Science. Her most recent book is The Myth of Closure, Ambiguous Loss in a Time of Pandemic and Change.

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Finally in this part of our show where we are commemorating three years of the COVID-19 pandemic in Minnesota, we have one more story for you. In March of 2020, Nicole Navratil was pregnant with her first child when the shelter in place order came from Governor Walz. So how did that affect the early life of her and her baby? Well, let's listen.

NICOLE NAVRATIL: I'm Nicole, and I live in Northeast Minneapolis. Three years ago, I was pregnant with our first child. The beginning of my pregnancy was pretty normal, and we started our childbirth classes in person and all that jazz. People made plans for us for baby showers, and then literally like everything kind of coincided. Our childbirth classes went online, and everything from there just kept going.

So that last kind of third of my pregnancy, we literally were home a lot. It was nice in that it got warmer outside, so that was helpful because I was able to get outside for walks and things like that. But we really didn't see very many people. I kept in touch with my doula, and we had our loose birth plan, which did not happen.

We're hoping for a water birth in a birth center, and we ended up with a c-section in the hospital, so pretty different. And no visitors, of course. I'm breathing because I'm feeling some of the anxiety coming back from that time. Yeah, I had my first COVID test in the hospital while I was in labor. Every step of the way visiting the risk, and we ultimately decided to have just our core two or three family members that could come see us right after our son was born.

Because for us, it was too much to try to do it all on our own. It was just very quiet-- very, very quiet, almost like complete stillness at that point in our lives. And then slowly as time passed a little bit, we said, OK. Somebody can come over, and we can sit at opposite ends of the backyard.

They can meet the baby from there, but it was still just-- all those decisions were wrought with anxiety. I just had the phrase come into my mind. It was like becoming a new parent in a pressure cooker. All the stuff you would normally deal with, but compressed and extreme and intense and right in your face every day.

It kind of gave me permission to just-- you don't have to do other things with a tiny kid. You can just be at home hanging out. I was home with him for 15 months. There were really, really hard days, but there was a lot of really golden moments. And when we're able to see friends and family, we really appreciate it.

CATHY WURZER: That was Nicole Navratil who became a new mom at the beginning of the pandemic in Minnesota. Thanks to everybody who shared their stories with us. We really appreciate it. Of course, we still would love to hear from you about how your life has changed over the last three years, lessons you've learned. Send us your story or a photo on Instagram. You can tag MPR News, or you can email us, minnesotanow@npr.org.