En español | Many Americans who went about daily life before the threat of COVID-19 may feel as if they have suddenly been thrust into a science fiction movie. But for caregivers, especially those who tend to military service members and veterans, heightened anxiety, ambiguity and social distancing are all part of daily life.
In that respect, the present pandemic not only provides an opportunity for civilians to learn from the military-caregiver mindset but also offers them a chance to understand what combat veterans and military families experience with the ongoing uncertainty surrounding their circumstances.
"Being a military caregiver or living with a loved one's deployment means living with the knowledge that we can't control the situation,” says Jennifer Mackinday, a program coordinator at the Elizabeth Dole Foundation, spokesperson for the Wounded Warrior Project and caregiver for her brother, James, who was wounded in Iraq in 2005. “Military families have learned how to embrace ambiguity and hold on to what we do know. We also understand that the one thing we can control is how we react and respond."
Add to that the fact that many wounded warriors are already in the heightened-risk category for contracting COVID-19, which puts everyone in the family on edge, especially when a member brings home the common cold.
Injured veterans often undergo multiple surgeries or procedures and treatments that require frequent hospital or doctor visits. They understand what it's like to be constricted in the house, and their caregivers are familiar with the need to be prepared for the unexpected or the sudden inability to leave the home.
"I approach everything as if it's a worst-case scenario, and my brother has lived the worst-case scenario,” says Mackinday. “Most combat vets, especially with hidden injuries like PTSD, have been practicing social distancing for years."
Triggers to past trauma
When resources are scarce and fear and panic exist, past trauma related to the war may be triggered. “Our veterans feel more helpless when they can't get out there and protect everyone, not just their families,” explains Melissa Comeau, a military caregiver, whose husband was injured in Iraq, and the author of Sleeping with the War. "There is a call to service that does not go away with wounds, illness or injury. And this virus is an enemy that you cannot see or fight with a gun.”
Comeau points out that military caregivers are already accustomed to managing multiple crises at once, staying stocked with supplies and finding numerous ways to distract the kids in times of peace and crisis.
In short, the mindset and lifestyle of someone who has recovered or is living with a serious combat wound are that of someone already living “a scaled-down life,” Comeau says. “And it's a sacrifice for everyone in the family. But you add to that the fact that schools are being canceled and it's one more challenge."
And then, as for caregivers everywhere, the threat is heightened for those requiring home health care aids or therapists. These families are struggling with hard decisions about whom to let inside their home and how to trust that people from outside their family are being equally cautious.
Many caregivers for vets have created rooms in their home to quarantine loved ones, due to constant worries about infected IV lines and the threat of airborne transmission. This is particularly hard for those with younger children and older relatives. Wounded veterans who served in Iraq and Afghanistan are part of the sandwich generation, being cared for by a spouse while at home with younger children, or perhaps living in their childhood home with an aging parent who is more vulnerable to infection.
Roxana Delgado, an epidemiologist in San Antonio and caregiver for her combat-wounded husband, Victor, describes the strain of being told that they should not come into the hospital or doctor's office until May, in order to limit exposure to infection.
Create emotional connections
"It's one of the biggest challenges in the current caregiving community — trying to live with the holding pattern for those who have a new condition or need a new treatment,” Delgado says.
She also stresses the need to reach out and be a good neighbor, mentioning an 82-year-old Korean War widow in her neighborhood who has a son in a wheelchair. “It's challenging for her to get out and shop right now,” she says. “But it gives me comfort and lowers my stress to help neighbors during this crisis.”
Don Appel, a therapist and social worker in New York City, advises that we can counter physical isolation with emotional connections. Pick up the phone; send a text; reach out or connect with loved ones, friends and coworkers to mitigate against the anxiety surrounding COVID-19.
"Don't overwhelm yourself,” Appel cautions. “Information is important, but bingeing the news can be harmful. You need updated information regularly, but you don't need to immerse yourself in it 24/7."
It's also interesting how people within the same household respond to the same stress. “People in fragile physical conditions need to be hyper-vigilant interacting with others, even members of their own families,” Appel explains. “Relationships can fray under the strain of the different perspectives that individuals bring to this pandemic. Give your family or partner an emotional space. We all are fragile and stressed. Try to offer a little forgiveness and understanding."
Ultimately, it's helpful for all of us to remember that the present situation is not permanent. Every generation has had its challenges, and the key to getting through COVID-19 is to keep adjusting and adapting to new conditions or information.
"As humans, we are used to seeing safety in numbers,” Mackinday says. “Especially with combat veterans, the guys have each other's backs. It may feel like we are all on our own right now, but we really aren't. We just have to change the way we support one another."
"I'll be excited when our family can hug again,” Comeau adds. “As a caregiver, I live for hugs."
Caregiver tips from the Elizabeth Dole Foundation
• Embrace the ambiguity — acknowledge the “not knowing” and hold on to what you do know.
• There are ways to mitigate our risk, and we need to respect the fact that high-risk people will require extra vigilance.
• It's not a crime to take care of yourself — make popcorn and turn on Netflix, and turn off your phone.
• This is a great time for people to reconnect with their families. You can video-chat with loved ones, play board games, organize the family photos that are on your laptop, hold a movie night.
• Humans crave routine, so if life was just disrupted, be sure to establish a new pattern at home that creates familiarity.
• Take care of your mental health, and limit your time on social media. Recognize the things that cause anxiety and angst and eliminate them.
• Seek out information from reliable sources like the Centers for Disease Control and Prevention, AARP and local government sites. Always look for a source link back to an official site and click on it.
• Be proactive with your health care providers and ask how you can interact with them during this period of social distancing and quarantine.
• Take advantage of telehealth opportunities. People communicate with health care providers in different ways, and many offer the chance to connect through apps, websites, chat and texting. Physical therapy instructions, for example, can be sent via email or shown in videos online.
• We always feel better when we help other people. Find small ways to reach out, call old friends, join an email “help” list in the neighborhood or pick up items for homebound residents and leave them outside their door.
• "Adopt” a family in the community. If someone is facing challenges, reach out proactively by phone or email.
• Feeling prepared lowers stress. Think ahead in two-week increments. Plan for excursions and supplies, and don't look beyond that. Envision the future in bite-size, digestible chunks.
• Mindfulness and guided-imagery practices can be conducted at home, without a professional. There are many places online (such as aarp.org) to find information about alternative medicine and therapies.