As doctors, nurses and first responders have tended to the physical devastation wrought by the pandemic, my friend, the Fort Worth, Texas, grief therapist Dr. Patrick O’Malley, and his colleagues have been working to help us cope with the profound emotional, psychological and spiritual challenges of this moment.

I was Patrick’s co-author of the 2017 book “Getting Grief Right: Finding Your Story of Love in the Sorrow of Loss.” More recently he has been interviewed for several national media reports on the COVID-19 crisis, the latest being mental health-related articles in the Huffington Post. I spoke with Patrick about a month ago as the pandemic took hold. A few days ago, I followed up.

Much of our talk this week centered on the agonizing choices people will be forced to make as the pandemic continues and the nation reopens.

Tim: In our book, we invite grieving people to explore the story of their losses in three chapters. The first is life with a loved one before death; the second the circumstances of the death itself, which includes the funeral and other grieving rituals; then there is a third chapter, when the last casserole dish has been returned and a grieving person must once again face life. I gather you think that analogy is relevant here.

Patrick: I do. There was life before COVID-19, the first chapter; then the traumatic response to the pandemic and all the disorientation that was part of that. That came so quickly. It’s stunning when you think back about it, the massive story that unfolded in days and hours. That was the death, if you will.

And now, since maybe late April, when we started talking about reopening, there is a new round of worry, a new round of anxiety. This to me is the beginning of the third chapter of this. As is the case with loss through death, this Chapter 3 is going to go on and on. The impact of this loss is going to have a long story to it.

To continue the grief analogy. A person’s life is going swimmingly, then his or her partner dies suddenly and tragically. The grieving person has some time to tend to the trauma. But now, their employer says, ‘It’s time for you to get back to work.’ For the grieving person, the disorientation and everything associated with the trauma doesn’t stop when Chapter 3 begins. That all bleeds into it. That’s what we’re going through now. We’re at the beginning of this long chapter.

Tim: What does that look like for the people you talk to?

Patrick: Basically, what I’m hearing is this: ‘I don’t know what to do.’ We’re in a period of integration and adjustment with mass confusion because of the mixed messages that are coming out.

Tim: In some ways, it was much less complicated when everyone was under lockdown.

Patrick: The new loss of control is ramping up some worry. In the beginning, I’m a worker and everything is shut down. I’ve got no choice. I’ve got toilet paper. I’ve got food. I get it. We were all learning in those first two weeks. Masks. Gloves. Six feet apart. But now, for a lot of folks, that control is gone. Instead, there are so many decisions about balancing health against jobs and finances.

Tim: As a therapist, how do you help people sort that out?

Patrick: I always start with affirmation. You’re not going crazy. It feels crazy. It’s  a crazy making time. But if you’re confused, that’s not a failing on your part. You don’t have enough information to know exactly what to do. Realizing that there are no perfect answers, we just have to ask ourselves these sorts of questions: What control do I have? What risk can I live with? Where do I have to stretch my risk tolerance to take care of my finances? It’s really a matter of giving people assurance that everybody’s plan is going be pretty choppy right now.

Tim: It also seems this new reality is also going to require some very delicate and difficult decisions when it comes to interacting with family and friends.

Patrick: It is. In this next chapter, I’m hoping that people can understand and respect each other’s risk management differences. If you say to me, ‘I want to come over for a visit,’ and I’m aware that I’m your fifth stop that night, I’ve got to be willing and able to say. ‘I’m not comfortable with that.’ And you’ve got to be willing to accept that I’m more conservative about this than you.

Like we’ve said, this chapter is not perfectible. You’ve got to make your best guess, based on your own best information, about what works for you and your family. I think ultimately most of us are going to have to accept some risk. But again, what is the level of risk you can live with? Then it’s important to be assertive with other people and say, ‘I’m sorry, but I’m not comfortable seeing you.’ I’m starting to see a more couples and families getting together with other families that they know have been following similar health protocols — and not seeing families who haven’t.

Tim: Like we said. Complicated and scary. It can be daunting to think that this is going to go on for a long time.

Patrick: It’s certainly normal to think about this in the long term, but it’s important to break the stress of this down into smaller parts and smaller units of time. What do I need to tend to in the next 14 days? Are there any decisions I need to make by this time next week? Try to play small ball on that.

In the meantime, as we’ve said, know that resurgence of worry right now is perfectly normal. Try to listen to your worries and see if you can get some information from them. Healthy worry helps you risk manage. It helps you protect yourself and think things through.

I also encourage people to keep an eye on the difference between useful worry and obsessive worry. Is worry producing some new ideas? Is my worry helping me risk manage? Is there something productive to it? Or is it nonproductive and I’m just stuck in a loop? If that’s the case, you might say to yourself, ‘I’m worrying in a way that’s draining my energy.’ But that’s hard to do. It’s fine line.

The key for dealing with most anxiety is to be able to objectify it. ‘OK, I’m doing that again.’ Externalize it. ‘Of course I am, these are hard times.’ And then redirect energy. ‘What do I need to look at right now?’ Some people need to use that ritual dozens of times a day because they can drift into obsessive worry.

Tim: This has been a remarkable time in terms of the best of the human spirit manifesting itself, most obviously in the heroism of doctors, nurse and first responders. But my sense is that sadness is everywhere. Do you get that?

Patrick: I do. With the majority of folks I talk with, there is an abiding sense of loss. Last time we talked I might not have seen my grandkids for a week. Now it’s been four. So there has been a deepening of that.

But I’m also hearing some incredible stories. There are people, who are financially secure enough, who say that they never could have slowed down to this pace otherwise. They don’t want to go back to the pace of their lives before. There’s a lot of tragedy and sadness and stress, but there is a lot of reviewing and reorienting to what’s big and what’s small and what values are. There also is a transforming going on.

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To purchase “Getting Grief Right” click here.