Healthcare workers have the task of being with COVID patients in their last minutes of life. Chaplain, Sherry Perry, talks about the challenges and encourages our staff as they offer their expertise and care.
Rosemary Cope: Welcome to this edition of the Vanderbilt Health and Wellness wellcast. I am Rosemary Cope with Work/Life Connections. Our guest today is Sherry Perry. Sherry is the staff Chaplain at the Vanderbilt University Medical Center, who will be helping us to explore how our hospital staff are emotionally impacted by the pandemic. There was a patient, a 75-year-old man, who was dying in his local hospital. No family members were allowed in the room with him, only one female nurse. He was not even Ryan's patient, but everyone else was slammed. So, Ryan wore full protective gear, dimmed the lights, turned on soothing music, freshened his pillows, held his hand, spoke softly to him and held an iPad close to him so that he could hear the voice of a grief-stricken family relative over Skype. After he died, Ryan wept in a hallway. A few days later, he privately messaged Dr. Heather Farley, who directs a comprehensive staff support program at Christiana Hospital in Newark, Delaware. "I'm not the kind of nurse that can act like I'm fine, and that something sad didn't just happen," he wrote. Another nurse reported that she has nightmares that, "I won't have my PPE. I worry about my patients, my co-workers, my family, myself. I can't turn my brain off." The COVID-19 pandemic is causing unprecedented anxiety and stress for all of us and its unique circumstances make coping difficult. For healthcare workers immersed in the fight against coronavirus, the burdens are incredible, fearing for their personal safety, stress and increased demands, and the pain of witnessing lives taken too soon. Sherry, in your role as a Chaplain, what have you observed about how Vanderbilt members are dealing with the emotional strain of their jobs? What sort of things would you encourage them to do?
Chaplain Sherry Perry: Well, Rosemary, what powerful stories you highlighted here. All of these stories resonate with Vanderbilt staff members here as well because we have experienced very similar ones and there have been moments just like these here over the past months of this pandemic. There have been moments of tears, of tenderness, moments of intense feelings. You know, this pandemic has upended our sense of normalcy and we have been stretched in ways physically, emotionally, and yes, we have been stretched spiritually in ways that we could never have imagined just a few months ago. Things we once had in our toolkits that have worked with other experiences of illnesses just don't seem to fit now. I think one nurse on the COVID unit expressed it very well when he said, "We've been stretched thin, bridging ourselves over an ever-widening gap," and then went on to explain families not being present at bedside to fill in gaps about the patient's story and help staff to navigate decisions on care, because they are seeing the challenges, be they good or bad, real-time with their own eyes when they are present, or they are able to interpret cultural values and needs, and we just need them there to do that sometimes. Another one is not being able to be as responsive to patients as often due to requirements for PPE donning and doffing. You know, you can't just run in, I’ve heard them talk about not being able to just run into a room for a glass of water when they hit the button and go, "I need this - can you help fluff my pillow," and they want to because that is such a part of care, and they can't do it because they've got to a) conserve PPE or really be conscientious of putting it on and off. Another one is filling in for others who are unable to come onto the unit or into the patient rooms for whatever reason. It puts staff in a position to be sort of like a stand-in for them, per se. This is a huge ... this can feel like a really big weight of responsibility to bear. You know, they are being asked to ... you know, you are in the room, can you hit that machine button? Since you are already donned up and you are in the room, can you adjust that for me? So, it adds a little pressure on them. Also, it has brought to light some injustices and inequities, and I've heard this. Patients and their families in certain demographics seem to be affected more than others. Things like income, immigration status and even our own unconscious biases due to race and ethnicity has come to light. Those of certain social economic backgrounds are unable to be present, sometimes because, look, they still have to work. They can't take off. They can't come in and risk an exposure and have to take off two weeks. And it pains them. It's a palpable, almost a grief, that they can't be there, even with our new visitation where you can sit outside the glass or come onto the unit in certain situations. There's language barriers. That was huge for a while. We had a cluster of non-English-speaking patients on the unit, and it strained the staff just being able to communicate. Not only did we not have the family members at the bedside, when we called them, we didn't always have someone that could interpret. And the family ... one of the stories I got involved with earlier was a woman, her husband was in our ICU, and he was bilingual. She was not. He was her connection to the outside world. He was her translator, and suddenly, she found herself calling the hospital to find out what was going on, but not getting a person to speak her language initially on the phone, and she would just hang up. And so, she was fearful. So, we unpacked a lot of that in the beginning through, God bless, interpreter services that Vanderbilt provides, because it really helped us put some things in place, like having an interpreter button on iPads. We got more iPads on the unit to take into the rooms and they were wonderful! They would zoom right in there with us. You could push a button and you could see the face of your interpreter, which I always turn toward the patient so they could see their family member. So, that was really nice. We adapted to some things. Also, this virus ... I think one of the biggest things I hear is it does not seem to have a predictable trajectory, and as much as we want to think so, it doesn't always have a predictable demographic. We can see a wide range of experiences from members of the same family, whom I talk to a lot. You can have five or six people in the same family all contract this virus, and those experiences can range from hardly having any symptoms at all to dying in our hospital. We've seen that. And these heavy emotions, they are big for anybody to bear. And when you have our staff trying to update family members, and they call them and they say, "I just want to update you on your family member," and if you ask the question, "How are you doing," you may hear their experience and their family's experience and these feelings of guilt, these feelings of shame. These are big emotions for our staff to carry right now when you consider that we are all experiencing it together. This is all part of our collective story. How would I encourage them? I would say, first of all, be very intentional in scheduling those break times. Take your lunch. Take your scheduled break. Those are small things, so important. You know, our tendency is to, "I'm in the middle of this, I've got to do this," and it's tempting not to take that lunch. I've been guilty of it myself when I'm up there. Oh, my gosh, It's already 3 o'clock. I came on the floor at 8 o'clock and I just breezed right through my lunch. It's easy to do, but it's real important to carve out that time, very important. I would also recommend utilizing PTO. One of the things they tell us early on in orientation is, "We give you PTO every year. You can lose it at the end of the year, so take it!" Take it, take it. And go do something that feeds your soul. I know it's hard to get out and maybe do some of the things that we once did, but there's opportunities out there observing social distancing and masking ... you know, all of those things that keep us and our community safe. Of course. Another thing I might recommend is ritualizing. These are powerful. Establishing a ritual. We know this in our religious communities. Ritual has power. Something as simple as turning off your pager when you leave for the day. One of the things I see as a daily ritual with the nursing staff and staff members is those unit phones. They put them in the little container before they walk off the unit. That's a great ritual to just, in your mind, put a little mindful practice in there to disengage and shift gears. Take your nurse hat off, your doctor hat off. In my case, I literally have a Chaplain hat that I take off. Take that off and be a daughter, be a wife, be a mother, be a friend, be a loved one. You have an identity outside of the care that you provide here. And all of those people in your orbit are also impacted by this. So, take care of yourself. Sometimes that ritual might just be changing out of your work clothes, taking a shower. Taking a shower is just ... you know, we do that because we have been in the hospital, we've been exposed to all these things. It makes sense to do that, but it can also be a ritual, a cleansing ritual. You are cleansing that day off, the stresses off. That can be another little mindful practice. Sometimes people color and draw. We have a nurse on the unit that got very attached to a family member whose mother passed on the unit, and she took that time to color, to use her gift of coloring and made her a hand-colored sympathy card. It was lovely. It was healing for both, for her and the family member. Journaling is great. And by all means, talk about it. Sometimes, when we walk out of the room, we need to ... you know, we can't wait until an appointment. We need to debrief. And if you have a friend nearby, a co-worker that just, in the moment, can resonate with you, that can say, "I feel ya," do that! And of course, our Employee Assistance Program is wonderful and it's a great resource. We have counselors. We have therapists. I think we all can benefit from seeking a listening ear, especially a very well trained one. And here at Vanderbilt, we have some exceptional resources for that. We have so many you can get lost in looking them up, but they're here. So, use them, use them, use them.
Rosemary Cope: Excellent observations and suggestions, Sherry. You know, I'm also thinking, it's those lonely deaths, and you mentioned one of those ... it's those lonely deaths that have hit the hardest for some. And there was an ICU-registered nurse at Robert Wood Johnson University Hospital Hamilton in New Jersey, and she said, "It's been agonizing to have to turn away people who want to visit their loved ones one last time," and she's trying to find ways to be compassionate where she can. Last week, she passed on a message from a patient's wife just before he died, and the message said that they loved him and that it was okay to go. But even simply carrying a message of such emotional weight can take a toll on our healthcare workers. So, Sherry, I also think about the difficulty our staff must have dealing with patients who don't recover from COVID. What are some helpful things that you might tell someone struggling with this?
Chaplain Sherry Perry: Thank you, Rosemary, for naming that. I think that the patients who do not recover, it's particularly hard. It can feel deflating and it can make the things you do as a human feel futile. You know, we always hope that those in our care will recover (that's our goal), yet, sometimes healing looks very different than our expectations for healing. Sometimes, healing looks like providing the best quality of life possible with well-managed pain and well-managed symptoms. Sometimes healing looks like providing spiritual and emotional care, not only to the patient, but to their family members and those loved ones that surround them. And also, it looks like psychological support. That's important, too. For many, their faith tradition would hold that ultimate healing is beyond our physical existence on this earth, and in those moments of the ones that don't recover, I think that sense of something greater than what is here, this can bring a sense of comfort and reassurance because it taps into a hope beyond this world, and that's powerful. It's very powerful and healing. I think another thing that we can do is to honor those lives. In this world of confidentiality and HIPAA, sometimes it can make us skittish just to even mention the names, but I think we need to mention the names. We've gotten to know that person. We know the names that their loved ones call them, that isn’t in their medical charts. I get that all the time. They'll go, your first name and last name, and I walk in there and they don't call me ... my name might be Robert Allen, but people call me Russ. Okay, Russ! That's your endearment. So, we need to honor those lives, and sometimes just even among us, just speaking your name. I'm not saying publish it on a website, but speaking the names. There was an editorial columnist from The New York Times. I love this quote. Her name is Anna Quindlen, and she says, "Grief remains one of the few things that has the power to silence us. It is a whisper in the world and a clamor within." When our experience of caring for someone with COVID does not end in full recovery, there is certainly grief to be had. We all feel it to some degree. There's some facilities that practice the pause. Take a moment to pause and just acknowledge the life of the person. That's something you can do in the moment. This was a wife or a mother, a father, a son, a daughter. Acknowledge that person's life, that it meant something, because it meant something to us who were caring for them, most certainly. Speak their name. Take a moment and speak their name.
Rosemary Cope: Absolutely. Your last statement is so very powerful. To be truly seen and acknowledged speaks volumes. So, a personal thanks to everyone at Vanderbilt who is involved in the care of a patient, and thank you, Sherry, for your own work at the hospital. If you would like to speak confidentially with an EAP counselor, please contact us at (615) 936-1327.
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