Compassionate, informed advice about healthcare decision making

Posts Tagged ‘covid’

The Health Risks of Loneliness

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“Oh. It’s the chaplain. How nice,” she greeted me as I entered her room at the nursing home. Mable was often alone in her room by choice. She was blind and over 100 years old.

This is the same Mable from my book, who, when I asked her, “How do you live to be 102?” responded, “Just keep breathing!”

I thought of Mable as I listened to a recent GeriPal podcast titled “Loneliness and Social Isolation: Podcast with Carla Perissinotto and Ashwin Kotwal.” (“GeriPal,” as in, Geriatrics and Palliative Care.)

As I said, Mable was often alone in her room, isolated. But was she lonely? I don’t recall if I ever asked her. The researchers on the podcast did point out that some elderly folks may be isolated but not lonely.*

Listening to the podcast, one particular visit with Mable came to mind. When I walked into her room, she was in bed, her eyes closed. I gently touched her hand and quietly said her name, “Mable.” She opened her blind eyes suddenly, startled.

“I didn’t mean to scare you,” I assured her.

“That’s okay. I was in my dream world,” Mable said.

“What’s it like in your dream world?” I asked.

“It’s wonderful!”

A couple of quotes from the podcast:

“Loneliness is different than isolation and solitude. Loneliness is a subjective feeling where the connections we need are greater than the connections we have. In the gap, we experience loneliness. It’s distinct from the objective state of isolation, which is determined by the number of people around you.” – Vivek Murthy, two-time (and current) U.S. Surgeon General.

“Loneliness and isolation…are linked with pretty serious health outcomes.… [We] demonstrated that over a six-year period, people that reported higher rates of loneliness had higher risk of dying, 45% increased risk of dying, and 59% increased risk of loss of independence and functional decline, outcomes that are significant and important to our patients.”

Fighting Covid AND loneliness

Photo by Hank Dunn, Fairfax Nursing Center

Now keep in mind, the researchers completed their findings BEFORE the pandemic. COVID made their research even more relevant. Nursing homes kept residents in their rooms, and facilities were closed to visitors to prevent the spread of the virus. This isolation may have reduced deaths by COVID but, perhaps, invited death by loneliness.

There must be a better way to mitigate the risk of both these health threats. Yes, we need to avoid the spread of COVID among residents and staff. And, so too, loneliness.

*“Loneliness in Older Persons: A Predictor of Functional Decline and Death,” JAMA Internal Medicine; July 23, 2012. “The epidemiology of social isolation and loneliness among older adults during the last years of life, ” Journal of the American Geriatrics Society; July 11, 2021.

Grief Upon Grief, Upon Grief — A Funeral, FINALLY, 42 Years Later

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Can you have a funeral for someone who died 42 years ago? Last week, I wrote about having to delay the burial of my mother-in-law’s ashes for ten months because of COVID. Why not 42 years? In 1996, I officiated this long-delayed funeral, choking back tears.

The summer of 1996 turned out to be a terrible one for me. I went through an unspeakable loss that involved a major betrayal and abandonment. By August, I couldn’t get my dead brother, Randy, out of my mind amidst my grief and sadness. By that time, he had been gone over 41 years.

Randy only lived a week, and never left the hospital. He was born without functioning intestines. It was clear that he would die within days. This was back when children were not permitted to visit hospitals, and I was just six years old. I never saw Randy. I never held him. I did not know what it was like to look upon his face.

And yet, during that summer, I missed him. Fresh grief has a way of bringing up old grief you didn’t even know you had.

The backstory

Mom and Dad were visiting for our son’s high school graduation in 1993. After dinner one evening, Randy somehow came up in conversation. I said to my parents, “Tell me about Randy’s death.”

Instantly, Mom burst into tears. Once she could speak, she said, “My father would not let me go to Randy’s funeral.”

My grandfather was a funeral director and arranged to remove my brother’s body quickly from the hospital. Mom had already been sent home, leaving her newborn son behind to die alone. Dad attended the graveside service, but my grieving mother was not allowed. My controlling, alcoholic grandfather decided it would be better for Mom to avoid the pain of putting her child in the ground.

In somewhat of a defense of my grandfather, this was how things were done in 1954. Avoid the pain and go on with your life as if nothing happened. At the time, funeral directors were the only grief experts. Granddaddy was doing what he thought best.

Nowadays, we encourage the parents, and even siblings, to hold their lifeless child. Some families even wash their children, preparing them for burial. These rituals are such an important part of the grief process.

Fresh grief, old grief

Although I always was aware of Randy’s short life, I can never remember him coming up in conversation until my inquiry in 1993. Just mentioning his name opened the floodgates. My mother carried that huge ocean of grief just below the surface all these years.

Did thoughts about Randy painfully arise when Granddaddy died? Randy died on November 22nd. Did Mom think about Randy when President Kennedy was killed on that same day nine years later? Did she think about Randy at my graduation from high school? I am guessing she thought of Randy all the time. I never knew.

When my father was taking his last breath in 2002, Mom’s parting words to him were, “You’re going to see Randy before me.”

Grief never goes away

Although I was not conscious of it, the loss of my brother was always a part of me, too. It didn’t occur to me until I was in the depths of despair that summer of 1996.

As Thanksgiving approached that year, I got an idea. My daughter and I were going to spend it with my parents in Florida. I decided to go to Randy’s grave and conduct a personal graveside service — a ritual. I called Mom and Dad and told them my plan, inviting them to join me. Mom said, “I would love to. You know what I told you about my father.” Indeed, I did.

So, on Thanksgiving 1996, 42 years after his death, we had a funeral for my brother. Mom, Dad in his wheelchair, my brother, his wife, my daughter, and I gathered at the grave. I read the words of committal (“Ashes to ashes, dust to dust”) and Psalm 23 (“The Lord is my shepherd”), we said the Lord’s Prayer, and I stammered through a prayer about Randy.

We turned toward each other. We embraced. We wept deeply. Forty-two years of sorrow ran down our cheeks.

Better-Late-Than-Never Rituals

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I was talking to a friend whose husband died unexpectedly last year from a heart attack. No warning. He died in his sleep. Because of the pandemic, they had no wake, no visitation, no funeral, no public events. She told me, “It’s like he just vanished.”

My mother-in-law, Sue, also died last year amidst COVID. We were fortunate to have a church funeral at the time, although it was only for immediate family. We sat spread out in family “pods.” The priest said all the familiar words that get said at these things. He knew her well, so it was very personal too.

Family and friends gather to say “good-bye” in COVID-delayed ritual

As meaningful as that service was, there remained a huge hole missing. There would have been scores, if not hundreds, who would have come from near and far to be with us in normal times. Family and friends would have filled the church, hugged our necks, and told us meaningful and funny stories about Sue. It didn’t happen.

Fast forward to last week. We finally buried Sue’s ashes in a public ritual. Those friends and family members did indeed come from near and far — from Dallas, Seattle, New York, Arizona, Chicago, Virginia, Wisconsin, Minnesota, Cleveland, and from just a few blocks away. Necks got hugged, and stories got told. You never get over grieving, but these public rituals can be an important part of the process.

Rituals denied by choice of the dead

As I write this, I think back to my brother’s death four years ago and what we missed. My sister, brother-in-law, and I traveled from Colorado and Virginia to visit Dennis barely two weeks before he died. I cherish the photo taken during that visit. The three of us stood outside his “cracker house” home on farmland north of Tallahassee. We would not see him again.

Hank and his sister Janice with their brother Dennis two weeks before he died

Dennis was a very private person. As he knew his death approached, he told his wife he did not want any services to remember him. Our only ritual was the dreaded phone call from my sister, “He’s gone!” It was my birthday, and my now widowed sister-in-law suggested that my sister not call me until a day later. You know — “don’t ruin his birthday.”

So, my sister and I cried together over the phone. That was that. We are now the last two of the six in our family of origin.

It is curious that we give the deceased such control over survivors’ grief rituals. How did my now-dead brother get the right to deny me gathering with family and friends to remember him? He won’t even be there. It would have been about us and not him — our needs, not his.

“Thanks for all the laughs.”

So, last week, we gathered at the columbarium of St. Paul’s on the Lake Catholic Church in Grosse Pointe, Michigan. Sue’s 88-year-old, life-long best friend, going back to their childhood days, reached into the niche, touched the urn, and said, “Thanks for all the laughs.”

These rituals are so important. It really is “better late than never.”

“We Were Called to Sacrifice as a Nation. We Didn’t Answer.”

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Do we care? Really? Has our overinflated sense of personal freedom condemned us to fail as a society that cares for each other?

Last year, I wrote about my first experience wearing a mask in public. I realized in the moment of walking into the post office that I was donning the mask out of concern for others. Before Christmas, the same office displayed large black ribbons in honor of a postal clerk who had died of COVID. Did we, the patrons, give him the disease?

During this pandemic, we have all been called upon to make some sacrifices for the common good. Many have made great sacrifices — retail workers, first responders, and healthcare providers, to name a few. The call was much more modest for most of us — wash our hands, wear a mask, don’t gather in large crowds, and get vaccinated.

The call to sacrifice

Contributing opinion writer, Margaret Renkl, reflected on this call to sacrifice in her piece, “We Were Called to Sacrifice as a Nation. We Didn’t Answer.” The article was published in The New York Times this past Memorial Day, a day we remember those who sacrificed all for the common good.

She likened the novel coronavirus to a deadly enemy — not unlike the fascists we confronted and defeated in World War II. My father and millions of men and women in his generation answered the call to join that fight. There was no question that he would go. It’s what that generation did. Our nation depended on those who were willing to sacrifice.

Renkl suggests this sense of national sacrifice was squandered in the Vietnam War. Not only were we misled by our government about the imagined progress of the war effort, but the sacrifice fell mainly on the poor and minorities who could not avoid the draft.

I was fortunate enough to attend college at that time and so was deferred from the draft. But I kept a constant eye on my draft status, wanting to avoid the fate of the others who died in our losing effort.

The false idol of personal freedom

Many feel the call to wear a mask or get a vaccine violates their personal freedom. Rep. Jim Jordan of Ohio put it this way in a congressional hearing in April, “‘Dr. Fauci, when is the time?’ Jordan kept asking. He wanted to know when it was ‘time to pull back on masking’ and ‘physical distancing.’ ‘When do Americans get their freedoms back?’” The Washington Post

Excuse me? We had (and still HAVE) the opportunity to save the lives of tens of thousands of our fellow citizens by wearing masks and getting vaccinated. Why wouldn’t we?

Many choose not to because of “freedom.” What is missed by so many who refuse these simple measures for the sake of freedom is that we do them mainly to protect others, not ourselves. To get to herd immunity, we must have enough of the herd answering the call to “sacrifice” by getting a shot or two.

Renkl’s article also touches on another huge issue of our time: climate change. The loss of a sense of the common good here has an even greater impact on our world. In this case, instead of the elderly and medically at-risk, the others we are protecting by addressing global warming are our grandchildren and great-grandchildren. Are our “personal freedoms” more important than they are?

Looking for a Sign… Calming Amidst Grief

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I had NEVER seen a street sign like it – “TRAFFIC CALMING AHEAD” – and I collect photos of unique street signs.

Like the one we saw driving home from the Memphis airport the other night: “THIS IS YOUR SIGN TO BUCKLE UP.” (The folks at the Department of Transportation do try to make us smile.)

Or the one I saw years ago when I was speaking in Boulder, Colorado. It was February. I went out one morning for a walk on a pedestrian path. I approached an underpass and could see some patches of ice in the shadows of the bridge.

Not to worry! This progressive, free-thinking university city put up a sign to warn me: “ICE MAY EXIST,” it read. I thought, “This is SO Boulder!”

The sign begged more questions. Ice may or may not exist, correct? Do I exist? If I do exist, how did I come into being? What is the nature of existence? What is the nature of non-being?? Goodness! I was just going out for a walk.

Obvious signs

It’s not just in Boulder that I pondered the meaning of life upon seeing a road sign. While driving home from church in Northern Virginia, I saw a sign that read, “ROUGH ROAD AHEAD.” Ya think? Here I imagined Buddhists writing the road signs with their idea that “life is suffering.”

Then there are the obvious signs. I saw a “WARNING — ALLIGATORS” sign as I put my kayak in the Hillsborough River outside Tampa. The authorities-that-be felt the need to put another sign right below: “NO SWIMMING.” Really? Who was thinking of swimming with the alligators? The people in Florida really are crazy.

 

I was a chaplain for a hospice in Ft. Pierce, Florida, which had a hospice house for patients to spend their last days. There were tables and benches on the grounds for patients, their families, and staff to take a break outdoors. Beside a nearby pond, there was a sign, “WARNING BEWARE OF VENOMOUS SNAKES.” Good Lord, these dying folks have enough to worry about.

Family calming ahead

The “TRAFFIC CALMING AHEAD” sign was on a quiet, tree-lined suburban street in Alexandria, Virginia. This sign was followed by one that said, “SPEED CUSHIONS AHEAD.” I’ve heard them called “speed bumps” or even “speed tables” but “cushions”?

My wife, Sally, and I were in town to attend a funeral for a friend who died after living with ALS for years. Sally had known his wife since before they were married. Over the weekend we twice visited the widow’s home — once the night before the funeral and then for a gathering afterward – and saw the signs.

As we drove to her home, the words on the sign morphed in my head to “FAMILY CALMING AHEAD.” Indeed, it was. The widow and her two college-age children welcomed mostly family into their home the night before the funeral. There was lots of hugging and laughter. The scene was repeated after the service with a larger gathering of friends, business colleagues, and more family.

The grief process can be a rough road for many, but these calming events in the first days are a good place to start the journey.

Could COVID Be the New “Old Man’s Friend”?

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Here’s the question: Should a nursing home resident with dementia get the COVID-19 vaccine?

There is no question that nursing home residents are at a high risk of dying should they get the coronavirus. That also goes for the underpaid and overworked staff who care for these vulnerable patients. One might think, “Of course, vaccinate them all.”

Not so fast.

I started thinking about this after reading a recent article from the bioethics think tank The Hastings Center, “Too Taboo to Contemplate? Refusing COVID Vaccination for Some People with Dementia.”

Just a month ago I wrote a blog post, “Making End-of-Life Decisions for Dementia Patients.” In it I wrote, “Here’s the question families of dementia patients face as they consider end-of-life decisions: Shall we save his life so he can become more demented and slowly decline further or shall we let him die peacefully?

Dena Davis, J.D., Ph.D., takes a similar approach in her Hastings Center article. She states the obvious: that if a person had declared in an advance directive that in the case of advanced dementia, they would refuse vaccines for flu or pneumonia, then that would also apply for COVID-19 vaccine. But, what of the patient who does not have a written advance directive or has failed to give such specific verbal directions?

Dr. Davis refers to several surveys where people expressed their preference to die sooner rather than spiral down with dementia. In one survey, more than half of the respondents were either “very unwilling” or “would rather die” than live in a nursing home. In another study of seriously ill but cognitively competent people a majority believed that either incontinence or “being confused all the time” were states equal to or worse than death.

We hardly need a scientific study to convince us that losing our minds and being totally dependent on others is a state almost all of us want to avoid. Now, a novel coronavirus comes along that is especially hard on elderly nursing home patients. It is also hard on the caregivers and vaccinating patients is partly to protect these folks and their families.

I agree with Davis’s personal preference that if she had dementia and was confined to a nursing home, she would give her surrogates instructions to withhold vaccines. Me too.

Once, pneumonia was thought of as “the old man’s friend” – a relatively peaceful way for the elderly to die, a welcome visitor. Dr. Davis speculates, “Could the novel coronavirus be today’s old man’s friend?”

Remembering COVID-19 While in the Midst

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me·mo·ri·al| məˈmôrēəl | noun 1 something, especially a structure, established to remind people of a person or event.

A memorial to COVID-19 surprised me at first. Is it too soon?

We usually think of memorials being erected long after the fact. World War II ended in 1945 and its memorial on The Mall in D.C. opened in 2004. At the other end of the reflecting pool stands the 1922 Lincoln Memorial honoring a president who died in 1865.

Also nearby is the Vietnam Veterans Memorial built in 1982 for the war that ended in 1975. This memorial is a particularly moving display of 58,320 names of the war dead. Initially, the design of two granite walls sunken into the ground was highly criticized with one official calling it “a black gash of shame.” It has become a pilgrimage site for families and brothers-in-arms to touch the names of those they have loved and lost. Here, grown men weep at the sight of the name of a fallen comrade.

On a recent walk I was surprised to see a metal engraved marker remembering those who died of COVID-19 and honoring the heroes. It stands in a small park in Leesburg, Virginia, right next to the rails-to-trail bike path. A local Girl Scout troop planted a tree and set the marker at the end of December. The marker reads: “This tree was planted in memory of those we lost during the COVID-19 Pandemic, and in gratitude for the heroes who emerged.”

 

COVID-19 memorial in Georgetown Park, tree and plaque installed by Girl Scout Troop #2718

My surprise stemmed from the fact that this pandemic is far from over. People are still dying in great numbers. We are still wearing masks as a daily reminder to be vigilant. We have been warned deaths could spike again. How can we gain the benefit of a “remembrance” when this event is still unfolding?

Do we need to be reminded?

Hospital staff take a moment of silence to commemorate the year anniversary of the start of the pandemic in Fort Worth

Of course, there have been temporary memorials like the candles at the White House the evening we passed 500,000 deaths. A story and photos appeared in my Facebook newsfeed with medical staff kneeling in prayer next to white flags at the Texas Health Harris Methodist Fort Worth hospital. I am sure they would like to put this all behind them, but they had to go back inside and care for more COVID patients.

Do we need to be reminded about the pandemic? No, but I think we want families of the dead to know that we noticed. What must it be like to have lost someone to a plague that the country is so ready to forget ever happened? Or, at least, we want things to “get back to normal.” The bereaved will never get back to pre-pandemic normal.

Perhaps the Girl Scouts are too young to realize that this pandemic is a once-in-a-century event (hopefully). Do any of us know the long-term effects of months of isolation and remote learning? Does this memorial remember children’s grief over the lost memories of events (like a prom) that could have been but never were?

What about the effect on the elderly isolated in nursing homes who, we know from research, are being prescribed increasing amounts of psychotropic drugs? How do we mark the loss of the mental health of those elders who have just months to a few years to live?

My guess is it will take a generation to memorialize this time. My hope is that we, as a people, will be better because we allowed ourselves to grieve…and to remember.

Signs of Hope Amid COVID

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When will our lives get back to “normal?” Is there hope this will ever happen?

I had cable news on the other day and saw this in the crawl at the bottom of the screen: “For the first time, vaccinations outnumber new hospitalizations 10 to 1.”

I took that as a very hopeful sign.

Think about it. Each time a person goes into the hospital with COVID-19, ten more just got a vaccination. And right now, those getting the shots, are the ones most likely to end up in the hospital if they were to get infected — the elderly and those with pre-existing conditions.

I must say, just seeing that crawl lifted my spirits slightly.

And then, there was the day I got my first dose of the Pfizer vaccine. (Yes, I qualified.) I got in the line of cars, filled out paperwork, inched the car along until it was my turn, received my shot from a National Guard member in fatigues, and joined the wait line for observation. My fifteen minutes were up, and I was on my way home.

My spirits lifted a little more.

Zoom brought out his feelings like nothing else

Laura Fraser (in San Francisco) and her 92-year-old father, Dr. Charles Fraser (in Denver) pose for a portrait via Zoom (Carolyn Van Houten/The Washington Post)

Stories continue to be told about the good that has come out of the pandemic. Just the other day the Washington Post ran a great piece about how Zoom has changed a family’s life. Laura Fraser writes about her 92-year-old father, Dr. Charles Fraser, a former physician living in a retirement facility with limited visitation.

Between his flip phone and clunky old computer, Dr. Fraser did not have the capacity to participate in an online chat. So, Laura writes:

“My husband and I bought a cheap laptop, loaded it with his email account, photos, Zoom and a password written in indelible ink on the keyboard, and mailed it off. After many tries, voilà! There he was on Zoom, with his crooked nose from the time a horse kicked him, and the familiar warm brown eyes. I hadn’t been sure I would see that face again, and I teared up.

“That’s all there is to it?” Dad asked. My sisters and their kids dialed in, and Dad held a smile so long I thought his computer had frozen.”

“Before he signs off, he tells us he loves us.”

Laura’s dad had never been one to talk about his feelings, his childhood, how he felt about his children,  or even how much he missed his wife, now gone ten years. On Zoom he has opened up for the first time. She ends her hope-filled story with this:

“A few weeks ago, over Zoom, Dad was able to see his great-granddaughter for the first time. He was delighted to learn that my nephew and his wife have named her after my mother, Virginia. ‘I just can’t wait to hug her,’ he says. His mood has lifted. He laughs as little Ginny burbles and coos. He does something else that’s new for him. Before he signs off, he tells us he loves us.”

Another little sign of hope in a time that needs so much.

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