#same could be said for (hospice) nursing but that has the added struggle of a) if i ever take another biology/chemistry class i will puke
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man i think practicing immigrant/human rights law would be so fulfilling but like the autism. makes my brain feel like it's going to explode every time i have to talk to another person or work in groups or make eye contact or speak. like in general.
#chatter#same could be said for (hospice) nursing but that has the added struggle of a) if i ever take another biology/chemistry class i will puke#and b) i can't make physical contact w other people w/o feeling like i'm going to die.#i just have so much love for other people but the scared bunny rabbit who lives in my brain and makes all my decisions does NOT
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How a Bounty of Vaccines Flooded a Small Hospital and Its Nearby College
This story also ran on Daily Beast. It can be republished for free.
When administrators at Hillsdale College, a conservative liberal-arts school in Michigan, heard its local hospital didn’t have a way to store the Pfizer-BioNTech covid vaccine, they offered the use of its science department’s ultra-low temperature freezer. The vaccine must be stored at minus 94 degrees Fahrenheit.
With that help, the small hospital — employing about 400 — was able to receive vaccines from the state: 1,950 doses in late December, more than twice what it requested, according to the hospital CEO.
Two weeks later, college faculty, staffers and administrators were among 900 people who received vaccinations at an on-campus clinic run by Hillsdale Hospital, even though college workers were not in the state-recommended priority groups eligible to get the vaccine in Michigan. The clinic was also open to faculty at the local beauty college.
Meanwhile, the number of doses allocated to the public health department of Hillsdale County, home to 46,000, was only 400, leaving the department scrambling to try to vaccinate front-line health workers in the region.
The hospital’s willingness to vaccinate Hillsdale College faculty outside of recommended state guidelines following the loan of a refrigerator comes amid growing concern nationally that younger, healthier, more privileged or merely lucky people can “jump the line” while others in the priority groups can’t get shots.
The twists and turns of how Hillsdale Hospital got more doses than it could initially give away speaks to the ad hoc, chaotic nature of the vaccine distribution process nationally, in which state, county and local officials complain about not knowing week to week how many doses they will receive to dole out. Some places initially got more than they needed, while others, like the Hillsdale County health department, received far less.
Decisions on who gets a dose often fall to local officials including, as in the case of Hillsdale, the hospital CEO, who first tried to get all front-line health workers vaccinated, then held another clinic for which he pegged eligibility to occupations with exposure to the public, such as pharmacists, hospice workers and educators.
Hillsdale College’s staff members were on the list. That was surprising — raising some eyebrows — because the school’s leaders have strongly opposed Democratic Gov. Gretchen Whitmer’s closure of in-person classes, hosted an in-person graduation in defiance of state mandates against large gatherings and reportedly were prepared to go to court if Michigan extended campus closure rules into this spring. The student newspaper had an opinion piece this fall cautioning against the rush to a vaccine as a threat to liberty and health. The school garnered national attention in September when its Washington, D.C., campus, hosted a conference in Virginia at which then-attorney general William Barr compared covid closure rules to slavery.
It Started with the College’s Freezer
Set amid the rolling hills of south-central Michigan about 90 minutes from Detroit, Hillsdale is a small town whose largest employers are the college, with about 800, and Hillsdale Hospital, the county’s only hospital, with 47 beds, along with a 40-bed skilled nursing facility and about 400 full- and part-time employees.
The college held in-person classes for much of the year, requiring masks only in public spaces inside buildings, but professors could request students wear them in class.
As of Thursday, Hillsdale County has recorded more than 3,000 since the pandemic began, with 68 deaths.
Around the time Whitmer closed all campuses to in-person classes in November as cases spiked, there were 76 active cases at the college and 179 people were in contact isolation, the school paper reported.
Hillsdale Hospital had initially requested 800 doses of the Moderna vaccine from the state health department, said Jeremiah J. Hodshire, the hospital’s president and CEO.
The Moderna product does not require ultra-cold storage.
Once the hospital secured the use of the college science department freezer, it modified its application, requesting instead the Pfizer product, which comes as 975 doses packed inside special ultra-cold transport containers, Hodshire said.
To officials’ surprise — and without explanation — the hospital received two shipments of 975 doses of the Pfizer vaccine, meaning they had lots leftover.
“We were concerned,” Hodshire said, and called state officials for an explanation, but ultimately kept them.
Many localities have complained of the unpredictability of these precious shipments from the federal government to the states and on to the localities, with most places getting far less than they need or requested.
What If They Gave a Vaccine and Nobody Came?
With a generous supply to dispense, the hospital faced another distribution dilemma. In an area of the country where many people are skeptical about covid, vaccines and government, there wasn’t a throng of vaccine takers.
Though the hospital in late December first offered vaccines to its 400 employees, as well as local doctors, dentists, nursing home staffers and their residents, turnout was low. Only about 400 doses were given. Hodshire received his vaccination, he said, after all the workers at his hospital who wanted one received a shot.
There are “a lot of nay-sayers in the community,” said Hodshire, who used his weekly podcast and Facebook Live events to assure listeners the vaccines were safe. Every time, he said, “we get people saying, ‘You are government agents, you are evil.’”
For the approximately 1,500 doses left, Hodshire arranged a vaccination clinic at a large conference hall at the college — not far from the fridge — and staffed by hospital personnel, along with an assist from the National Guard and volunteers from the small local health department.
He invited optometrists, pharmacists, and K-12 educators. But he also added a group not specifically included in the state priority list for the next phase: higher education employees, including those from the local beauty college — not based on age but, he said, on whether they had direct dealings with students or families. (The state, meanwhile, was about to move to add seniors to its priority list.)
Hodshire pointed to federal guidelines that say groups can overlap to ensure efficient distribution of available vaccine supplies.
More than 200 higher education staff members received shots from that batch of 1,500. No students were vaccinated, a college spokesperson said in an email.
“There was no quid pro quo” for use of the refrigerator, said Hodshire, 45; the goal was to find demand to meet supply.
The college, he said, had made no secret of its intent to revive on-campus classes, “whether the government allowed them to or not.” Leaving college staff members to mingle with students on campus and off, without an opportunity for vaccination, “would have been egregious on my part.”
The hospital, Hodshire said, shared those plans with the state and received no pushback.
Michigan Department of Health and Human Services spokesperson Lynn Sutfin said in an email that the agency does not collect or approve plans from hospitals about vaccination efforts.
But, she added, “we do not want providers to waste vaccine and would rather they provide vaccine to someone outside of the prioritization groups as opposed to losing doses.”
Even after the early January clinic at the college, the hospital had 340 doses left.
So, it set another clinic for late January, offering sign-ups to day care workers, bank employees, clergy and grocery clerks — again, with a requirement that all be involved in public-facing positions.
At the same time, the country’s health department was having the opposite experience — struggling with scarce supplies to vaccinate those in the first eligibility group, health care workers. Later in the month, the health department opened eligibility to the state’s next priority group, which included other essential workers and seniors, resulting in jammed phone lines and fully booked appointments.
All 400 of its initial allotment of vaccines were from Moderna, because the health department does not have an ultra-cold storage freezer, said the county’s health officer Rebecca Burns.
“The hospital hasn’t opened [vaccination clinics] to 65 and older seniors,” Burns said. “If they were to do so, they would have a huge response.”
Moving Forward
At the hospital’s late January vaccination clinic, 50 health care workers who sat out the first round stepped forward for their shots.
Only then did the facility expand sign-ups to those 65 and up for the remaining 225 slots, which were left after interested clergy, day care and other retail workers signed up.
“They filled within 12 minutes of registration going live,” wrote hospital spokesperson Rachel Lott in an email.
For the last full week in January, the county health department learned from the state that it would get 300 more vaccine doses, Burns said. The hospital would get 100 doses, this time of the Moderna vaccine, Hodshire said. It plans to distribute them at a joint clinic with the county health department set for an upcoming weekend.
“Moving forward, we are going to be partnering with them to serve all the eligible populations as we have vaccine available,” Lott wrote.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
USE OUR CONTENT
This story can be republished for free (details).
How a Bounty of Vaccines Flooded a Small Hospital and Its Nearby College published first on https://smartdrinkingweb.weebly.com/
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How a Bounty of Vaccines Flooded a Small Hospital and Its Nearby College
This story also ran on Daily Beast. It can be republished for free.
When administrators at Hillsdale College, a conservative liberal-arts school in Michigan, heard its local hospital didn’t have a way to store the Pfizer-BioNTech covid vaccine, they offered the use of its science department’s ultra-low temperature freezer. The vaccine must be stored at minus 94 degrees Fahrenheit.
With that help, the small hospital — employing about 400 — was able to receive vaccines from the state: 1,950 doses in late December, more than twice what it requested, according to the hospital CEO.
Two weeks later, college faculty, staffers and administrators were among 900 people who received vaccinations at an on-campus clinic run by Hillsdale Hospital, even though college workers were not in the state-recommended priority groups eligible to get the vaccine in Michigan. The clinic was also open to faculty at the local beauty college.
Meanwhile, the number of doses allocated to the public health department of Hillsdale County, home to 46,000, was only 400, leaving the department scrambling to try to vaccinate front-line health workers in the region.
The hospital’s willingness to vaccinate Hillsdale College faculty outside of recommended state guidelines following the loan of a refrigerator comes amid growing concern nationally that younger, healthier, more privileged or merely lucky people can “jump the line” while others in the priority groups can’t get shots.
The twists and turns of how Hillsdale Hospital got more doses than it could initially give away speaks to the ad hoc, chaotic nature of the vaccine distribution process nationally, in which state, county and local officials complain about not knowing week to week how many doses they will receive to dole out. Some places initially got more than they needed, while others, like the Hillsdale County health department, received far less.
Decisions on who gets a dose often fall to local officials including, as in the case of Hillsdale, the hospital CEO, who first tried to get all front-line health workers vaccinated, then held another clinic for which he pegged eligibility to occupations with exposure to the public, such as pharmacists, hospice workers and educators.
Hillsdale College’s staff members were on the list. That was surprising — raising some eyebrows — because the school’s leaders have strongly opposed Democratic Gov. Gretchen Whitmer’s closure of in-person classes, hosted an in-person graduation in defiance of state mandates against large gatherings and reportedly were prepared to go to court if Michigan extended campus closure rules into this spring. The student newspaper had an opinion piece this fall cautioning against the rush to a vaccine as a threat to liberty and health. The school garnered national attention in September when its Washington, D.C., campus, hosted a conference in Virginia at which then-attorney general William Barr compared covid closure rules to slavery.
It Started with the College’s Freezer
Set amid the rolling hills of south-central Michigan about 90 minutes from Detroit, Hillsdale is a small town whose largest employers are the college, with about 800, and Hillsdale Hospital, the county’s only hospital, with 47 beds, along with a 40-bed skilled nursing facility and about 400 full- and part-time employees.
The college held in-person classes for much of the year, requiring masks only in public spaces inside buildings, but professors could request students wear them in class.
As of Thursday, Hillsdale County has recorded more than 3,000 since the pandemic began, with 68 deaths.
Around the time Whitmer closed all campuses to in-person classes in November as cases spiked, there were 76 active cases at the college and 179 people were in contact isolation, the school paper reported.
Hillsdale Hospital had initially requested 800 doses of the Moderna vaccine from the state health department, said Jeremiah J. Hodshire, the hospital’s president and CEO.
The Moderna product does not require ultra-cold storage.
Once the hospital secured the use of the college science department freezer, it modified its application, requesting instead the Pfizer product, which comes as 975 doses packed inside special ultra-cold transport containers, Hodshire said.
To officials’ surprise — and without explanation — the hospital received two shipments of 975 doses of the Pfizer vaccine, meaning they had lots leftover.
“We were concerned,” Hodshire said, and called state officials for an explanation, but ultimately kept them.
Many localities have complained of the unpredictability of these precious shipments from the federal government to the states and on to the localities, with most places getting far less than they need or requested.
What If They Gave a Vaccine and Nobody Came?
With a generous supply to dispense, the hospital faced another distribution dilemma. In an area of the country where many people are skeptical about covid, vaccines and government, there wasn’t a throng of vaccine takers.
Though the hospital in late December first offered vaccines to its 400 employees, as well as local doctors, dentists, nursing home staffers and their residents, turnout was low. Only about 400 doses were given. Hodshire received his vaccination, he said, after all the workers at his hospital who wanted one received a shot.
There are “a lot of nay-sayers in the community,” said Hodshire, who used his weekly podcast and Facebook Live events to assure listeners the vaccines were safe. Every time, he said, “we get people saying, ‘You are government agents, you are evil.’”
For the approximately 1,500 doses left, Hodshire arranged a vaccination clinic at a large conference hall at the college — not far from the fridge — and staffed by hospital personnel, along with an assist from the National Guard and volunteers from the small local health department.
He invited optometrists, pharmacists, and K-12 educators. But he also added a group not specifically included in the state priority list for the next phase: higher education employees, including those from the local beauty college — not based on age but, he said, on whether they had direct dealings with students or families. (The state, meanwhile, was about to move to add seniors to its priority list.)
Hodshire pointed to federal guidelines that say groups can overlap to ensure efficient distribution of available vaccine supplies.
More than 200 higher education staff members received shots from that batch of 1,500. No students were vaccinated, a college spokesperson said in an email.
“There was no quid pro quo” for use of the refrigerator, said Hodshire, 45; the goal was to find demand to meet supply.
The college, he said, had made no secret of its intent to revive on-campus classes, “whether the government allowed them to or not.” Leaving college staff members to mingle with students on campus and off, without an opportunity for vaccination, “would have been egregious on my part.”
The hospital, Hodshire said, shared those plans with the state and received no pushback.
Michigan Department of Health and Human Services spokesperson Lynn Sutfin said in an email that the agency does not collect or approve plans from hospitals about vaccination efforts.
But, she added, “we do not want providers to waste vaccine and would rather they provide vaccine to someone outside of the prioritization groups as opposed to losing doses.”
Even after the early January clinic at the college, the hospital had 340 doses left.
So, it set another clinic for late January, offering sign-ups to day care workers, bank employees, clergy and grocery clerks — again, with a requirement that all be involved in public-facing positions.
At the same time, the country’s health department was having the opposite experience — struggling with scarce supplies to vaccinate those in the first eligibility group, health care workers. Later in the month, the health department opened eligibility to the state’s next priority group, which included other essential workers and seniors, resulting in jammed phone lines and fully booked appointments.
All 400 of its initial allotment of vaccines were from Moderna, because the health department does not have an ultra-cold storage freezer, said the county’s health officer Rebecca Burns.
“The hospital hasn’t opened [vaccination clinics] to 65 and older seniors,” Burns said. “If they were to do so, they would have a huge response.”
Moving Forward
At the hospital’s late January vaccination clinic, 50 health care workers who sat out the first round stepped forward for their shots.
Only then did the facility expand sign-ups to those 65 and up for the remaining 225 slots, which were left after interested clergy, day care and other retail workers signed up.
“They filled within 12 minutes of registration going live,” wrote hospital spokesperson Rachel Lott in an email.
For the last full week in January, the county health department learned from the state that it would get 300 more vaccine doses, Burns said. The hospital would get 100 doses, this time of the Moderna vaccine, Hodshire said. It plans to distribute them at a joint clinic with the county health department set for an upcoming weekend.
“Moving forward, we are going to be partnering with them to serve all the eligible populations as we have vaccine available,” Lott wrote.
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
USE OUR CONTENT
This story can be republished for free (details).
How a Bounty of Vaccines Flooded a Small Hospital and Its Nearby College published first on https://nootropicspowdersupplier.tumblr.com/
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‘I Couldn’t Let Her Be Alone’: A Peaceful Death Amid the COVID Scourge
As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance, but also by the cruelty of the coronavirus.
Because of the pandemic, it wasn’t safe to visit her mom, Patti Breed-Rabitoy, who had entered a hospital alone, days earlier, with a high fever and other symptoms that were confirmed to be caused by COVID-19.
Breed-Rabitoy, 69, had suffered from lung and kidney disease for years but remained a vital, bubbly presence in the lives of her husband, Dan Rabitoy, and three grown children. She was a longtime church deacon and youth leader in Reseda, California, a fan of garage sales, bingo games and antique dolls. Then came COVID-19, likely contracted in late April following one of her thrice-weekly dialysis sessions. Now she lay sedated and on a ventilator, her life ebbing, with no family by her side.
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“I had seen these things on TV and I would pray for those people and say, ‘I can’t imagine what they’re going through,’” said Breed, 44. “And now I was living it.”
A single mom of two young sons, she was wrenched with guilt at not being with her mother. “You always picture you’re going to be right by your parent’s side,” she said.
Unlike many families of dying COVID patients, Breed and her family were able to find some comfort in her mother’s final hours because of the 3 Wishes Project, a UCLA Health end-of-life program repurposed to meet the demands of the coronavirus crisis. In the U.S., where more than 120,000 people have died of COVID, it’s part of a wider push for palliative care during the pandemic.
At 5 p.m. on May 10, Mother’s Day, before Breed-Rabitoy’s life support was removed, more than a dozen family members from multiple cities and states gathered on a Zoom call to say goodbye. John Denver’s “Rocky Mountain High,” one of her soft-rock ’70s favorites, played on speakers. Online, a chaplain prayed.
Breed-Rabitoy had been deeply sedated for more than a week, since a terrible night when she struggled to breathe and asked doctors to place her on the ventilator. Confusion abounded, Breed said. Could her mom still hear in that state? Two nights in a row, Breed asked nurses to prop a phone near her mom’s ear.
“I prayed with her. I sang her favorite songs. I read her the Bible,” she said.
Finally, a nurse gently explained that her mother was too sick to recover. If they removed the ventilator, it would be to allow her to die.
That’s when hospital staffers described the 3 Wishes program and asked whether the family had any personal requests for her last moments. They decided on the music and the family Zoom call. Dan Rabitoy requested that a nurse hold his wife’s hand as she died.
After it was over, family members received keychains stamped with her fingerprint and a copy of the electrocardiogram of the last beats of her heart.
“I’m grateful to have these keepsakes,” Breed said. “All these things have been healing.”
Dr. Thanh Neville co-founded the 3 Wishes Project at UCLA Health in 2017. Since then, the program has fulfilled nearly 1,600 wishes for dying patients in the ICU.(Courtesy of Robert Hernandez/UCLA Health)
The project was developed in Canada but co-launched at UCLA Health in 2017 by Dr. Thanh Neville, an intensive care physician who serves as 3 Wishes’ medical director. It aims to make the end of life more dignified and personalized by fulfilling small requests for dying patients and their families in the ICU.
Before COVID-19, the program had granted nearly 1,600 wishes for more than 450 patients, nearly all in person. The deathbed scenarios have varied, from music and aromatherapy at the bedside to meeting a patient’s request for one last mai tai cocktail.
“We’ve done weddings and mariachi bands and opera singers and 20 to 30 family members who could come in and celebrate,” said Neville, 41. “And none of this is possible anymore.”
COVID-19 has “changed everything,” said Neville, a researcher who focuses on improving ICU care for the dying. Also a clinician, she spent weeks this spring tending to seriously ill COVID patients. Since March, her hospital system has seen more than two dozen COVID deaths.
In the beginning, visitors were strictly prohibited. Now, some may come — but many don’t.
“I would still say the majority of COVID patients die without families at their bedside,” Neville said. “There are a lot of reasons why they can’t come in. Some are sick or old or they have small kids. A lot of people don’t want to take that risk and bring it home.”
It has been hard to keep 3 Wishes going during a time when in-person memorials and celebrations are banned and infection control remains the primary focus. Neville even had to change the way the fingerprint keychains were made. Now, they’re treated with germicidal irradiation, the same method that lets health care workers reuse N95 masks.
The 3 Wishes Project is offered when death is imminent: Patients are enrolled after a decision has been made to withdraw life-sustaining technology or if the chance of death is greater than 95%. The program was created to help patients, caregivers and clinicians navigate the dying process in a less clinical, more humane way. Wishes needn’t be limited to three, and they can be articulated by patients, family members or hospital staffers.
The program is based on palliative care tenets that focus on the humanity of the patient amid intensive medical care, said Dr. Rodney Tucker, president of the American Academy of Hospice and Palliative Medicine. Seemingly small acts that honor an individual life help counter the efficiency-driven environment of the ICU, which can be dehumanizing. They’re at the core of care that has been shown to ease both angst for the dying and grief for those who loved them. “It helps the family that’s left behind cope more successfully with the loss,” he said.
Such efforts also remind providers of the humanity of their practice, which can help them cope with the stress of witnessing death daily, especially during something as extraordinary as a pandemic, he said.
A study published by Neville and colleagues last year found that 3 Wishes is a “transferrable, affordable, sustainable program” that benefits patients, families, clinicians and their institutions. They calculated that the mean cost of a single wish, funded by grants and donations, was $5.19.
Genevieve Arriola, 36, has been a critical care nurse for eight years. When the pandemic struck, she found herself juggling medical care and emotional support more than ever. She took care of Breed-Rabitoy for three days straight, all the while communicating with the dying woman’s family.
“This was a very delicate situation for someone who is married to her for over 20 years and a daughter who was miles away in Oregon and couldn’t see her mom,” she said.
She was also the nurse who held Breed-Rabitoy’s hand as she died.
“I pretty much felt honored to be that person,” Arriola said. “I couldn’t let her be alone. If no one can be there, I can.”
Weeks after her mother’s death, Breed is grappling with the loss. The last time she saw her mom was March 16, at a McDonald’s off Interstate 5 near Grants Pass, Oregon.
The pair met for less than 30 minutes before Breed-Rabitoy headed south down the interstate, her long-planned family visit cut short by concerns about COVID. She had just learned that the local dialysis center was closed to outside patients, and she was worried about growing reports of infection and death. “She told me, ‘I feel like this disease is coming after me,’” Breed recalled.
Now, the keepsakes from 3 Wishes are placed where Breed can see them every day.
“It added such a level of love and dignity we weren’t expecting,” she said. “It made the process of losing a loved one to COVID-19 so much more bearable.”
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
from Updates By Dina https://khn.org/news/palliative-care-during-covid-peaceful-death/
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‘We’re going to be OK’
With tender humility and grit of purpose, Spectrum Health nurses put their personal fears aside to support colleagues, watch over their families and care for their community.
They don’t consider themselves heroes.
Nurses take care of others. It’s what they’re called to do.
They rely on faith and take every precaution to protect themselves so they don’t take the virus home to the families they love.
These are the experiences of four nurses working in rural hospitals during this pandemic.
Faith through fear
Jan Moriarty, a nurse of 37 years, said the most challenging part of her job in the Big Rapids Hospital Emergency Department has been resisting fear.
She’s careful to appropriately use personal protective equipment and leans on her faith.
“I have a strong faith in God, so I rest on that,” Moriarty said. “This is what I do. I know there are risks involved with the job. This is something that I chose to do, and I love it. This has not changed that.”
Outpatient surgery nurse Denise Jacobsen starts each shift at United Hospital in Greenville praying with colleagues in the hospital chapel.
“We meet in the chapel every morning and we do a little prayer before we go into our department, which has been comforting for us,” Jacobsen said. “That’s how we’ve been coping with it, just prayer and supporting one another. We’ve always supported each other, but especially more so during this epidemic.”
Jacobsen worries about the possibility of the virus hitchhiking a ride on her clothes when she goes home, especially since her mother’s health is failing. She initially wore a mask at home, but has since removed the mask so her mother, who receives hospice care, could better communicate.
“At least she can see my face, because my mom can’t hear and reads lips,” Jacobsen said. “That was challenging.”
Fellow United Hospital nurse Nichole Johnson has two children at home and experienced similar anxiety. She eased herself off the 24/7 news cycle, and educated herself with evidence-based articles and papers.
“It has eased my anxiety and my fears as I’m finding out facts,” she said. “As long as I’m practicing best practices and doing what I’m supposed to do, I would like to think I’m doing my part to not spread this and to not bring it home.”
Reed City Hospital Emergency Department nurse Amber Besko said the greatest challenge for nurses is the fear of the unknown—particularly, how to keep their families safe and what will happen if patient volumes increase?
“In the beginning it was a struggle, for sure, just worrying about it every day, thinking ‘Am I going to bring it home … or am I going to get sick?’” she said.
Family connections
Support among family members—for the nurses and their patients—has been key.
Besko, who has a big extended family, has tried to keep them all connected virtually.
“We’ve been doing a good job of keeping everyone’s anxiety low,” she said. “I reassure them that it’s OK, that we’re going to be OK and we just have to make sure everyone stays safe.”
Jacobsen said adhering to social distancing within her family has been challenging.
“Not seeing my grandchildren at all has been very trying,” Jacobsen said. “We’re doing story time over FaceTime. You just try to come up with different ideas on how to spend time with them, but it’s not the same as having them sit in your lap and reading them a story while you’re holding them.”
The nurses acknowledge their patients face the same struggles. Not being able to be with their families due to state-ordered visitor restrictions has been difficult and sometimes heart wrenching.
“Especially if someone is getting bad news,” Jacobsen said. “You’re trying to call and update the family on the phone. They’re upset because they can’t be there and you’re trying to console them. That has been the hardest thing, because you just feel so bad.”
Moriarty said the nursing staff is proactive in connecting with patients’ families.
“I think that’s very important, because I totally understand people are frustrated and scared,” Moriarty said. “Most of the people have been really, really good about it. They realize we’re … doing it to protect everybody.”
Besko said they advocate harder for patients in these situations, considering them extended members of their own families.
“We sit with them in their rooms when they’re anxious,” Besko said. “It’s just taking that little bit of extra time.”
Wearing protective masks has added an extra barrier to communication, but the nurses hope their patients can hear the smile in their voice and see the caring in their eyes.
“A lot of nursing is body language,” Besko said. “It’s talking and crying with patients … or laughing with them just to get them to feel a little better.”
Community support
Community support keeps spirits high among nurses and health care workers on the front lines of this COVID-19 fight.
Signs of appreciation and encouragement outside hospitals greet team members on their way to and from work. And businesses and individuals who’ve dropped off supplies and treats nourish their souls.
“It’s been awesome,” Moriarty said. “It’s really humbling.”
“That’s kind of a tearjerker,” Jacobsen said, choking back emotion. “It definitely warms my heart to think we’re having outside support from complete strangers. It’s just been amazing.”
“We love having that support and it makes us feel like we’re doing good in our community,” Johnson said. “The generosity has really been amazing. It’s greatly appreciated.”
“It’s been a blessing every time someone is so generous and wants to bring in something for us,” Besko said.
The support comes from colleagues, too.
Besko said a couple of nurses have made peers surgical caps on their off days. Lab department personnel brought in flowers for the emergency department team and said, “We thought you guys needed something to smile about today.” And the Reed City environmental services team members made crocheted headpieces with two buttons, so you can connect your mask and save your ears.
“Everybody is trying to help everybody,” Besko said.
“We call each other our work family,” Johnson said. “We have a tight bond. We can put each other at ease during these tough times.”
Nursing heroes
Despite increased attention from the community, none of the nurses considers themselves to be a hero.
“This is what I do every day,” Johnson said. “We don’t have a pandemic every day, but we still do patient care every day. This is just what we do.”
“I’m just doing my job,” Moriarty said. “There’s a lot of bigger heroes than I am, but I love my job and do it to the best of my ability.”
“I see myself caring for patients like I normally do,” Jacobsen said. “It’s just a different way to care for them now, but I never really thought of myself as a hero.”
“I chose this position, and obviously we didn’t know this was going to happen,” Besko said. “It’s something I signed up for. It’s something I’m passionate about it.”
The nurses said the COVID-19 challenge we’re all facing has brought the community together and made them each appreciate things we may have taken for granted before.
“It shows you how precious our lives really are,” Jacobsen said. “To hear stories about families losing multiple family members to COVID, that one day we’re here and the next day we’re not.”
“I think it’s made me a little stronger, realizing I can do this,” Moriarty said. “It was a little daunting at first, having to put on the PPE equipment that we’re not used to having to wear. Just knowing that I can do this, it’s not that big of a deal.”
“It’s made me slow down and realize it’s the little things in life,” Besko said. “You don’t always get to be home with your loved ones as much as we are right now. You really get to take that time to appreciate everything you have.”
Patients are showing more appreciation, too, Besko said, sharing a story about a gentleman who recently sought care at the emergency department.
“As he left he was clapping for us and said, ‘I just want you guys to know how much we appreciate it,’ and he was clapping all the way out the door, even though he was the one who was sick.”
It also helps to keep in mind that life will go on in time.
“Things are going to change and it’s all going to be OK in the end,” Besko said. “Eventually things will calm down once we have it figured out and we’ll get back to normal life and get back to hugging our loved ones and seeing them.”
“It’s just a matter of time and a matter of keeping everyone safe.”
‘We’re going to be OK’ published first on https://smartdrinkingweb.tumblr.com/
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Let’s Talk About Death (Over Dinner)
Michael Hebb
On gauging someone’s readiness to talk: “You can be the change you want to see by extending the invitation and showing your willingness to talk, but that’s really all you can do.” PG. 24
“Despite the necessary ambiguity of advice in this book, there is one solid, golden rule that gets me through every difficult conversation about death -– or sex or drugs — with family, strangers, friends, lovers and even sworn enemies. I know that I need to identify and say the things I am afraid of saying. This is the tried-and-true method: to meet each person with radical vulnerability in these hard topics. Honesty and vulnerability are contagious.” PG. 33
Prompt: If you only had thirty days left to live, how would you spend them? Your last day? Your last hour?
Prompt: What foods do you remember a departed loved one cooking for you?
“One of the perennial pieces of wisdom shared by hospice nurses is to let our loved one know it is okay to leave us when it is time. Many deaths are prolonged by the sense that we need to stay alive for our family. Doing the impossibly difficult thing of letting a loved one knows that you are going to be okay will reduce suffering.” Pg. 54
Prompt: If you were to design your own funeral or memorial, what would it look like?
“... Because life is an incredible gift, and death helps us recognize this. We need more than a place to put our grief. We need opportunities to express our overwhelming joy at being alive, and we need to do it together.” Pg. 60
Prompt: Is there an excess of medical intervention at the end of life?
“... We live cures. We’re excellent at saving lives, but struggle to accept we can’t save everyone. And a good death is as important as a successful resuscitation.” PG. 65
Prompt: Do you have your will, advance-care directives and power of attorney complete and if not, why?
Prompt: What is the most significant end-of-life experience of which you’ve been a part?
Prompt: Why don’t we talk about death?
The message to shout from the mountaintop is not that the bad stuff that happened to you in childhood is going to kill you; instead it’s this: if you do talk about it, your chances of healing are much higher.” Pg. 98
Why we don’t talk about death: 1) the base-rate bias (we only provide probability for specific ages), 2) the normalcy bias (the belief that if something doesn’t happen to us, it never will), 3) the courtesy bias (we often state opinions that are socially acceptable, so that we do not offend the other person).
Prompt: How do you talk to kids about death?
“Death is a land that has no experts — we are all looking into the void together.” Pg. 108
Prompt: Do you believe in an afterlife?
“Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.” - pg. 109
“I’ve always thought life is like a penny,” Monica said, reflecting on the experience. “You can see one side or the other, but you can’t see both at the same time. This side is life, and death is the other side of the coin. But it’s all one thing.” Pg. 113
“Everything we say about death is actually about life.” Kyoto Mori pg. 116
Allie Hoffman - reporter with People Magazine (Covered Brittany Maynard)
“I try to ask myself every day: Could I live more like that? Could I acknowledge the fragility of right now? Could I stay on the lookout for a flash of sapphire under the dying leaves?” Pg. 123
Are you an organ donor? What surprised me about reading this chapter is the feeling people (in this prompt, they discussed teenagers) get when they receive an organ that saves their lives. It’s almost like a rebellion against their own bodies – because someone had to die for them to live. Also, the fact that people simply do not want to be organ donors (unless religious) simply because they can’t bear to think about it... despite the lives they know they would save.
Prompt: What song would you want played at your funeral? Who would sing it?
Prompt: What does a good death look like?
Prompt: What do you want done with your body?
“When we don’t know how to honor our loved ones, it adds immense confusion to devastating loss and elongates the healing process. If we know of a clear ritual to honor their legacy, if we know their desires, we have a powerful role to play.” PG. 149
“Ritual is a powerful and imperfect science. Ritual and death have been fused for the entire history of mankind. Nowhere is it clearer than in a relationship to how we treat our bodies or our dead loved ones. As we consider what we want, it is important to realize that we are pulling from thousands of years of tradition.” PG. 151
Prompt: Are there certain deaths we should never speak of?
“When author and speaker Megan Devine talks about grief, she says that one of the most important things you can do is to be “known as the person who can withstand the details.” PG. 169
Prompt: If you could extend your life, how many years would you add? Twenty, fifty one hundred, forever?
“Consciously or not, we realize that life without an end would be come a flat, featureless expanse, just one thing after another, literally ad infinitude. Endlessness would suck the vitality out of our existence.” PG. 173
“We need endings. Because the most basic ending of all is built into us. My mortality does not negate meaning. It creates meaning. It is not how long I live that matters. It is how I live. And I intend to do it well, to the end. We are finite beings within infinity.” PG. 174
“To sum up this deep dive into life extension and primal fear: I hope that we can begin to be more clear: Are we afraid of talking about death, or are we afraid of dying? Are we afraid of dying, or are we afraid of not having left and authentic mark on the world? And perhaps we can shed even more of presumptions and anxiety and accept that it is enough to use have lived and then died. As Lesley so poignantly asked: What’s wrong with dying?” PG. 178
Prompt: What do you want your legacy to be?
“I don’t think anyone decides to have a child because they think it’s going to be easy. It’s all about accepting uncertainty. Paul was initially way more certain than I was — he even wanted to have twins. In Breath Becomes Air Lucy asks Paul, “Don’t you think saying goodbye to your child will make your death more painful?” And Paul responds, “Wouldn’t it be great if it did?” He added later, “We would carry on living, instead of dying.”
Prompt: How long should we grieve?
“Grief has no time limit, it is not about time. It is about letting go of a person we loved, a future that we imagined them in, and it also means letting go of a part of ourselves that we may be attached to. There is a wound that is created, and every wound heals at a different rate.” PG. 190
“It’s been said that we’re not as afraid of death as w are of grief. I think it is worth meditating on that thought. It is pretty immense.” PG. 191
“People will say to her... “My mom doesn’t understand how to be there for me. My best friend isn’t reaching out to me. My friends left me.” And Dianne tells them, not unkindly. “That’s the way it goes, sister, because people are people. In times of grief, choose your tribe.” PG. 192
“Accepting death doesn’t mean you won’t be devastated when someone you love dies...”
Prompt: What would you eat for your last meal?
Prompt: Is there a way you want to feel on your deathbed?
“Shame drips into every part of our lives, and death has some of the richest waters for it to dissolve. As bestselling author Brene Brown states, “Shame needs three things to grow: secrecy, silence and judgement....” “From a physiological perspective, shame throws us into flight, flight or freeze. It is not a state where growth occurs. When we shame each other around death, we literally suspend our ability to heal or grow.” PG. 209
Prompt: What would you want people to say to you at your own funeral?
“If I don’t know how to properly receive love, then what could I possibly know about being alive? I was only using one side of my heart –– giving love, taking care of people (and avoiding those who I didn’t want to love anymore). I had built up this massive muscle — unbalanced and in danger. I didn’t arrive at a pithy epitaph that day, but what this bizarre gift did provide was the clear directive that receiving love is where I needed to focus my attention.” Pg. 214
“What if, whenever possible, we leaned in toward mortality a little more?... What if we stopped pretending, until the last breath was drawn, that it was all going to get better? What if we gave the experience some space, not just for ourselves to grieve, but for the person who’s dying to grieve too?... It takes unbelievable gumption and heart to say, this is it, so hold me and tell me you love me. It takes strength to invite death in and to know when to stop raging against the dying light. To not put on a happy face and not to make any more plans together and just sit with the truth that one of you is leaving.” PG. 215
Epilogue
“It is a conversation that expands our understanding of compassion and has the capacity to connect us more poignantly than any topic I have encountered. As Ram Dass reminds us, “We are all just walking each other home.”
“It drives home the truth that there is no one way to end a conversation about death, and there Is no one way to talk about death. Death walks with us our entire life. The best thing I can suggest is that we all get better acquainted with our constant companion.” PG. 221
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8 Things I Learned from Watching My Mum Die
“Pain changes your life forever. But so does healing from it.” ~Kayil York
In 2012 my mum got diagnosed with cancer. After an operation, she was cancer-free for some time when in March 2017 it was discovered that the cancer had returned and had spread everywhere, notably to her lungs.
She was adamant that she did not want further treatment, which would have been palliative at best anyway and would have had significant side effects. Nobody was able to make a prognosis regarding how much longer she had left. Being seventy, there was a chance that it would develop slowly.
Nothing much seemed to happen for a little while when suddenly from one day to the next, she couldn’t use her legs anymore, and a few weeks later in July 2017, she was able to move into a hospice, having her last wish fulfilled. After a further four weeks, she passed away.
Those four weeks were a rollercoaster. Her condition changed up and down. But mostly I could not get my head around how she could die. I simply couldn’t imagine how her body could go from functioning to shutting down.
I lived about 500km away and went up to see her for long weekends during that time. I experienced the hospice as a very peaceful place. Nevertheless, I often sat by her bed, holding her hand and feeling utterly overwhelmed and helpless and scared.
I was convinced that I should be doing something, saying something, but could not think of anything at all that might ease her final passage. The relationship with my mum had always been difficult, thus this also felt like the last chance to make my peace with her, with us.
Seeing her in pain was horrific. She quickly advanced to a stage where she was no longer able to ring for the nurses. Wrinkling her forehead became the indicator for her pain. It was terrible to know that this was probably happening when nobody else was in the room and who knows how long it could take for anyone to notice.
Once the nurse came to administer more painkillers, it took another ten to fifteen minutes until you could see them work and my mum’s face slowly relaxing. The ten longest minutes.
After three weeks, swallowing became an issue. Even just taking a sip of water became a massive struggle and ended in coughing fits. The doctors said there was nothing they could do to make it easier. With all the medical advances, it seemed crazy that she had to endure any pain at all.
Her last four weeks were the toughest in my life so far and the first time I experienced the death of somebody close, and from such close quarters. At the same time it also turned out to be the most rewarding time.
One of the things that struck me was that almost everyone has or will experience the death of a loved one. It had such a monumental impact on me, and I can only assume that it does for a lot of people, too, and so I would like to share my story.
Here are some of the lessons I learned, which arose from a very specific situation but which I feel are equally applicable to other challenging situations in life.
1. You are alone.
Dying is personal. Watching somebody die is personal. Your whole life is personal.
There is simply no manual or set of guidelines to refer to. Not to how we live, not to how we die, and not to how we grieve.
Sometimes we might confuse our personal life lessons with universal laws. A number of people were giving me advice (I didn’t ask for). Advice about having to be there for her final breath (in the end my mum decided to slip away with no one else in the room). Advice about the importance of the funeral or on the appropriate length and ways of grieving.
Some of the forcefulness behind the messages were overwhelming at the time and had me doubting my own feelings and decisions. While I fully appreciate they meant well, I had to remind myself that only I can decide for myself what to do and how to do it. There is no right or wrong. What feels right to someone, might feel very wrong to you.
Listen to your inner voice! Tune in, and your heart will tell you what to do. We all have an inner compass; it’s just a matter of learning to access and trust it. Equally, when the tables are turned, be conscious of how you talk to people. Offer support and share your experiences by all means but give room for the other person to go their own way.
2. You are not alone.
In other ways I was not alone. One of the most important lessons for me was to accept help. Yes, bloody ask for help! I tend to be a control-freak, proud of my independence, always having been able to deal with things by myself. Suddenly I felt frighteningly helpless. I felt like everyone else had it figured out and I was failing miserably.
Everyone in the hospice was amazing, whether it was talking to me, listening to me, letting me cry, offering me a cup of tea, providing me with food, or holding my hand. It meant the world and I stopped regarding accepting help as a weakness. There is no merit in going it alone, whatever it may be. You want to help those you love—allow them to be there for you, too.
3. The power of a good cry.
In line with my wish to be independent, I hate crying in front of people. I worried it would upset my mum. I worried I made other people uncomfortable. I worried the tears would never stop.
Then somebody told me that it’s physiologically impossible to cry continuously. I can’t remember the time, but it’s something like twenty minutes after which the crying will automatically cease. That thought comforted me: The worst that could happen would be to cry for twenty minutes. That seemed manageable. Besides, there didn’t seem to be much I could do to stop the tears from coming anyway.
Once I relaxed about crying, I discovered how transformative tears could be. They offered and still offer a release of tension that would otherwise keep building up inside. They have a message that is worth listening to. They are part of life. Don’t feel ashamed. Don’t worry on other people’s behalf, because it’s not for you to figure out how they deal with your tears.
4. Feel it all.
I used to strive for a life made up of only happy moments. People would tell me that without the crap, we wouldn’t appreciate the good. But I’ll be honest: I was not convinced.
When feeling ‘negative’ emotions, in addition to feeling them, I was annoyed that I felt them, adding another layer of frustration. I engaged in an internal fight against those emotions, and as you may guess this only made things worse.
Here I was dealing with feelings that were new to me, also in an intensity that was new to me and which felt uncomfortable as hell. I quickly worked out though that I couldn’t push them away. I couldn’t distract myself. Eventually I came to accept them as part of me and part of the experience. And the thing is that everything passes—the “good” as well as the “bad.”
Don’t judge your feelings. Allow them to flow through you. Fighting them will only make them linger longer. Feel them and seek to learn from them. Everything we feel can teach us a lesson.
5. Some things you cannot prepare for.
Since my mum’s initial diagnosis, I had been mentally preparing for her death. Or so I thought. Grief took on many different forms for me. I hadn’t expected any of them and had nevertheless been going through various scenarios beforehand. It turned out to have been a waste of time to even attempt preparing for any of it. And this applies to most things in life.
It will be whatever it will be. But most importantly you will be okay!
It sucks at times. It still comes over me at random times. The realization that she is no longer around hits me again and again, as if it’s news. I often dream of her. Things happen, and I want to tell her about it and then realize that I can’t talk to her ever again. I have no idea where else my grief will take me so I have given up spending time of trying to anticipate it but I have faith that I will manage.
6. Carpe diem.
We know we will die one day and still generally live our lives as if we are around forever.
Okay, I am not saying that I am seizing every minute of every day since my mum passed away. I forget. But I also remember. I remember that life is short. Death puts things into perspective in many ways. Is it worth getting upset or stressed over certain things? Do I really want to hold a grudge? Is this really worth my time? Is this who I want to spend my time with? How will I feel looking back on my life when my time comes?
I ask myself these questions more often nowadays, and it has changed my life for the better. I am overall more relaxed and I stress less. I am more precious over how I spend my time and who with. I am less willing to put up with things that don’t feel good to me (this is where your inner voice plays a crucial role, too). It is liberating to say the least.
7. Gratitude rocks.
Almost a decade ago, I started a daily gratitude diary. I found it tough in the beginning. After a crappy day, I just didn’t think anything good had happened. But practice changed my mindset with lasting effects.
It’s not about forcing yourself to be happy all the time; it’s about changing your perspective and focusing on the “good” without denying the “bad.” It helps me not to take things for granted in everyday life.
Even during my mum’s last weeks, I found many things on a daily basis that I felt grateful for: I was grateful that even on her deathbed we were able to share a laugh. I was grateful to witness through her friends and family how she had touched other people’s lives. I was grateful how it brought me back closer to some people. I was also grateful for little things like sitting on her balcony in the sun or listening to music together.
Above all I was and am grateful for having been given the opportunity to witness her dying. Especially given our difficult relationship, I am grateful I was able to say goodbye – I am aware not everyone gets the chance.
8. Resilience is a superpower.
If I got through this, I will get through other stuff, too. Death is outside your control. You have no choice but to deal with it when it comes your way. You do have a choice how to deal with it though.
You can find the lesson in whatever life serves you. You can combine all of the above and be safe in the knowledge that you will be okay. I feel more resilient and I am confident that it will help me master other situations in the future. It doesn’t mean that there won’t be pain. But you are able to handle it and bounce back.
I sense that my list of lessons learned will continue to grow. One of the keys I believe is to be open-minded, drop the pre-judgment and expectations. I never would have imagined that all or any of this would come from my mum’s death.
Whether it’s grief you are dealing with or other challenging circumstances, I hope you will find the cathartic power in your experience that can lead to incredible personal growth. Whatever this may look like for you.
About Karen Schlaegel
After a career in event management, Karen started her life coaching business. She supports people in activating their strengths, identifying their goals, working toward them, and generally moving through life with more ease, happiness, and fun. After eight years in London she moved to Bavaria and is offering coaching online and in person in English and German. karenschlaegel.com / instagram.com/karen_schlaegel.
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‘I Couldn’t Let Her Be Alone’: A Peaceful Death Amid the COVID Scourge
As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance, but also by the cruelty of the coronavirus.
Because of the pandemic, it wasn’t safe to visit her mom, Patti Breed-Rabitoy, who had entered a hospital alone, days earlier, with a high fever and other symptoms that were confirmed to be caused by COVID-19.
Breed-Rabitoy, 69, had suffered from lung and kidney disease for years but remained a vital, bubbly presence in the lives of her husband, Dan Rabitoy, and three grown children. She was a longtime church deacon and youth leader in Reseda, California, a fan of garage sales, bingo games and antique dolls. Then came COVID-19, likely contracted in late April following one of her thrice-weekly dialysis sessions. Now she lay sedated and on a ventilator, her life ebbing, with no family by her side.
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“I had seen these things on TV and I would pray for those people and say, ‘I can’t imagine what they’re going through,’” said Breed, 44. “And now I was living it.”
A single mom of two young sons, she was wrenched with guilt at not being with her mother. “You always picture you’re going to be right by your parent’s side,” she said.
Unlike many families of dying COVID patients, Breed and her family were able to find some comfort in her mother’s final hours because of the 3 Wishes Project, a UCLA Health end-of-life program repurposed to meet the demands of the coronavirus crisis. In the U.S., where more than 120,000 people have died of COVID, it’s part of a wider push for palliative care during the pandemic.
At 5 p.m. on May 10, Mother’s Day, before Breed-Rabitoy’s life support was removed, more than a dozen family members from multiple cities and states gathered on a Zoom call to say goodbye. John Denver’s “Rocky Mountain High,” one of her soft-rock ’70s favorites, played on speakers. Online, a chaplain prayed.
Breed-Rabitoy had been deeply sedated for more than a week, since a terrible night when she struggled to breathe and asked doctors to place her on the ventilator. Confusion abounded, Breed said. Could her mom still hear in that state? Two nights in a row, Breed asked nurses to prop a phone near her mom’s ear.
“I prayed with her. I sang her favorite songs. I read her the Bible,” she said.
Finally, a nurse gently explained that her mother was too sick to recover. If they removed the ventilator, it would be to allow her to die.
That’s when hospital staffers described the 3 Wishes program and asked whether the family had any personal requests for her last moments. They decided on the music and the family Zoom call. Dan Rabitoy requested that a nurse hold his wife’s hand as she died.
After it was over, family members received keychains stamped with her fingerprint and a copy of the electrocardiogram of the last beats of her heart.
“I’m grateful to have these keepsakes,” Breed said. “All these things have been healing.”
Dr. Thanh Neville co-founded the 3 Wishes Project at UCLA Health in 2017. Since then, the program has fulfilled nearly 1,600 wishes for dying patients in the ICU.(Courtesy of Robert Hernandez/UCLA Health)
The project was developed in Canada but co-launched at UCLA Health in 2017 by Dr. Thanh Neville, an intensive care physician who serves as 3 Wishes’ medical director. It aims to make the end of life more dignified and personalized by fulfilling small requests for dying patients and their families in the ICU.
Before COVID-19, the program had granted nearly 1,600 wishes for more than 450 patients, nearly all in person. The deathbed scenarios have varied, from music and aromatherapy at the bedside to meeting a patient’s request for one last mai tai cocktail.
“We’ve done weddings and mariachi bands and opera singers and 20 to 30 family members who could come in and celebrate,” said Neville, 41. “And none of this is possible anymore.”
COVID-19 has “changed everything,” said Neville, a researcher who focuses on improving ICU care for the dying. Also a clinician, she spent weeks this spring tending to seriously ill COVID patients. Since March, her hospital system has seen more than two dozen COVID deaths.
In the beginning, visitors were strictly prohibited. Now, some may come — but many don’t.
“I would still say the majority of COVID patients die without families at their bedside,” Neville said. “There are a lot of reasons why they can’t come in. Some are sick or old or they have small kids. A lot of people don’t want to take that risk and bring it home.”
It has been hard to keep 3 Wishes going during a time when in-person memorials and celebrations are banned and infection control remains the primary focus. Neville even had to change the way the fingerprint keychains were made. Now, they’re treated with germicidal irradiation, the same method that lets health care workers reuse N95 masks.
The 3 Wishes Project is offered when death is imminent: Patients are enrolled after a decision has been made to withdraw life-sustaining technology or if the chance of death is greater than 95%. The program was created to help patients, caregivers and clinicians navigate the dying process in a less clinical, more humane way. Wishes needn’t be limited to three, and they can be articulated by patients, family members or hospital staffers.
The program is based on palliative care tenets that focus on the humanity of the patient amid intensive medical care, said Dr. Rodney Tucker, president of the American Academy of Hospice and Palliative Medicine. Seemingly small acts that honor an individual life help counter the efficiency-driven environment of the ICU, which can be dehumanizing. They’re at the core of care that has been shown to ease both angst for the dying and grief for those who loved them. “It helps the family that’s left behind cope more successfully with the loss,” he said.
Such efforts also remind providers of the humanity of their practice, which can help them cope with the stress of witnessing death daily, especially during something as extraordinary as a pandemic, he said.
A study published by Neville and colleagues last year found that 3 Wishes is a “transferrable, affordable, sustainable program” that benefits patients, families, clinicians and their institutions. They calculated that the mean cost of a single wish, funded by grants and donations, was $5.19.
Genevieve Arriola, 36, has been a critical care nurse for eight years. When the pandemic struck, she found herself juggling medical care and emotional support more than ever. She took care of Breed-Rabitoy for three days straight, all the while communicating with the dying woman’s family.
“This was a very delicate situation for someone who is married to her for over 20 years and a daughter who was miles away in Oregon and couldn’t see her mom,” she said.
She was also the nurse who held Breed-Rabitoy’s hand as she died.
“I pretty much felt honored to be that person,” Arriola said. “I couldn’t let her be alone. If no one can be there, I can.”
Weeks after her mother’s death, Breed is grappling with the loss. The last time she saw her mom was March 16, at a McDonald’s off Interstate 5 near Grants Pass, Oregon.
The pair met for less than 30 minutes before Breed-Rabitoy headed south down the interstate, her long-planned family visit cut short by concerns about COVID. She had just learned that the local dialysis center was closed to outside patients, and she was worried about growing reports of infection and death. “She told me, ‘I feel like this disease is coming after me,’” Breed recalled.
Now, the keepsakes from 3 Wishes are placed where Breed can see them every day.
“It added such a level of love and dignity we weren’t expecting,” she said. “It made the process of losing a loved one to COVID-19 so much more bearable.”
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
‘I Couldn’t Let Her Be Alone’: A Peaceful Death Amid the COVID Scourge published first on https://nootropicspowdersupplier.tumblr.com/
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‘I Couldn’t Let Her Be Alone’: A Peaceful Death Amid the COVID Scourge
As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance, but also by the cruelty of the coronavirus.
Because of the pandemic, it wasn’t safe to visit her mom, Patti Breed-Rabitoy, who had entered a hospital alone, days earlier, with a high fever and other symptoms that were confirmed to be caused by COVID-19.
Breed-Rabitoy, 69, had suffered from lung and kidney disease for years but remained a vital, bubbly presence in the lives of her husband, Dan Rabitoy, and three grown children. She was a longtime church deacon and youth leader in Reseda, California, a fan of garage sales, bingo games and antique dolls. Then came COVID-19, likely contracted in late April following one of her thrice-weekly dialysis sessions. Now she lay sedated and on a ventilator, her life ebbing, with no family by her side.
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“I had seen these things on TV and I would pray for those people and say, ‘I can’t imagine what they’re going through,’” said Breed, 44. “And now I was living it.”
A single mom of two young sons, she was wrenched with guilt at not being with her mother. “You always picture you’re going to be right by your parent’s side,” she said.
Unlike many families of dying COVID patients, Breed and her family were able to find some comfort in her mother’s final hours because of the 3 Wishes Project, a UCLA Health end-of-life program repurposed to meet the demands of the coronavirus crisis. In the U.S., where more than 120,000 people have died of COVID, it’s part of a wider push for palliative care during the pandemic.
At 5 p.m. on May 10, Mother’s Day, before Breed-Rabitoy’s life support was removed, more than a dozen family members from multiple cities and states gathered on a Zoom call to say goodbye. John Denver’s “Rocky Mountain High,” one of her soft-rock ’70s favorites, played on speakers. Online, a chaplain prayed.
Breed-Rabitoy had been deeply sedated for more than a week, since a terrible night when she struggled to breathe and asked doctors to place her on the ventilator. Confusion abounded, Breed said. Could her mom still hear in that state? Two nights in a row, Breed asked nurses to prop a phone near her mom’s ear.
“I prayed with her. I sang her favorite songs. I read her the Bible,” she said.
Finally, a nurse gently explained that her mother was too sick to recover. If they removed the ventilator, it would be to allow her to die.
That’s when hospital staffers described the 3 Wishes program and asked whether the family had any personal requests for her last moments. They decided on the music and the family Zoom call. Dan Rabitoy requested that a nurse hold his wife’s hand as she died.
After it was over, family members received keychains stamped with her fingerprint and a copy of the electrocardiogram of the last beats of her heart.
“I’m grateful to have these keepsakes,” Breed said. “All these things have been healing.”
Dr. Thanh Neville co-founded the 3 Wishes Project at UCLA Health in 2017. Since then, the program has fulfilled nearly 1,600 wishes for dying patients in the ICU.(Courtesy of Robert Hernandez/UCLA Health)
The project was developed in Canada but co-launched at UCLA Health in 2017 by Dr. Thanh Neville, an intensive care physician who serves as 3 Wishes’ medical director. It aims to make the end of life more dignified and personalized by fulfilling small requests for dying patients and their families in the ICU.
Before COVID-19, the program had granted nearly 1,600 wishes for more than 450 patients, nearly all in person. The deathbed scenarios have varied, from music and aromatherapy at the bedside to meeting a patient’s request for one last mai tai cocktail.
“We’ve done weddings and mariachi bands and opera singers and 20 to 30 family members who could come in and celebrate,” said Neville, 41. “And none of this is possible anymore.”
COVID-19 has “changed everything,” said Neville, a researcher who focuses on improving ICU care for the dying. Also a clinician, she spent weeks this spring tending to seriously ill COVID patients. Since March, her hospital system has seen more than two dozen COVID deaths.
In the beginning, visitors were strictly prohibited. Now, some may come — but many don’t.
“I would still say the majority of COVID patients die without families at their bedside,” Neville said. “There are a lot of reasons why they can’t come in. Some are sick or old or they have small kids. A lot of people don’t want to take that risk and bring it home.”
It has been hard to keep 3 Wishes going during a time when in-person memorials and celebrations are banned and infection control remains the primary focus. Neville even had to change the way the fingerprint keychains were made. Now, they’re treated with germicidal irradiation, the same method that lets health care workers reuse N95 masks.
The 3 Wishes Project is offered when death is imminent: Patients are enrolled after a decision has been made to withdraw life-sustaining technology or if the chance of death is greater than 95%. The program was created to help patients, caregivers and clinicians navigate the dying process in a less clinical, more humane way. Wishes needn’t be limited to three, and they can be articulated by patients, family members or hospital staffers.
The program is based on palliative care tenets that focus on the humanity of the patient amid intensive medical care, said Dr. Rodney Tucker, president of the American Academy of Hospice and Palliative Medicine. Seemingly small acts that honor an individual life help counter the efficiency-driven environment of the ICU, which can be dehumanizing. They’re at the core of care that has been shown to ease both angst for the dying and grief for those who loved them. “It helps the family that’s left behind cope more successfully with the loss,” he said.
Such efforts also remind providers of the humanity of their practice, which can help them cope with the stress of witnessing death daily, especially during something as extraordinary as a pandemic, he said.
A study published by Neville and colleagues last year found that 3 Wishes is a “transferrable, affordable, sustainable program” that benefits patients, families, clinicians and their institutions. They calculated that the mean cost of a single wish, funded by grants and donations, was $5.19.
Genevieve Arriola, 36, has been a critical care nurse for eight years. When the pandemic struck, she found herself juggling medical care and emotional support more than ever. She took care of Breed-Rabitoy for three days straight, all the while communicating with the dying woman’s family.
“This was a very delicate situation for someone who is married to her for over 20 years and a daughter who was miles away in Oregon and couldn’t see her mom,” she said.
She was also the nurse who held Breed-Rabitoy’s hand as she died.
“I pretty much felt honored to be that person,” Arriola said. “I couldn’t let her be alone. If no one can be there, I can.”
Weeks after her mother’s death, Breed is grappling with the loss. The last time she saw her mom was March 16, at a McDonald’s off Interstate 5 near Grants Pass, Oregon.
The pair met for less than 30 minutes before Breed-Rabitoy headed south down the interstate, her long-planned family visit cut short by concerns about COVID. She had just learned that the local dialysis center was closed to outside patients, and she was worried about growing reports of infection and death. “She told me, ‘I feel like this disease is coming after me,’” Breed recalled.
Now, the keepsakes from 3 Wishes are placed where Breed can see them every day.
“It added such a level of love and dignity we weren’t expecting,” she said. “It made the process of losing a loved one to COVID-19 so much more bearable.”
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
‘I Couldn’t Let Her Be Alone’: A Peaceful Death Amid the COVID Scourge published first on https://smartdrinkingweb.weebly.com/
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‘We’re going to be OK’
With tender humility and grit of purpose, Spectrum Health nurses put their personal fears aside to support colleagues, watch over their families and care for their community.
They don’t consider themselves heroes.
Nurses take care of others. It’s what they’re called to do.
They rely on faith and take every precaution to protect themselves so they don’t take the virus home to the families they love.
These are the experiences of four nurses working in rural hospitals during this pandemic.
Faith through fear
Jan Moriarty, a nurse of 37 years, said the most challenging part of her job in the Big Rapids Hospital Emergency Department has been resisting fear.
She’s careful to appropriately use personal protective equipment and leans on her faith.
“I have a strong faith in God, so I rest on that,” Moriarty said. “This is what I do. I know there are risks involved with the job. This is something that I chose to do, and I love it. This has not changed that.”
Outpatient surgery nurse Denise Jacobsen starts each shift at United Hospital in Greenville praying with colleagues in the hospital chapel.
“We meet in the chapel every morning and we do a little prayer before we go into our department, which has been comforting for us,” Jacobsen said. “That’s how we’ve been coping with it, just prayer and supporting one another. We’ve always supported each other, but especially more so during this epidemic.”
Jacobsen worries about the possibility of the virus hitchhiking a ride on her clothes when she goes home, especially since her mother’s health is failing. She initially wore a mask at home, but has since removed the mask so her mother, who receives hospice care, could better communicate.
“At least she can see my face, because my mom can’t hear and reads lips,” Jacobsen said. “That was challenging.”
Fellow United Hospital nurse Nichole Johnson has two children at home and experienced similar anxiety. She eased herself off the 24/7 news cycle, and educated herself with evidence-based articles and papers.
“It has eased my anxiety and my fears as I’m finding out facts,” she said. “As long as I’m practicing best practices and doing what I’m supposed to do, I would like to think I’m doing my part to not spread this and to not bring it home.”
Reed City Hospital Emergency Department nurse Amber Besko said the greatest challenge for nurses is the fear of the unknown—particularly, how to keep their families safe and what will happen if patient volumes increase?
“In the beginning it was a struggle, for sure, just worrying about it every day, thinking ‘Am I going to bring it home … or am I going to get sick?’” she said.
Family connections
Support among family members—for the nurses and their patients—has been key.
Besko, who has a big extended family, has tried to keep them all connected virtually.
“We’ve been doing a good job of keeping everyone’s anxiety low,” she said. “I reassure them that it’s OK, that we’re going to be OK and we just have to make sure everyone stays safe.”
Jacobsen said adhering to social distancing within her family has been challenging.
“Not seeing my grandchildren at all has been very trying,” Jacobsen said. “We’re doing story time over FaceTime. You just try to come up with different ideas on how to spend time with them, but it’s not the same as having them sit in your lap and reading them a story while you’re holding them.”
The nurses acknowledge their patients face the same struggles. Not being able to be with their families due to state-ordered visitor restrictions has been difficult and sometimes heart wrenching.
“Especially if someone is getting bad news,” Jacobsen said. “You’re trying to call and update the family on the phone. They’re upset because they can’t be there and you’re trying to console them. That has been the hardest thing, because you just feel so bad.”
Moriarty said the nursing staff is proactive in connecting with patients’ families.
“I think that’s very important, because I totally understand people are frustrated and scared,” Moriarty said. “Most of the people have been really, really good about it. They realize we’re … doing it to protect everybody.”
Besko said they advocate harder for patients in these situations, considering them extended members of their own families.
“We sit with them in their rooms when they’re anxious,” Besko said. “It’s just taking that little bit of extra time.”
Wearing protective masks has added an extra barrier to communication, but the nurses hope their patients can hear the smile in their voice and see the caring in their eyes.
“A lot of nursing is body language,” Besko said. “It’s talking and crying with patients … or laughing with them just to get them to feel a little better.”
Community support
Community support keeps spirits high among nurses and health care workers on the front lines of this COVID-19 fight.
Signs of appreciation and encouragement outside hospitals greet team members on their way to and from work. And businesses and individuals who’ve dropped off supplies and treats nourish their souls.
“It’s been awesome,” Moriarty said. “It’s really humbling.”
“That’s kind of a tearjerker,” Jacobsen said, choking back emotion. “It definitely warms my heart to think we’re having outside support from complete strangers. It’s just been amazing.”
“We love having that support and it makes us feel like we’re doing good in our community,” Johnson said. “The generosity has really been amazing. It’s greatly appreciated.”
“It’s been a blessing every time someone is so generous and wants to bring in something for us,” Besko said.
The support comes from colleagues, too.
Besko said a couple of nurses have made peers surgical caps on their off days. Lab department personnel brought in flowers for the emergency department team and said, “We thought you guys needed something to smile about today.” And the Reed City environmental services team members made crocheted headpieces with two buttons, so you can connect your mask and save your ears.
“Everybody is trying to help everybody,” Besko said.
“We call each other our work family,” Johnson said. “We have a tight bond. We can put each other at ease during these tough times.”
Nursing heroes
Despite increased attention from the community, none of the nurses considers themselves to be a hero.
“This is what I do every day,” Johnson said. “We don’t have a pandemic every day, but we still do patient care every day. This is just what we do.”
“I’m just doing my job,” Moriarty said. “There’s a lot of bigger heroes than I am, but I love my job and do it to the best of my ability.”
“I see myself caring for patients like I normally do,” Jacobsen said. “It’s just a different way to care for them now, but I never really thought of myself as a hero.”
“I chose this position, and obviously we didn’t know this was going to happen,” Besko said. “It’s something I signed up for. It’s something I’m passionate about it.”
The nurses said the COVID-19 challenge we’re all facing has brought the community together and made them each appreciate things we may have taken for granted before.
“It shows you how precious our lives really are,” Jacobsen said. “To hear stories about families losing multiple family members to COVID, that one day we’re here and the next day we’re not.”
“I think it’s made me a little stronger, realizing I can do this,” Moriarty said. “It was a little daunting at first, having to put on the PPE equipment that we’re not used to having to wear. Just knowing that I can do this, it’s not that big of a deal.”
“It’s made me slow down and realize it’s the little things in life,” Besko said. “You don’t always get to be home with your loved ones as much as we are right now. You really get to take that time to appreciate everything you have.”
Patients are showing more appreciation, too, Besko said, sharing a story about a gentleman who recently sought care at the emergency department.
“As he left he was clapping for us and said, ‘I just want you guys to know how much we appreciate it,’ and he was clapping all the way out the door, even though he was the one who was sick.”
It also helps to keep in mind that life will go on in time.
“Things are going to change and it’s all going to be OK in the end,” Besko said. “Eventually things will calm down once we have it figured out and we’ll get back to normal life and get back to hugging our loved ones and seeing them.”
“It’s just a matter of time and a matter of keeping everyone safe.”
‘We’re going to be OK’ published first on https://nootropicspowdersupplier.tumblr.com/
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