Compassionate, informed advice about healthcare decision making

Posts Tagged ‘pandemic’

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.

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?

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