Frontline Workers Process A Year Of Trauma Through Writing

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Over the last year, Maryland psychotherapist Kerry Malawista noticed frontline health care workers struggling with what she called “the ghosts of the COVID deaths they carry.”

Borrowing the expression from Tim O’Brien’s collection of Vietnam War-era stories, she started The Things They Carry Project, a series of writing workshops for health care workers and first responders. Each session is guided by a known writer and a therapist, who together help doctors, nurses and hospital domestic workers understand it’s ok to lay down their burdening thoughts.

Some of Malawista’s patients work on the front lines of the pandemic in intensive care units and emergency rooms.

“It was at the year anniversary of the pandemic in March that the grief really was starting to hit them,” she says. “It was like things were finally slowing down. And I was hearing just the pain they were feeling.”

She recommended that one doctor write down the feelings he struggled to find words for. The doctor said the exercise helped him and continued to write, sparking the idea to start the program.

Maine emergency physician Michael Schmitz understands the struggle of providing care during the pandemic. Many people believe the stereotype that doctors, especially in the emergency room, don’t feel the impact of their experiences at work, he says.

“And of course, the opposite is very much true,” he says. “All those experiences are still with you.”

Schmitz carries the weight of how personal protective equipment disrupted the way he communicates with patients by concealing his facial expression, especially when meeting someone for the first time.

At work, he saw elderly patients on a daily basis who couldn’t communicate with their families because of COVID-19 restrictions. He struggled the most with giving families the news that their loved one — who they couldn’t come to see in the hospital — had COVID-19 on Christmas.

And outside of the ER, frontline workers needed to take care of their families, help kids adjust to remote learning and cope with people posting that COVID-19 isn’t real on social media, he says.

“It’s just a weight of those experiences,” he says. “I wouldn’t call it grief in my particular case. I would just say there was a weight and this program made a space to put it down.”

And Malawista knows a thing or two about carrying a weight. Her daughter, Sarah, died at age 18.

Psychotherapist Kerry Malawista says “The Gleaners” by Jean Francois Millet is comforting because it shows a middle distance, which in processing grief is necessary to gain perspective and hope. (Getty Images)

An artist, Sarah taught her mother about foreground, background and something called the middle distance by looking at Jean Francois Millet’s oil painting “The Gleaners.” Her daughter explained that the middle distance gives the painting balance and perspective.

In Georgia O’Keeffe’s painting “From the Faraway, Nearby,” an elk skull with huge antlers dominates the canvas atop a faraway mountain — with no middle distance. The painting helped Malawista realize people need a middle distance in their lives, too.

People often can’t see past overwhelming trauma and grief while they’re experiencing it, she says, or sometimes feel distant and deny the effect of the loss.

“I came to think how we really need a middle distance to bridge those two worlds in order to go on and live a good, full and creative life, one that both includes the loss and the grief,” she says. “We can’t get rid of that completely, but also can see a distance where we might be OK and carry the loved one with us.”

For both Malawista and Schmitz alike, writing helps facilitate healing.

Shifting between the up close, the far away and the middle distance can help health care workers take care of patients while processing the feelings that come with the job, Schmitz says.

Psychotherapist Kerry Malawista says “From the Faraway, nearby” by American artist Georgia O’Keeffe lacks the ‘middle distance’ which creates a jarring effect. That effect is true in life, where we need a middle distance to process grief. (Matt Dunham/AP)

Through the program, Schmitz wrote a poem called “3-M Mask” about the masks he wears at work every day. Writing the poem gave him a sense of release.

“The thing that was the most helpful was that other people also talked about how these boundaries around COVID — whether it was a computer screen because they were doing mental health support for people or wearing PPE — how that affected their ability to care for other people,” he says. “And they had many of the same fears and frustrations.”

Malawista says the program attracts a wide range of people, from firefighters to people organizing burials to doctors, who all share their own grief.

“I think at first people are numb, sort of like soldiers going through one foot in front of the other and you have no option,” she says. “And then suddenly, like I saw in March, when you can slow down, that’s when you start to feel.”


Now as the country continues reopening and a sense of normalcy returns for many Americans, there’s one thing Schmitz wants to hear from people.

“The most powerful thing that people have said is just thank you,” he says. “Those are the words that go in the little bank that you hold in the center of your chest and that get you through the more difficult times.”

And gratitude is something Schmitz feels toward Malawista for starting the writing program and connecting him with others who are willing to confront difficult feelings during a difficult time.