Life and Death in Quarantine
As the weeks go on and COVID-19 continues to take its toll, it feels as if death is staring us in the face day after day, while we grapple with redefining our lives. It has become pretty clear over the past few weeks and months that coronavirus is not the great equalizer, as many had optimistically claimed, nor is it a unifying force, as our country is more divided than ever. But it does seem inescapable. Everyone is directly impacted, whether they contract the virus or not. Everyone's relationships, family dynamics, values, and sense of self have changed. The way we view ourselves and our place in the world has changed. Coronavirus has spared no one.
Working in healthcare, the atmosphere is tense. Anxiety is palpable. There's a sense of impending doom, like we're just waiting for the shoe to drop. We're pacing ourselves, recognizing that this is a marathon, not a sprint, and this race might just be beginning. I hear stories and read articles about New York and wonder if that will be us, and how soon. When I arrive at work (after getting my temperature taken and donning my mask for the day), the first thing I want to know is how many COVID patients we have, and is the count more or less than yesterday, and how many are on ventilators, because our hospital population is reflection of the entire local community. Navajo Nation, west of Santa Fe, has the highest per capita rate of COVID-19 infection (outside of NY and NJ), and the death toll is rising. Our hospital has joined the efforts to help care for these patients as their local hospitals are over capacity and overwhelmed, so it is likely that our numbers will continue to escalate.
Besides our COVID population, I have observed that people are fearful to come to the hospital, so they are waiting longer at home, getting sicker with other chronic medical conditions and needing a lot more help once they do arrive. People are fearful of clinics, or they lost their health insurance when they got furloughed, or they no longer have reliable transportation or social support, just a few of the factors that contribute to less preventative care and wellness visits. I have also observed a scary influx of patients whose conditions are exacerbated by psychiatric illness, stress, and altered mental status. Everyone is scared. People are having mental breakdowns. Depression is amplified. It's becoming increasingly apparent that COVID will continue to severely impact people's mental health for many months or years to come. And the reality of really sick people in the hospital without any visitors, sometimes unable to contact any friends or family members, sometimes nameless or listed as "Jane Doe" or "Criticalcare 1" in the medical record, often dying alone, is devastating.
The cancelation of elective surgeries and office visits is also taking its toll. There is a very blurry line between "urgent" and "emergent," so many people are suffering in pain and fear as they await surgeries and treatments. I'm trying (from a distance) to support my own family members as they cope with the ambiguity and uncertainty of canceled surgeries, postponed diagnostic tests, rescheduled procedures, and prioritization of patients. In our healthcare system, we aren't accustomed to the concept of distributive justice or allocation of resources. We are used to having unlimited access to any tests or procedures prescribed, and now patients are faced with being told that they have to wait because their illness or condition is not as emergent as someone else's. But who's to say that one person's suffering is greater or less than another's, or that the delay won't negatively impact their recovery?
I unfortunately got a glimpse into what my patients and their families may be experiencing as we lost a member of our own family last month after an extensive hospital stay. My fun and joyful father-in-law died in Sioux Falls after a long battle with chronic conditions and end-stage multi-organ failure. Hospitalization during a pandemic is really hard mentally and emotionally for everyone involved. Patients are depressed and lonely when they can't have visitors. Nurses and physicians can be overwhelmed by constant phone calls from concerned family members. There may be shortages of medications or equipment while hospitals fight to provide care to COVID patients in their ICUs. And families may struggle to paint a realistic picture of their loved one's prognosis or the severity of their illness when they can't seen his or her face. We were fortunate to be able to FaceTime with Grandpa while I was on maternity leave, and have two Zoom calls with the whole family in the final weeks of his life, but we lack genuine connection when using technology, I think. After he died, there was a small ceremony attended by immediate family only, as social distancing orders prohibited large gatherings. Even though my father-in-law (thankfully) did not contract COVID or suffer from respiratory failure, COVID impacted his hospitalization, his end-of-life care, and the family's ability to fully grieve him. The one blessing through Jeff's end-of-life journey was that his wife and younger son could visit him in the final hours of his life after he was transferred to the hospice unit, and he was also surrounded by love and prayers from those who couldn't be at his bedside.
I read a beautifully written article in the New Yorker last week entitled Reinventing Grief in an Era of Enforced Isolation that really hit home for me. The author, Lauren Collins, describes her experience of losing her father to leukemia during the pandemic. Quoting a piece written by a reporter friend of hers, she says, "'We may be about to confront death on a scale few of us have ever known, while being stripped of time-honored consolations: wakes, funerals, shivas,' it read. 'When the hour calls for togetherness, we will be apart.' It felt strange knowing that my family and I were now members of a 'vanguard' that we’d never aspired to join, reinventing grief in an era of enforced isolation." Later she writes, "My father’s death was complicated by the coronavirus, not caused by it. Losing someone you love in the midst of a pandemic that has taken more than two hundred thousand lives is a great lesson in proportion. In a way, mourning under quarantine has a sense to it. Pain is cruel because it doesn’t stop the world from turning, but, for now, the world has stopped turning, relative to its usual pace." My own family dynamics are further complicated by my husband's requirement to quarantine at home for two weeks after traveling out of state to support his family after his father's death. All of this uncertainty makes it difficult to fully grieve a great man.
All of our lives are complicated by coronavirus whether our friends and family test positive for the virus or not. It has altered our sense of time. The world is still turning, time is passing, and sometimes it feels very fast while other times it seems to be standing still. We try to adapt to a world without my father-in-law in it, a world where we can't have the physical togetherness that we crave, a world where we have to support each other in different ways.
And at work, all the uncertainty makes it difficult to fully support each other, and fully grieve our patients, and fully embrace humanity and dignity in the midst of a pandemic. Yet we do our best to appreciate life and death. We seek self-care in the form of humor. We share funny memes and videos and stories about our families. We eat good food and celebrate craft donut deliveries. We may be as sad and scared as our patients, but we support each other and express gratitude for the human connection that we are lucky to experience.
Working in healthcare, the atmosphere is tense. Anxiety is palpable. There's a sense of impending doom, like we're just waiting for the shoe to drop. We're pacing ourselves, recognizing that this is a marathon, not a sprint, and this race might just be beginning. I hear stories and read articles about New York and wonder if that will be us, and how soon. When I arrive at work (after getting my temperature taken and donning my mask for the day), the first thing I want to know is how many COVID patients we have, and is the count more or less than yesterday, and how many are on ventilators, because our hospital population is reflection of the entire local community. Navajo Nation, west of Santa Fe, has the highest per capita rate of COVID-19 infection (outside of NY and NJ), and the death toll is rising. Our hospital has joined the efforts to help care for these patients as their local hospitals are over capacity and overwhelmed, so it is likely that our numbers will continue to escalate.
Besides our COVID population, I have observed that people are fearful to come to the hospital, so they are waiting longer at home, getting sicker with other chronic medical conditions and needing a lot more help once they do arrive. People are fearful of clinics, or they lost their health insurance when they got furloughed, or they no longer have reliable transportation or social support, just a few of the factors that contribute to less preventative care and wellness visits. I have also observed a scary influx of patients whose conditions are exacerbated by psychiatric illness, stress, and altered mental status. Everyone is scared. People are having mental breakdowns. Depression is amplified. It's becoming increasingly apparent that COVID will continue to severely impact people's mental health for many months or years to come. And the reality of really sick people in the hospital without any visitors, sometimes unable to contact any friends or family members, sometimes nameless or listed as "Jane Doe" or "Criticalcare 1" in the medical record, often dying alone, is devastating.
The cancelation of elective surgeries and office visits is also taking its toll. There is a very blurry line between "urgent" and "emergent," so many people are suffering in pain and fear as they await surgeries and treatments. I'm trying (from a distance) to support my own family members as they cope with the ambiguity and uncertainty of canceled surgeries, postponed diagnostic tests, rescheduled procedures, and prioritization of patients. In our healthcare system, we aren't accustomed to the concept of distributive justice or allocation of resources. We are used to having unlimited access to any tests or procedures prescribed, and now patients are faced with being told that they have to wait because their illness or condition is not as emergent as someone else's. But who's to say that one person's suffering is greater or less than another's, or that the delay won't negatively impact their recovery?
I unfortunately got a glimpse into what my patients and their families may be experiencing as we lost a member of our own family last month after an extensive hospital stay. My fun and joyful father-in-law died in Sioux Falls after a long battle with chronic conditions and end-stage multi-organ failure. Hospitalization during a pandemic is really hard mentally and emotionally for everyone involved. Patients are depressed and lonely when they can't have visitors. Nurses and physicians can be overwhelmed by constant phone calls from concerned family members. There may be shortages of medications or equipment while hospitals fight to provide care to COVID patients in their ICUs. And families may struggle to paint a realistic picture of their loved one's prognosis or the severity of their illness when they can't seen his or her face. We were fortunate to be able to FaceTime with Grandpa while I was on maternity leave, and have two Zoom calls with the whole family in the final weeks of his life, but we lack genuine connection when using technology, I think. After he died, there was a small ceremony attended by immediate family only, as social distancing orders prohibited large gatherings. Even though my father-in-law (thankfully) did not contract COVID or suffer from respiratory failure, COVID impacted his hospitalization, his end-of-life care, and the family's ability to fully grieve him. The one blessing through Jeff's end-of-life journey was that his wife and younger son could visit him in the final hours of his life after he was transferred to the hospice unit, and he was also surrounded by love and prayers from those who couldn't be at his bedside.
I read a beautifully written article in the New Yorker last week entitled Reinventing Grief in an Era of Enforced Isolation that really hit home for me. The author, Lauren Collins, describes her experience of losing her father to leukemia during the pandemic. Quoting a piece written by a reporter friend of hers, she says, "'We may be about to confront death on a scale few of us have ever known, while being stripped of time-honored consolations: wakes, funerals, shivas,' it read. 'When the hour calls for togetherness, we will be apart.' It felt strange knowing that my family and I were now members of a 'vanguard' that we’d never aspired to join, reinventing grief in an era of enforced isolation." Later she writes, "My father’s death was complicated by the coronavirus, not caused by it. Losing someone you love in the midst of a pandemic that has taken more than two hundred thousand lives is a great lesson in proportion. In a way, mourning under quarantine has a sense to it. Pain is cruel because it doesn’t stop the world from turning, but, for now, the world has stopped turning, relative to its usual pace." My own family dynamics are further complicated by my husband's requirement to quarantine at home for two weeks after traveling out of state to support his family after his father's death. All of this uncertainty makes it difficult to fully grieve a great man.
All of our lives are complicated by coronavirus whether our friends and family test positive for the virus or not. It has altered our sense of time. The world is still turning, time is passing, and sometimes it feels very fast while other times it seems to be standing still. We try to adapt to a world without my father-in-law in it, a world where we can't have the physical togetherness that we crave, a world where we have to support each other in different ways.
And at work, all the uncertainty makes it difficult to fully support each other, and fully grieve our patients, and fully embrace humanity and dignity in the midst of a pandemic. Yet we do our best to appreciate life and death. We seek self-care in the form of humor. We share funny memes and videos and stories about our families. We eat good food and celebrate craft donut deliveries. We may be as sad and scared as our patients, but we support each other and express gratitude for the human connection that we are lucky to experience.
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