It was a beautiful Tuesday morning on September 11th, 2001. I was making rounds in the hospital greeting a couple of patients with a smile, as I knew they were well enough to go home that day.
Others were holding steady but not quite ready to return home for their recovery. In another section, patients were either tenuous, holding onto life with whispered prayers and the modern machines of medicine, or they were preparing for the final paradigm shift of life.
In my career, I spent the most time with the third group where death most commonly approaches like a steam engine. The whistle blows and is followed by the low rumble of the engine, and we can sense the friction of the wheels upon the track. When it finally rounds that last corner, we are prepared as it approaches because we know death is arriving.
However, sometimes death arrives like a semi-truck that has run a stop sign. This morning, it arrived by planes hitting towers, government offices, and into fields.
The world stopped.
We held our breath. We couldn’t have imagined what we were seeing on the small screens in our patient’s rooms. Death had arrived and no one was prepared. To this day I can remember the emotions of that day—patients and families just wanted to go home. They sought safety in their people and familiar surroundings. I had to convince some they were not well enough to go home. A sense of fear settled like a fog everywhere I walked.
I reflect on this day and all the days since when death arrived suddenly at the hands of evil.
Most people, thankfully, will never have to endure the horrors of a terrorist attack. But if our news feeds are any indication, countless people lose loved ones to senseless acts of violence every single day. What about them?
At most funerals (especially at the services of those who have lived a long life) people eulogize the departed by mentioning the various good things they did in life. For many, the fact that the deceased lived a life full of meaning, guided by positive values, is the good to be found in death. Their worthy legacy is what is most remembered.
This is not always the case with those who die violently and prematurely. All too often, the terrible way they died is what overshadows everything else. Survivors are not just forced to live without a loved one, but they are haunted constantly by the evil that marked their family member’s final moments.
This is a different kind of suffering and a very complicated kind of grief journey. Personal factors like emotional regulation, secondary stressors, prior history of trauma, and access to support will play a major role in how each person responds.
Professional counselors, grief support group leaders, clergy, and victim advocates vary in their ability to help victims navigate the grief that accompanies traumatic loss. The best professionals take special care to watch for and treat symptoms of complicated grief, depression, and PTSD–all of which are common following traumatic loss.
Most mourning parents tend to focus on the loss itself, or the stressors that are indirect consequences of the violence (such as having to work with the police), or they bounce back and forth between these two realities. It is important to understand that these are coping mechanisms, and everyone will react differently. The best way to help is to acknowledge that uniqueness in grieving is okay. As family, friends, and community seek to comfort those most closely affected, they must be willing to tread in the waters of their own discomfort and fears.
Grief after a violent death shares many characteristics with grief from other kinds of death; however, the following reactions may also be expected:
- Shock with manifestations of anger, despair, disbelief, guilt, and anxiety
- Denial of the death
- Survivor’s guilt
- Yearning to see the person one more time
- Possible regret for the last words spoken before separation
- Restlessness, loss of concentration and loss of interest in life
- Panic attacks, nightmares, insomnia, or physical manifestations
- Inability to function
- Irrational thoughts and actions
- Fear of being alone, or isolating to cope
Given the unique grief of those who have lost a loved one to violence, it is important to have an accurate window into the shock and trauma they are trying to navigate. The experiences below can offer a helpful guide for offering constructive compassion:
- I am in shock. I don’t know what to say and I know you don’t know either. Please sit with me; when I am ready, I will speak.
- I am in shock. I just want to go to sleep and wake up to a different reality. For now, can you sit in the other room so that I may rest?
- I am in shock. My mind is fearful, anxious, restless. Please get a doctor.
- I am in shock. I cannot believe he/she is gone. I am in denial. I need to see them, touch them, and say goodbye.
- I am in shock. I can’t plan a funeral, take care of my children, or do the everyday aspects of my life. Please help me.
- I am numb and in a daze. I cannot remember yesterday, and I can’t think about tomorrow. I need a counselor.
- I am in despair. I imagine all day what their final moments were like. I have nightmares all night. I need a counselor and/or a grief group, and I want justice.
- I am afraid. If this could happen in my safe world, then my world is no longer safe. What if this would happen to another family member or to me? Help me take the necessary steps to feel safer.
- I am alone. No one understands. That’s why I isolate myself and don’t call you back, or go to the store for groceries, or do any of the things I once loved to do. I need you to break through these barriers that I keep creating.
- I am alone. I need to be with others who have also suffered this same fate, so that I may live. Help me find them.
- I am alone. I need to talk about my loved one even though it makes me cry. I need to remember who they were, not what happened. Will you sit with me and look at pictures and videos? Will you go with me into their room, which I am afraid to enter?
- I am alone. When you send me a card, a note, or a letter, I treasure it—even if I don’t mention it. It is comforting. It shows me you care.
Grief and loss do not have a time stamp. Grief never goes away; when it is processed healthily, it only becomes more bearable and less debilitating. It becomes a part of the imprint that is left on our hearts to remind us of the beautiful life that was lost.
As we support those who lost so much on September 11, 2001, may we also support those that lost loved ones to violent and premature deaths.
Dr. Pamela Prince Pyle is a board-certified internal medicine physician, who was one of three physicians selected in 1992 by Carolina Health Specialists to begin the first hospital-based internal medicine practice outside of a university setting in the United States. In 2009, Dr. Pyle began traveling to Rwanda for medical work with Africa New Life Ministries and was instrumental in the founding and growth of the Dream Medical Center in Kigali. She is the author of “A Good Death: Learning to Live Like You Were Dying,” coming in 2022. To learn more visit her website.