In the Absence of Physical Presence

Physical presence means so much. Phone calls are good. Video connections can be better. But there is nothing like experiencing physical presence with the potential or reality of a hand on the shoulder, a hand in another’s hand, and a body-to-body hug.

But now we live in a strange and stressful time of necessary physical distancing with the COVID-19 pandemic. In these days and weeks (and months?) when we feel frightened and worried, the gifts and resources of presence are limited and restricted. We connect by phone, text, social media, and video—and thank goodness for these options—but we know they are not the same. They certainly help, but there is just no way they can be as powerful and comforting as physical, whole-body, whole-self presence.

In training healthcare professionals, the importance of presence is often emphasized. The goal is to be, no matter what one’s role, a “non-anxious, caring presence.” “Non-anxious” because those who are suffering—physically, emotionally, mentally, or spiritually—have enough anxiety on their own. They don’t need the burden of our anxiety, too. “Caring” because it’s not enough to be a neutral presence. We need to communicate connection and compassion in our presence. Effectively communicating caring is not a simple thing. It takes intentionality, awareness, sensitivity, and openness to another’s pain. While we often focus most on the words we say, people experience our caring more often through our body language, the expressions in our faces—especially our eyes—and the way we say our words. Two people can say the same words but leave a very different impression of caring and compassion.

Earlier in my career, I worked in pediatric oncology and was often on-call for my patients if they were in the hospital at what could be, or looked to be, the end of their lives. For most patients and families, I had been with them for the twisting and turning path from diagnosis through treatment to this time where treatment was no longer helpful. If I got a call in the middle of the night that death was near or had just occurred, I came. Entering the patient’s room, few words, if any, were needed. We knew each other as I had had the privilege of being there in good times and bad. My physical presence in the middle of the night did the speaking. It said, “I care about you. I grieve with you. I will help and support you any way that I can.”

In those pediatric cancer years, about once a month I would also be on-call for the whole hospital from midnight to 8 am. Sometimes I would be called because a patient who I did not know had died. In some ways, these were more difficult. For the families I knew, my presence carried layers of meaning because of our shared experiences. For these unfamiliar families, my presence was a question mark of meaning. I would enter the room as a stranger, and the family’s understandable thoughts were “who are you and why are you here?” It was still possible to be a “non-anxious, caring presence,” but it was much more of a challenge to connect and for the family to experience compassion.

We have all been there when the presence of family and friends made a difference. During times of crisis, when we’ve been in the hospital, and for funerals, it’s mostly presence that speaks to us. People often fumble for words, stand speechless, or say unhelpful things. But what matters most, what says the most, is that they came. There is no eloquence like presence.

Our experienced grieving selves know about the challenge of living in the absence of physical presence. We have lived with the deaths of family and friends. We have yearned for their touch and the experience of their bodies and their whole-self presence. But the comfort of their touch and physical presence was not to be found, and that loss brought deep, human grief. Our grieving selves learned, however, that we are not left without all presence. We have rich and layered memories. We carry an ever-increasing community of friends and family in our hearts—those we could never leave behind. Looking at our bodies and at our homes, there are pieces of presence everywhere. Clothes, jewelry, tattoos, pictures, mementos, and more. And stories, so many stories. There are times, too, when we experience presence in ways that we don’t always share with others for fear of skepticism or judgment. A red bird lights just outside our window or lands in our path. We hear a sound of a voice, feel a brush of something pass, catch a glimpse. We have dreams. In times of trial, we sometimes hear their voices in our heads and in our hearts.

Despite all these ways that presence manifests when physical presence is absent, we are left disappointed. These other expressions of presence are significant, but we understandably want more. Our grieving selves work to make a truce with this reality. We grieve the presence that is lost to us while we seek and cherish the evidences of presence left to us. What presence is left does not feel like enough, but our wiser selves understand that we can live as if it is enough. And for that presence left and possible, we are grateful.

Our grieving selves have much to teach us and others who may not have lived as long or as deeply in times of physical distance. It is possible to live, and even live well, in these circumstances, although it is not easy and we need not pretend otherwise. Sometimes we even grow in such times, but we should never burden ourselves or others with this obligation. Our best grieving selves have learned that there are seeds of presence to be found planted deep within us by our past experiences with those we love. Not as good as a hug, but a comfort nonetheless.

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Greg Adams, LCSW, ACSW, FT
Program Coordinator
Center for Good Mourning
[email protected]

Other Voices 

The minimization of death and grief related to older people has been commonplace for as long as I know. Just ask anyone who’s received “sympathies” like…

"At least he lived a good long life.”

“Don’t be sad; you had 80 good years with her.”

“It’s the natural order of things.”

Statements like these are often a misguided attempt to provide comfort to the person who’s grieving. But in reality, they can be quite minimizing. If you reread them – don’t they all seem like they could be followed with “…and so you shouldn’t be sad.”

When supporting a grieving person, it’s never advisable to try and point out a silver lining. Nor should you ever explain to a grieving person why they should feel any less devastated than they do. Someone they love just died, and they are entitled to all their pain. Continue Reading...

In the Spotlight

Especially in new and stressful situations, it can help to have examples of what to say to communicate clearly and with compassion. VitalTalk has an excellent resource just for these times. This playbook is a super-concentrated blast of tips that will enable you to navigate through your day with honesty, empathy, and compassion—in a way that is sustainable. See More


Particularly for Parents

PBS Kids is a great resource for parents looking for ideas and suggestions to talk with children about important but challenging topics—like the coronavirus. A great legacy for Mr. Rogers and Sesame Street. "When we can talk about our feelings, they become less overwhelming, less upsetting and less scary.” Read More


Living All the Way

“Our collective silence about death, suffering and mortality places a tremendous burden on the people we love, and on the doctors and nurses navigating these conversations. We should not be discussing our loved one’s wishes for the first time when they are in an I.C.U. bed, voiceless and pinned in place by machines and tubes.” Learn More

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For Your Library

Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others by Laura van Dernoot Lipsky with Connie Burk, Berrett-Koehler Publishers, Inc., 2009. 

This is not a new book, but it is a new book for me. Thankfully, someone recommended it in some venue in the past year, I ordered it, and it sat in my office waiting its turn for attention. Perhaps it was somewhat fortuitous that it came at this time of worldwide stress, suffering, and loss with COVID-19.

All of us are exposed to suffering and trauma in the world, and we are especially aware of that now with daily, and sometimes hourly, updates on deaths from the coronavirus pandemic. Some of us, however, are “up close and personal” with suffering and trauma in our work lives, sometimes for a long time. The range of individuals and work situations is broad and greatly varies: hospitals, paramedics and EMTs, fire fighters, law enforcement, animal shelter workers, child protective services, courts, environmental researcher and activists, domestic violence workers. And the list could go on.

Laura van Dernoot Lipsky knows this world. She worked with trauma survivors directly for over twenty years. Her experiences and exposure changed her and sometimes in unhealthy ways. She shares that she was visiting relatives in the Caribbean and stood on a cliff looking at a beautiful view. After acknowledging the beauty of the setting, she wondered how many people had killed themselves jumping off these cliffs, where would the helicopter land, where is the nearest trauma center, and on and on. It was time to explore more deeply had she had been influenced by her experiences and search for ways to live well in a trauma exposure world. The result was this book and more related work that can be found at

Trauma stewardship is a helpful concept and refers to a daily healthy practices and approaches for those working with pain and suffering of people, animals, and nature. The author insightfully describes sixteen different trauma exposure responses including a sense that one can never do enough, exhaustion, fear, guilt, and cynicism. Those of us who have worked in trauma fields will find much with which to identify. After thoughtfully describing the challenges of trauma exposure responses, there is a humane and helpful description of ways to respond differently—with intention, compassion, insight, and sometimes action. Principles of mindfulness are explored and integrated throughout the text. One of the strengths of the approach of trauma stewardship as presented is its breadth. Multiple ways of using and adapting the concepts presented are described and illustrated. Throughout there are quotes and New Yorker cartoons that both inspire and lighten the tone of the emotionally heavy content. There are also lengthy first-person accounts of people on the front-lines of trauma.

I wonder what my past work experiences would have been like if I had been provided this kind of information in the beginning. Perhaps some hard-earned lessons would have come sooner and with less burden. Maybe some of the ideas would not have resonated as they do now. Regardless, this book is for those up close and personal to the pain of the world whether you are just starting out or have been doing it a long time. Highly recommended.

Taking Questions: "Can you help my understand my grief?"

“We didn’t know whether it would be weeks or months, but we expected his death, and had prepared for it in the time leading up to it. We had the conversations we wanted to have, and the day he died, I was there to kiss his cheeks and massage his forehead, to hold his hand and say goodbye. I was at his bedside when he took his last breath. And yet, nothing prepared me for this loss. Can you help me understand my grief?”


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