By Anna Gustafson, Michigan Advance
Molly Nixon’s heart couldn’t take it anymore.
The day she decided to leave her job as a nurse at Mercy Health in Muskegon, she dissolved into tears because she knew the three COVID-19 patients she was caring for that day were going to die.
“I’d briefly met my three patients, and there was the realization that none of them were going to make it, and they were all going to die alone in the hospital,” said Nixon, who lives in Cedar Springs.
“That was nine months into the pandemic, and my heart couldn’t take it,” she continued. “When I would show up to work as a nurse, that was my joy: to help people and make things a little bit better. Then, I would show up to work, and none of that was possible. We couldn’t have visitors; people died alone. It was so awful every day.
“I had to leave.”
Nixon had no plans when she gave her employer notice she was resigning. All she knew was she was crumbling. The trauma from seeing people die day in and day out, from being the last person someone would see in their lifetime, had left her feeling like so many other people immersed in a pandemic where a virus was (and is) taking aim at our lungs, filling them with fluid and debris until it feels like you’re drowning on dry land.
She felt broken.
She was wading through a life filled with death and anger over people not taking the pandemic seriously and the palpable, wrenching loneliness that came with people leaving the world with no family or friends by their side.
“My husband was quite relieved when I finally quit because, unbeknownst to me, I’d come home and I was a bear,” she said, explaining the role trauma played in her life at that time. “I would come home and yell at everybody, go to my room and slam the door. My husband didn’t know what to say because, gosh, what do you say? It was a relief when it ended.”
Now, two years into the pandemic in Michigan, Nixon is working as a hospice nurse in Grand Rapids. There, she sees death every day as she did at the hospital — but, this time, she “can give death dignity and meaning. That’s a gift and that’s been my healing.”
“People dying in the COVID unit — nothing was gained,” said Nixon, who lost her own uncle to COVID-19 after he refused to be vaccinated. “Nobody came out of that with any sense of peace. Even now, for reasons I don’t fully understand, people are not getting vaccinated and they’re still dying. We just lose somebody who matters. I’ve become a little ambivalent about that out of a sense of helplessness. I would love to go and educate the world on how you can save yourself and your loved ones. You don’t have to lose like that. But unfortunately, people are having to learn the hard way and that’s awful.”
These feelings of helplessness, anger and sadness that can mask itself as ambivalence are certainly not unique to Nixon. From people who have lost those they love most in the world to COVID-19 to health care workers once hailed as heroes and now being spit on by patients angry over mask requirements and those known as “essential workers” who made poverty wages while having to endanger their own well-being to work in-person when others were isolating during the stay-home orders, people have dealt with a lot over the past two years.
Bruised and hurting: How do we heal?
Gov. Gretchen Whitmer announced the first two COVID-19 cases in Michigan and declared a state of emergency on March 10, 2020.
In some ways, we know what has happened since then: we know of the 2,064,093 COVID-19 cases that have been diagnosed in Michigan since the start of the pandemic — more than 20% of the state population. We know of the 32,374 Michiganders — as well as the nearly 1 million Americans and 6 million people worldwide — who have died from the virus over the past two years.
We know of the increased political polarization and how that has played out during the pandemic — Republicans’ resistance to wearing masks and, more so than Democrats, refusal to get a vaccine — the armed protests filled with white nationalists waving signs emblazoned with swastikas and Confederate flags against the pandemic health orders; the violent plan to kidnap and kill the governor over her COVID policies; an increasingly vicious portion of the population hurling threats at public health and education officials; the often conservative gaslighting around COVID-19 and efforts to downplay a virus that is now the third leading cause of death in the United States.
We know that, combined with systemic racism and longstanding barriers to health care for people of color, Black, Hispanic and Indigenous Michiganders died from COVID-19 at far higher rates than white people. With that as a backdrop, we know so many of us took to the streets to protest police brutality against Black citizens in the wake of the deaths of George Floyd and Breonna Taylor.
There’s been the complete upheaval of the way we live — how we go to school and work, the way we interact with others, the constant fear among so many of us that we will die or our loved ones will die.
All of that has left us with widespread trauma, explained Dr. Claudia Finkelstein, the Director of Wellness, Resilience and Culture of Caring at the College of Human Medicine at Michigan State University.
“Surviving a global pandemic in the midst of huge racial inequities in the midst of giant income inequality — if that doesn’t qualify as trauma, I don’t know what does,” Finkelstein said.
It is in the space that is left — in the spaces between this onslaught of death, lingering sickness, fear and loss — that some of the biggest questions remain: How do we heal? How do we come to terms with the staggering loss we’ve experienced? How do we do that against a backdrop in which there often seem to be two starkly different narratives: one in which COVID-19 is real and dangerous and one in which it (falsely) is not?
“There’s been a recognition that when communities are faced with a disaster that there’s a natural progression of emotional responses,” said Dr. Debra Pinals, the medical director of behavioral health and forensic programs at the Michigan Department of Health and Human Services. “Much of that work has been based on sudden disasters, like a tornado or earthquake, when you spend time recovering and have a period of heroic effort together and then there’s unhappiness, fear you’ll never be able to gain what you’ve lost, and a building up of community cohesion and a rebuilding and looking back and recognizing what happened.”
With the COVID-19 pandemic, however, that has been different, experts explained. We’ve all suffered, to varying degrees, but there hasn’t been a national sense of cohesion — there hasn’t been the COVID-19 equivalent of the rally to unify after, for example, the Sept. 11, 2001, attacks, experts said.
But, there is still collective trauma and grief — meaning trauma and grief that is experienced not just by individuals but by our entire society. And in a country where the pandemic has taken two years off the average life expectancy, the trauma and grief felt by a vast portion of the population weighs heavy on us, leaving us with increased depression, anxiety and substance abuse, among a litany of other issues.
As we start to speak of something called “normalcy” (whatever that even means these days), drop mask mandates, and return to life that, in some ways, may resemble that which we knew before March 2020, health experts said it’s crucial we assess the mental health of our country, expand access to behavioral services, and remember to lend each other some grace as we navigate a nation and world that is reeling from loss.
And that continues to experience tremendous loss: over the past week, about 1,500 Americans died from COVID-19, even as the omicron surge is receding.
“In some ways, this was a perfect storm for behavioral health issues,” said Dr. Darren Jones, the chief of behavioral health at Beaumont Health in Southeast Michigan. “You had the pandemic itself — people are incredibly afraid of contracting COVID, of their loved ones getting COVID — and we also have societal fallout that became very difficult. We had people experiencing firsthand grief, the loss of loved ones, but they were unable to grieve in the ways we traditionally do in society. We weren’t able to have funerals; people couldn’t visit with loved ones in their final hours.
“The major way people cope with stress is socially — that social support is so important, and, yet, we’ve never been so isolated from each other as we were,” Jones continued. “That social impact was really devastating.”
Now, bruised and hurting, we are slowly emerging from the pandemic’s crisis mode and heading into this often confusing space in which we want things to be normal, we want to exist as we did before the pandemic, but none of us can erase the past two years. Instead, we have to try to keep our heads above water as we deal with the emotional fallout.
“We have largely been in crisis mode for two years; as we move out of crisis mode, that’s when the time for action will be,” Jones said about connecting people with necessary mental health support. “We want to be mindful as we move out of the crisis phase of the pandemic that when people are under threat, they go into fight or flight mode. In some sense, many of us have been in this type of stress response for two years now. That takes a tremendous toll on people. This may be when we see the biggest behavioral health fallout because people have been fighting to cope with day-to-day demands (during the pandemic), and, at some point when that starts to dissipate, people are going to experience depression or post-traumatic stress disorder (PTSD).”
To heal, “we’re going to have to help each other,” said Dr. Michelle Riba, a past president of the American Psychiatric Association, a professor of psychiatry at the University of Michigan and the co-director of the Workplace Mental Health Solutions, a program at University of Michigan’s Eisenberg Family Depression Center.
We are, Riba said, going to need to remember: we all went through this — to varying degrees, of course, and some experienced far more loss than others, but we all, to some extent, suffered. And, she explained, to heal, we need to ask each other about our respective experiences.
“It may be that people aren’t ready to share, but we all have a story about this,” Riba said.
‘The grieving process is an absolute monster that comes and goes’
These stories, those interviewed by the Advance said, are ones no one wants to live. They are stories filled with pain and loss, with wounds that feel forever open.
With structural racism pervading everything from health care to employment, these stories fill Detroit — a majority Black city that was known as a COVID-19 epicenter in the early days of the pandemic. The overwhelming majority of Michigan’s pandemic deaths occurred in Detroit in the early days of the virus, a stark reminder that institutionalized inequity has not only left Black communities to face poverty and chronic illness at higher rates than white ones, but it left them to battle disproportionately higher COVID-19 rates.
According to a study released last week by the Michigan Coronavirus Racial Disparities Task Force, Black Michiganders made up four of 10 COVID-19 deaths in the early days of the pandemic, a startling number considering Black individuals make up 14% of the population. Due to efforts by state and local leaders, that number has been essentially halved; Black Michiganders now make up about 18% of COVID-19 deaths, the task force reported.
But at the beginning of the pandemic, the virus swept through the state’s largest city, killing entire families and the first Michigan child to die from the disease, 5-year-old Skylar Herbert of Detroit. It left spouses without the loves of their lives, children without parents, friends without the companions who had once filled their worlds with laughter.
Eileen Wilson, of Detroit, lost her husband after more than 51 years of marriage in April 2020 after he was hospitalized with COVID. Tom Wilson, an active local Senior Olympics participant who swam regularly and was a well-known community activist, was 73.
After graduating from Detroit Cathedral High School in 1966, Tom Wilson enrolled at Wayne State University, where he played fullback on the football team. He earned a bachelor’s degree in education there and later received a master’s degree from Eastern Michigan University. A former Detroit neighborhood City Hall manager and Detroit Public Schools physical education teacher, Tom Wilson was known to many as the “spirit of Detroit.”
“For the first year, I just walked around on automatic pilot,” said Eileen Wilson, who still lives in Detroit.
She managed to complete the necessary forms, make calls and handle an assortment of end-of-life matters. All the while, every moment of every day seemed to present her with memories of the man she had known since they were teenagers.
“It was so much administrative stuff to do, and we were well-organized people,” she recalled about her life in 2020.
Every time she hears a song by the Temptations — especially “My Girl” — she thinks about her husband. “That was one of the favorites that he was always singing to me,” she said.
Wilson said several of her friends have lost spouses during the pandemic, although some were not due to COVID-19.
“The grieving process is an absolute monster that comes and goes,” she said. “Sometimes you feel sort of OK, but not all the way OK, and, boom, it will come down on you.”
A coping mechanism, she said, is that those who have suffered loss continually talk with each other.
“You will not fully understand it until it happens to you personally,” she said. “Losing a husband is different from losing a child or a father or a mother.”
For Detroiter Tionna Barksdale, the pandemic has been deeply painful in several ways.
Her 47-year-old sister, Laneeka, who had worked as a Detroit casino employee, died of COVID-19 in March 2020. Since that time their mother, Stephanie Barksdale, died on Dec. 29, 2021, of cancer. Yet Tionna Barksdale says going through both significant family losses and a divorce during the pandemic have given her “a super power of strength.”
“I’m helping her children to get back on their feet,” Barksdale said of her sister’s children.
‘Instead of grief, I was so angry’
Nixon, the nurse, not only had to face the death of her patients, but the death of her own uncle from COVID-19.
He was a “great person,” Nixon explained, someone who was a devout Christian and worked with children as a wrestling coach and leader in his church. But he refused to get a COVID vaccine, she said.
“I had to unfriend him on Facebook; I didn’t want to argue anymore, and I was in such a place of trauma that I couldn’t discuss it with him without being triggered,” she said of conversations around the COVID vaccine.
“He got COVID; he didn’t have great lungs to begin with — he’d been a welder for a long time — and he got a pulmonary embolism and died,” Nixon said. “Instead of grief, I was so angry with him. The vaccine had been out. I’d had two shots and a booster by that point. There was absolutely no reason for this to happen.”
She debated whether she wanted to go to the funeral because of these complicated emotions surrounding his death. Ultimately, she strapped on her N95 mask and went.
Instead of grief, I was so angry with him. The vaccine had been out. I’d had two shots and a booster by that point. There was absolutely no reason for this to happen.
– Molly Nixon, a nurse who worked with COVID-19 patients, on the death of her unvaccinated uncle
“It was a huge loss, not only for our family, but all the youth he worked with over the years,” she said. “He was a good influence on a lot of young men. I just don’t understand how the vaccine is more scary than what I was seeing every day.”
But, for Nixon, anti-vaccine attitudes are commonplace among family and friends — and, especially as a nurse who worked with COVID-19 patients, that has made her trauma even worse. It became so difficult that “my friend circle is much smaller.”
“Having questions about the vaccine is fair and reasonable, but to say nurses who have been the most trusted profession for years are full of crap?” Nixon said. “I don’t care who you voted for; I just want you to be all right.”
Nixon has managed to change some family members’ minds about getting vaccinated and she said she remains hopeful that can still happen with others, even those who may have dug their feet in against getting the shot. Currently, about 60% of Michiganders eligible for a vaccine are fully vaccinated — meaning they’ve gotten two shots of the Pfizer or Moderna vaccine or one shot of the Johnson & Johnson vaccine.
“We need to change the narrative,” Nixon said of the conversation around COVID vaccines. “I generally see that it is conservative Christians who feel that this is not real or the vaccine is harmful. … I wonder if maybe pastors can have a role in saying, ‘Hey guys, I love you, and we’re all on the road to heaven, but can we not be in the express lane?”
This kind of messaging would be far more powerful than anything coming from the media or politicians, Nixon said.
“If no one trusts the news, it’s not going to matter what the news says,” Nixon said. “People don’t trust politicians. It has to come from a trusted source.”
Ultimately, Nixon said, she hopes the country can bridge the gaps that have widened during the pandemic — and remember that, while people may frame loss differently, people across the ideological spectrum have suffered loss.
“I’m fairly liberal, but I’d like to remind people on both sides of the political spectrum that there are genuinely good people who believe different things than you,” Nixon said. “In order for this country to heal, we all need to believe that again. I hope we can come back together. There’s a lot of hurt in this country, and we need to find a way to get by.”
‘Let’s normalize getting help’
In the coming weeks, months and even years, it’s going to be crucial that people dealing with trauma and grief from the pandemic can say: I’m not OK. And then access help, experts said.
Part of that means both expanding mental health care providers in the state and country and training a wide variety of people, including educators and primary care doctors, on how to spot mental health issues and connect people with the right resources.
“There’s a whole move towards trauma-informed policies and care,” Finkelstein said. “I’m thinking if we have undergone a collective trauma, wouldn’t it be interesting for educators, police, health care providers, policymakers to have a look at trauma-informed principles and look at how each of the policies that they enact or the words they use may either help or worsen a population that’s been through trauma.”
Jones noted the need to grow mental health resources, particularly in the wake of the pandemic.
“We have major access challenges with behavioral health that are related to socioeconomics, as well as the way our health care systems are designed,” he said. “I think you have people who don’t know how to connect to behavioral health services. It’s easier to get connected with medical or physical health services in this country than it is behavioral health.”
To expand mental health services, Pinals said the state is “working hard on workforce development.”
While the demand for mental health services is challenging, Pinals emphasized that, in some ways, it’s a positive sign that the deeply harmful stigma around seeking mental health services is dissipating.
“One thing the pandemic has done is made it more OK to talk about mental health challenges,” she said. “It’s very important people know there’s no shame in seeking help. Bringing that to the foreground is going to be really important to help the community heal.”
The state has also increased mental health offerings during the pandemic, Pinals explained. Using federal dollars, DHHS provides its “stay well” initiative — which offers virtual support groups, resources about meditation and other coping mechanisms, help lines, and more.
Recently, the DHHS launched its “Michigan Crisis Action Line” in the Upper Peninsula. The line, which offers suicide prevention and access to mental health services, will soon be statewide, Pinals said.To access information about the crisis line, click here.
Nixon also emphasized the importance of attacking the stigma around mental health and said she has focused on sharing her challenges with mental health during the pandemic with others in order to normalize reaching out for support. She has, for example, shared with others how antidepressants have helped her cope.
But it’s not just that which will help, Nixon said — for those in health care, mental health has been severely impacted by the fact that people still refuse to get a vaccine.
“Let’s normalize getting help, normalize taking medication if you need it, and stop calling people heroes,” Nixon said. “I don’t think calling a nurse or doctor a ‘hero’ is helpful. Calling someone a ‘hero’ implies we’re willing to sacrifice ourselves for you, and that’s not helpful. We have a vaccine now. This could be over. But it isn’t. At this point, they’re not a hero anymore; you’re making them a martyr. You’re sacrificing them because of your choices.”
Outside of professional therapy, it will be important for us as a society to honor and remember those who have died during the pandemic, Riba said.
“On a personal level, we have to think about those we lost,” she said. “Many of us postponed funerals and those kinds of rituals, and we have to think about how we honor those people and say goodbye one or two years later. Families have to get together and talk about that. As communities, how do we honor what we’ve gone through in the last couple of years?”
‘I bring a message of hope’
Part of honoring what we’ve gone through is a recognition that life will go on — and good things will come, experts said.
“There’s this idea of post-traumatic growth; it’s a really ancient idea that through dealing with adversity, as difficult as that can be, people can report positive changes in their lives once they’ve made it through that adversity,” Jones said.
That belief that there can still be good is massively important for any kind of healing, Jones explained. And that’s not to say the healing won’t be horrendously painful, or that people won’t need to access help, but it does mean that it’s not naive to be hopeful about the future.
“Despite all of the headache, all of the sadness and loss we’ve all observed and in various ways experienced, for me I bring a message of hope and recovery and resilience,” Jones said. “We know people all around the world are resilient, and our communities are resilient. We’re going to get through this by taking care of ourselves and each other.”
Pinals also emphasized this.
“Over time, we’re really learning about human resilience and the idea of post-traumatic growth,” she said. “Even with traumatic incidents, you can grow in different ways and integrate that experience and create positive things in your life.”
For those who feel hopeless, it’s important for them to know that’s normal in the wake of staggering loss — but it’s not permanent, experts said.
“We shouldn’t assume the grief and loss will be over in a month, two months, five months,” Riba said. “We’re going to have to reach out in all sorts of different ways.”
Part of that reaching out, Riba explained, is by dramatically expanding the way people access mental health — something all of the experts interviewed by the Advance for this story emphasized.
To do that, Riba said it is important to think about ways mental health professionals can reach individuals without people having to seek them out — something that takes time and resources that many marginalized communities do not have.
“For some people, getting on three buses to get to a mental health center is impossible,” she said. “Access to mental health services is very important; it has to be local. You have to think about barbershops, hairdressers, churches, synagogues, mosques, having mental health counselors in schools.”
One thing the pandemic has done is made it more OK to talk about mental health challenges. It’s very important people know there’s no shame in seeking help. Bringing that to the foreground is going to be really important to help the community heal.
– Dr. Debra Pinals, the medical director of behavioral health and forensic programs at the Michigan Department of Health and Human Services
‘I’ve got a long way to go’
As Nixon’s days treating COVID-19 patients in a Muskegon hospital recede into the past, she is breathing easier. Her days feel meaningful again. The people whose lives are ending around her can be surrounded by those they love. They are not alone, and neither is she.
But the pandemic has left its scars, and there are constant reminders of darker times: of the deaths that have now, astoundingly, almost accumulated to 1 million people in the United States.
“I still can’t go back to Muskegon; I had to meet a lady out there to pick something up, and for the next three days I was a wreck,” Nixon said. “I don’t know that I can step foot in a hospital as a nurse ever again. I’ve come a long way and done a lot of healing, but I’ve got a long way to go.”
This road to healing is one Nixon knows she’ll take; she has to. But it’s one filled with tight turns and long tunnels, and a darkness that creeps up on her. There are memories of people who were once here and are now forever gone.
Two years ago, the 961,000 people who have since died from COVID-19 were here. Tom Wilson was here, swimming and singing “My Girl” to his wife. Laneeka Barksdale was here with her sister and children. Skylar Herbert was playing with her parents.
They were all here; their seats at dining room tables were not empty; the lungs that would fill with fluid were breathing.
Two years later, they are gone. They are gone, and nothing we can do will bring them back.
And so, now, we are left with memory and what to do with that. We are left with the fact that we are here. We are here; we can remember.
We should remember, Riba said. As we have withstood the pain of this pandemic, we will withstand the pain of those memories. We will keep telling stories about those who have died. We will tell them to those around us, because we are not alone.
Right now, Nixon said, she can’t return to Muskegon because of the pain of those memories. She can’t go to the beach there, like she has done every summer, because of that trauma.
Perhaps, she said, one day she will return.
