Goodbyes in the Time of COVID

As COVID-19 has changed visiting policies in hospitals and other facilities, it has also changed how people say goodbye to the ones they love, and how we as social workers support them in saying those goodbyes. Anticipatory grief is happening virtually and in isolation, and part of our work during this pandemic is connecting families with patients, supporting them as they say goodbye, and acknowledging the loss of saying that goodbye in person. As a palliative care social worker, I have encountered many instances in which family members could not be present to say goodbye to the patient. Some family members are COVID+ themselves, are immunocompromised, or live across the country or world. While one healthy visitor is allowed to visit a patient who is imminently dying, predicting someone’s final hours and minutes can be difficult to do, and sometimes family are concerned about coming to the hospital and putting themselves at risk.

Technology has allowed us to support families in their grief, and for those who do not have access to a video camera, telephone communication has proved vital. There are some roadblocks to connecting families with patients- clinicians working remotely, a limited number of staff who are allowed to enter a COVID+ patient’s room, a high number of palliative care consults, limited technology that staff and family members have access to, and ever present technological glitches. Despite these barriers, my palliative care colleagues have wielded creativity, compassion, and collaboration to facilitate goodbyes, and share messages of love in a time of overwhelming death and despair.

Over the past several weeks, my team has been able to coordinate Zoom video meetings so that families can see their COVID+ family members at the end of their lives. We have set up Zoom meetings, disseminated the login information, and our physicians and nurses have brought iPads to patients so families could see their hospitalized family members. In instances where the physician cannot enter a patient’s room (either to limit exposure or to conserve PPE), and the patient cannot hear their families on the iPad, we have invited those in attendance at these meetings to write messages in the chat box, or to say messages out loud with the promise that we would deliver these messages to the patient. Over Zoom, families have joined together in grieving the loss of their family members who have meant so much to them, sharing memories and gratitude, and saying their goodbyes.

After these meetings, I have transcribed their written and spoken messages so they could be placed by the patient’s bedside. The physician on my team suggested I compile them into transitional documents for families, which they could continue to reflect on as the patient transitioned. I have emailed the documents to families with space for additional messages for those who had been unable (either logistically or emotionally) to join the call, and placed one-page abbreviated versions by patients’ bedsides so physicians and nurses entering the rooms could read brief messages to patient from their families. This interdisciplinary intervention aimed to facilitate connections between patients and families, and we hoped it would provide opportunities for care providers to connect with their patients as well. Working within the boundaries we had, we hoped to provide support, and were grateful that families could connect with patients and with one another through video and written text.

Another intervention we have used with caregivers for patients who did not have access to a video camera or smart device, and were unable to visit at the end of life due to visitation restrictions, was to pass on messages verbally. In circumstances where bringing a phone to the patient is not possible, I have asked friends and family members what they wanted to say to patients. They have shared messages such as “You are not alone” and “I love you.” These messages are then imparted to the patients by physicians, nurses, and social workers. It is so important for friends and families to know that, though they are not with them physically, their messages will be delivered.

Collaboration has always been inherent in palliative care, though I have never been as grateful for it as I am now. As families and patients remain in quarantine, healthcare workers are bringing people together virtually in a number of creative ways, and palliative care social workers are uniquely positioned to provide anticipatory grief support to the families and friends of patients with COVID-19. As we navigate the psychosocial impact of COVID-19 on grieving families, we can continue to explore new ways of facilitating communication and share our newfound interventions with each other.

Kasey Sinha, Palliative Care Social Work Fellow at Mount Sinai Beth Israel in New York, NY. SWHPN is accepting guest submissions on COVID-19 practice and interventions at [email protected].

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Comments on "Goodbyes in the Time of COVID"

Comments 0-5 of 4

Kasey Sinha - Thursday, May 28, 2020

Thank you, Grace, Allyson, and Allie. I am in awe of all the work you and our social work colleagues are doing right now for patients and families.

Allie Shukraft - Monday, May 18, 2020

What a wonderful post Kasey -- thank you for sharing your work, and your voice!

Allyson Galishoff - Thursday, May 07, 2020

Kasey, I am so glad I was able to see the wonderful work you are doing at Mount Sinai Beth Israel. Incredibly impressive how you have put together such meaningful ways to connect patients with loved ones during this awful time.

Grace Christ - Thursday, May 07, 2020

Beautifully written description of your many inventive approaches you use to provide connections between loved ones and COVID patients - below is note I put on the list serv about the impact of these on the grief process as well as solace in the moment!! Impressive Kasey! Grace Christ, PhD, SWHN Board. My comments on the list serv I applaud all of the social workers on this list serv and those participating in SWHPN online groups for the continuous efforts to facilitate visits/connections between dying patients and their loved ones: virtual if not in person within the limits of safety!! So important if it is possible. yes, it is overwhelming to hear their sorrow in the moment and their grief may be complicated. As it was for 3500 individuals after the 9/11 destruction of the world trade center. The Columbia University/FDNY family program I directed provided an intervention for a cohort of firefighter families for 5 years after that event. Even when remains of the firefighter were never found, rituals, aftertalk, emotional support, cognitive restructuring etc enabled them, including many children, to work through their grief. It can be done. Any efforts to connect now will help COVID family survivors over time as well. Important to hear all the methods people are using!!! Thank you for your indefatigable efforts to provide connection and shelter in this extraordinarily difficult situation.

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