By Peg Newman
Please note: Patients and staff names have been changed and details that could identify individuals have been changed.
It’s easy to forget what those first months were like. I drove to work on the Southeast Expressway; a highway once clogged with rush hour traffic was near empty. COVID followed everyone everywhere – TV, radio, print media, the Internet, signs on doors to any stores still open. Phone calls with family members and friends were dominated by stories about COVID. Any news predicting a vaccine was always exciting but most stories were about hardships, isolation and death.
Brigham and Women’s Hospital where I worked as a chaplain had the intensity of a war zone. I remember walking down hallways on the COVID floors and glancing into the rooms as I went by. Room after room had patients on ventilators, a scene mimicking a futuristic movie about the end days. Some hospital entrances were closed and staff were rerouted to enter at one of two entrances where staff were required to put on fresh masks, cleanse their hands, and attest on line or via cell phone that they were symptom free.
Elevators posted occupancy limits with people waiting for space as they stood in socially distanced lines. Administrative staff whose jobs could be put on hold were redeployed to fill newly created roles like monitoring safety procedures and managing the ever-increasing need for equipment and supplies. People installed Plexiglass dividers in the cafeteria, offices, and places like the emergency room waiting area with unavoidably close seating.
It took time to get used to wearing personal protective equipment. To be optimally effective, two tight fitting rubber straps held in place the first N9 masks that stretched to the back of your head. Those masks were so tight that people who wore them for a half hour or more usually had indented marks across their cheeks. At first the gowns, another form of PPE, were made of a strong paper-like material but after their depletion, the new ones consisted of a plastic that didn’t breathe. In other words, if you got warm, you got sweaty. The plastic face shields were challenging especially for people who wore glasses, the clear plastic fogging up with the moisture of one’s breath. Being one of those glass-wearing people, I ordered various products on line that were supposed to eliminate the fog – sprays, treated cloth, rub-on creams – but none of them worked.
Before leaving a room, we had to discard our gown and gloves in the trash by the door. Then, entering the hallway, we cleansed our hands with alcohol, put on fresh gloves, and removed our face shields. Next, we used sanitizing wipes to disinfect our face shields before we slid them back into a plastic bag or hung them on a hook in the hallway. In case that process left a droplet of COVID on our gloves, we pulled them off inside out and then discarded them. After cleansing our hands and putting on new gloves, we removed our N95’s and placed them in plastic containers. Peeling off our final pair of gloves, we put our regular masks back on and cleansed our hands with alcohol.
In the early days when donning and doffing (putting PPE on and off) procedures were rigorously adhered to and limited supplies meant masks and face shields had to be reused, five pairs of gloves had to be put on and taken off to avoid contaminating N95’s and face shields. Those of us who went from one floor to another had to carry our PPE in a brown paper bag (like a grocery store bag) wherever we went. To be safe, we had to follow this laborious protocol with new patients who had not yet received negative test results that ruled out COVID.
From the environmental staff who cleaned patient rooms to the food service workers who delivered meals and picked up trays, everyone’s job took on a new intensity but the nurses bore the largest share of stress. It was more than just the long hours spent with patients and learning new strategies to care for those patients with a new, sometimes unpredictable illness. It was nurses who most often talked to family members, sometimes taking several calls during their 12-hour shifts. Listening to a mother’s fears, a son’s angry questions, or an elderly husband’s confusion took an emotional toll. Sometimes their questions left no answers. Often reassurance was the only thing that could calm the anxious person on the other end of the phone, but when the prognosis was grim, there was little the nurse could say.
One night I got on an elevator with a nurse I didn’t know. Coat on, on her way home, she glanced my way. Seeing my ID with the word “Chaplain” in bold letters, she looked at me and said, “I’ve been a nurse for over 30 years and I’ve never, never, seen anything like this. This kind of suffering, all the deaths. Sometimes it doesn’t feel real. But then you see it is real.” Getting off the elevator, she added, “And then you come back tomorrow and do it all again.”
I wondered what I could possibly have said if time permitted a response. I was in awe of the nurses who spent their days in patient rooms on the COVID floors, especially the ICU’s. I tried to offer words of support and concern for their well-being but I felt terribly ineffective. I knew I made a difference with patients and their families but with nurses I feared sounding patronizing or insincere and the right words were sometimes hard to find.
Both freshly minted residents and well-seasoned doctors had to find ways of coping as they faced new challenges and many deaths. One night I was paged: “EOL prayer COVID, Janet Jones rm 909.” EOL means end of life. I quickly looked up Janet’s information. She was 54 and a Catholic who had received the Sacrament of Anointing of the Sick two days earlier. I grabbed my brown paper bag of PPE and headed to the ninth floor. When I arrived, I was surprised to see four doctors huddled, talking quietly outside Janet’s room.
Visitors were not allowed in the hospital but an exception was sometimes made when a patient was actively dying. “Is their family in the room?” I asked.
“No,” replied one doctor, the only female in the group. “Our patient died alone. We got to know her pretty well. We were hoping you could offer a prayer. We have iPads. I can go in the room with you and the others can stay in the hall on Zoom.”
Properly suited up, we went into the room. I asked, “Can you tell me about Janet?”
The doctor started to give me medical information, but quickly realizing I was looking for something more personal, she explained, “I didn’t know her that well but everyone really liked her a lot. She had a great sense of humor and was so grateful for anything you did for her. I know she has two grown children. Gary called her daughter a little while ago. He said she was pretty broken up.”
Aware of the three doctors waiting in the hallway, I unfolded my paper with the traditional Catholic Prayer of Commendation and read it slowly, pausing where I always paused, hoping as I always hope that the words offer comfort. Then I added a few words of my own, asking for comfort for her family and the doctors and nurses who gave her such wonderful care. The doctor added, “Rest in peace Janet. You put up a good fight. Thank you for being such a great patient.”
Walking down the hallway toward the elevator, I thought about how unusual my visit had been. I appreciated meeting a group of doctors who felt the need to pause, take in the sadness of the moment, and honor their patient. I wished that sort of thing happened more often. I was reminded that all of us in every role had inner lives that were not often shared with others, sorrows that could grow lighter if shared with others.
Banning visitors from the hospital was no small matter, not for the patients and not for their loved ones. The threat that a visitor could bring COVID into a setting where people were already sick left no room for discussion. The threat was real. Also real were the fear and loneliness the patients had to endure – the increase of their fear and loneliness, the grip of anxiety and worry among family members. Some relatives sat in parked cars outside the hospital just to be close to their loved one.
In those first weeks and months, the chaplains connected patients with their families, sometimes through FaceTime, more often with family Zoom calls. It didn’t matter if the patient was intubated and non-responsive – families wanted to see their loved one. Some nights all I could do was set up Zoom calls. Not being tech-savvy, I found the logistics challenging, but I saw how important these calls were. On some calls, there were family members scattered across the country who came together remotely to talk to each other as well as to the patient.
One call in particular showed me the impact a Zoom call could have. The patient was an 80-year-old woman named Bernice. Her son requested the call and wanted to include Bernice’s two sisters. The three sisters in this loving and prayerful family turned out to be triplets. Bernice was intubated and medicated for comfort. Her short white hair was neatly combed, her skin pale. She looked uncomfortable with the breathing tube extending from her mouth to a machine at the side of her bed. Entering the room, I set up the call and then prepared the family members.
“I think you all know that Bernice has a tube in her mouth that helps her breathe. Sometimes family members are distressed when they see this but it’s there to make sure a person gets enough air into their lungs. To keep Bernice comfortable, they give her medication so she won’t be able to respond to you but it’s very likely she can still hear you.”
Adjusting the position of the iPad so everyone could see Bernice, I suggested, “Why don’t you talk for a while before we pray.”
“Bernie,” both sisters called to her at the same time. Bernie opened her eyes for just a moment and everyone knew she was there with them. Her son and each triplet told her how much they loved her and that they were praying for her. If Bernice could have spoken, she could not have found words more meaningful than her silent moment of connection.
Bernice was not the only patient I saw who broke through the haze of an intubated and medicated state shortly before dying. Marty’s wife Evelyn was at his bedside. Their four adult children and a few other family members had gathered in one person’s home to see Marty on a FaceTime call and to be there to hear the prayers when the chaplain arrived.
After a few minutes of conversation with Evelyn, I asked if it was a good time pray. She nodded. I explained that I was going to pray the Christian Prayer of Commendation which is a sending forth, a time when we will ask Jesus and all of Marty’s loved ones who have gone before him to welcome him home.
Then, as I often do, to include the family more actively in the prayer, I asked that we pray together the Lord’s Prayer. Shortly after we began, Marty, though silent, began to move his lips. It might have been the sound of his family’s voices or the familiarity of the words from a lifetime of praying the only prayer that Jesus taught his followers, but Marty moved his lips, clearly trying to pray with us. His family knew he could hear them and that he could take their last words with him as he died.
One of his daughters suggested that the family sing together. A young voice loudly suggested “This Little Guiding Light of Mine.” The words go on from that phrase to say that the light will continue to shine. It can’t be hidden under a bushel basket. It ends, “let it shine, all the time, let it shine.” I suggested to everyone in Marty’s family that it was his light that would continue to shine because they would be carrying his light in their hearts for the rest of their lives. Just as I thought my comment may have sounded trite or corny, I noticed the nurse who had stayed in the background nodded as the tears rolled down her cheeks, my comment reminding myself that it’s often the simplest things, words or deeds, that can have the greatest impact.
Chaplains often reassure one another that it’s okay if patients see you cry – as long as you’re not sobbing – because it communicates your care and concern. I’ve said that to student chaplains a number of times but during the worst days of COVID, I found that I wanted – needed – to be in control of my emotions. My feelings, positive and negative, felt very close to the surface. I sometimes found the smallest thing incredibly touching and meaningful when in truth it was ordinary, something I would barely react to in normal times – a compliment from a patient or a family member or the offer from a colleague to make me a cup of tea.
More troubling was the tendency I had to lose patience or get angry much too easily. Looking back, I see that I had little compassion for chaplaincy residents who had a hard time dealing with COVID. Fortunately, I knew enough not to verbalize my thoughts. I suspected I was being judgmental and perhaps unfair but what I really wanted to say was, “If you can’t deal with this, you have no business being a chaplain.”
Though COVID swept through the hospital like a tsunami, it also called forth generosity. Restaurants wanting to acknowledge the nurses and other staff sent in prepared meals at no cost. With the arrival of spring, people donated dozens and dozens of pots with bright yellow daffodils for staff to take home. Others papered bulletin boards with notes mailed to us by appreciative family members and sometimes with notes from appreciative COVID survivors. Shown hanging were enormous signs throughout the city thanking hospital staff for their service. There was even a billboard expressing gratitude. Passing it every day on my way to work, I felt reassured that people knew what was going on in our hospitals and nursing homes and appreciated what staff were experiencing. It made a difference.
A team of four priests volunteered to help. They moved into the dormitory of a nearby college and responded to emergency calls in the city’s four largest hospitals. The priests were generous with their time, compassionate, and willing to do more than just the sacramental visits for which they had signed up. If they were afraid or even just nervous to be close to people with COVID, they hid it well. They donned their PPE like everyone else and graciously told the nurses how much they appreciated the work they were doing. Their ministry often extended to calling family members to offer comfort. They made me proud to be Catholic.
I was also proud to be part of the team that provided care at Brigham and Women’s Hospital and there was something we did that reminded me to feel good about our work. When a COVID survivor was being discharged, an announcement was made over the PA system beckoning all available staff on the first floor to come to the front entrance where a nurse or a family member would be pushing the patient’s wheelchair through the lobby toward the door. Everyone clapped and cheered and offered congratulations. Though we congratulated the patient on their recovery, we also expressed our acknowledgement of the difficult work of a large team of dedicated staff. It was so easy to dwell on the losses; important was the reminder of a great many successes.
Staff in all departments needed things that made them feel good, not just because of the work they did at the hospital, but also because of the dealings in their personal lives. None of us were immune to losing loved ones. I was in the office one morning when Sally called. She didn’t tell me her position but she said she worked at the hospital but now she was a patient. At first, I thought she called to ask for a chaplain to visit her but then she explained, “I’m hoping you can visit my father. He’s a patient too. My mother was a patient but she died a few days ago. We all got COVID at the same time. My father is sick but I think he’s suffering more from a broken heart than from COVID. I’m getting better but I know my father thinks I’m not telling him how sick I am. He keeps saying he can’t lose me too. Could you reassure him and maybe pray with him?”
Everyone – chaplains, nurses, maintenance workers, phlebotomists, kitchen staff, security guards – brought COVID home with us. For some it was fear or anger. For others it was a feeling of helplessness or even despair. For me, it was patients. The idea of leaving work at work has long been considered a part of good mental health for people who work in human service. It’s spoken of as if it’s actually a choice. I can only speak for myself. It’s not always a choice. Even though I try, sometimes there are people I just can’t leave behind.
Such a person was Chuck. I was paged to the ER to provide support for the husband of a woman who died of COVID. Donning my PPE, I stepped into the room where a man stood holding his wife’s hand. After the usual phrases like “I’m so sorry for your loss”, I asked Chuck to tell me about Coco, his wife. Often people say only a few things that come to mind but Chuck took the opportunity to tell me about everything from their courtship to the birth of their children and then their grandchildren. I felt like I almost knew her – her love of gardening, her belief that she was an excellent cook (secretly debated by those close to her), her philosophy on raising children, and much more.
Just as I thought the visit was beginning to wind down, Chuck began to tell me about the day, the hours before she died. Coco had been sick for a couple of days but over the course of this day, her breathing was becoming more and more labored so he decided to bring her to the hospital. Due to her weakness and trouble staying awake, he settled her into the back seat where she could lie down. While driving, he could hear the worsening of her labored breathing. Sometimes several seconds would pass between breaths. This time seconds passed and then a minute. Chuck knew Coco had died.
“I didn’t know what to do. I couldn’t turn around and bring her home. I wanted to pull over and get in the back seat with her but I was afraid I’d fall apart and I wouldn’t be able to drive so I just kept driving. When we got here, I didn’t tell them I knew she was dead. They put her on a stretcher and brought her in.” Chuck was choking back his tears.
We prayed together and then I walked with Chuck back to the area where he’d left his car. We hugged. I watched as he walked over the valet who had parked his car. I wanted to walk over and wait with him. He looked so alone. However, my pager reminded me that there were other people waiting for me to visit. The memory of my time with Chuck and Coco came home with me that night and stayed with me a long time.
Though there were times when I was exhausted physically and emotionally, I never had to wonder if my physical and emotional energy would return. I’d had plenty of practice during the early years of the AIDS pandemic when I ran a residence for people approaching the end of their lives. I’m drawn to suffering; it’s not where I live now but it’s familiar territory. The more painful or difficult a situation is, the clearer it is to me that I might be able to make a difference. Most situations I face in my work cannot be fixed, but making a difference makes a difference to me. It’s what I’m called to do.
Peg Newman is a certified chaplain who lives and works in the Boston area. For nine years she ran a residence for people with HIV/AIDS but when AIDS was no longer a terminal diagnosis, she returned to school to become a chaplain. She has worked in large city hospitals as well as several different prison settings. Currently she is writing a memoir.