The physical ravages inflicted by COVID-19 are captured in daily tallies from around the world. But it is also taking an emotional and spiritual toll — on patients fighting the disease in solitude, on families unable to be with their ailing loved ones and on the caregivers working valiantly to prevent traumatic medical crises and death.
UCI Health chaplains Pirjo Carlisle and Patrick Thompson know this all too well.
Thompson remembers his first COVID-19 patient. The man’s heart had just stopped beating and his wife and son were pleading with the doctor to try to save him if he went into cardiac arrest again.
“His son, who was in his late 20s, turned to me and said, ‘How are you doing? It must be so hard to work in this environment right now,’ ” Thompson recalls. “That’s the first time a family member has ever said that to me. And the patient’s wife showed the same concern for our staff’s well-being.”
The patient’s heart did stop again and the medical team tried in vain to save him. After he died, his wife and children could only stand at his door, one at a time, to say goodbye.
“Afterward, we walked them down to the lobby, but we couldn’t hug them or comfort them as we normally would,” says Thompson. “This patient’s death was so hard on all of us that we needed to call a Code Lavender right afterward.”
A Code Lavender is called when there is an unexpected or traumatic death of a patient or for other serious reasons. Staff members who treated the patient gather together to express their feelings, support each other and decompress.
“Giving our medical teams space to talk and get their feelings out is a big relief for them,” says Carlisle, who has been a chaplain for 12 years.
Technology bridging the gap
Carlisle and Thompson normally consider themselves behind-the-scenes people. Now they are on the frontlines, providing unflagging spiritual and emotional support to those in need. However, the way they interact with patients, families, and caregivers has had to change dramatically during the health crisis.
Before the spread of COVID-19, visitors to UCI Medical Center’s Douglas Hospital were able to sit with relatives, hold their hands and comfort them. Now, the chaplains have taken on the role of surrogate family members as they try to keep patients and their families connected.
Required to suit up in full personal protective equipment (PPE) when visiting COVID-19 patients and to wear masks and gloves with everyone else, Carlisle and Thompson have had to use all their creativity to comfort those in need.
Technology has played a big role in bridging that gap. UCI Medical Center supplied iPhones and iPads so that patients and their families could at least see and talk to each other by video conference and phone calls.
“The devices have been a huge blessing and I’m glad the families have some way to interact, but it’s just not the same as having your loved ones physically present,” says Thompson, who has ministered to patients for three years.
Carlisle has found that the masks and shields make it so hard to hear clearly that she uses the phones to call patients directly.
“The distractions of the PPE and the machines make it harder for patients to unload their pain, whether emotional, physical, or spiritual,” she says. “Many of them have told me it was better for them to talk over the phone, that they felt freer to express themselves.”
Lack of touch
While technology has been a huge help, it can’t solve the chaplains’ biggest challenge — the lack of touch — which is an integral part of comforting and healing.
“One thing the pandemic has taught me is the importance of touch — holding a hand, a hug — the human element has been lost and that deeply affects people,” says Thompson.
Both chaplains use several techniques to compensate for the loss of touch.
According to Carlisle, more than 60% of her work as a chaplain involves attentive, empathetic, active listening. This has become even more important during the pandemic.
“When patients are able to verbalize their fears and worries, this immediately has a positive effect on their physical health,” she says. “I encourage people to cry. When they are able to express their grief and pain through tears, the body becomes more relaxed and the medicines are received better.”
Thompson finds that sitting on a stool beside the patient breaks through the barrier of mask and face shield. He and the patient can be face-to-face so at least their eyes can connect. He also finds that holding their hand, even though he has to wear gloves, provides some measure of solace.
It’s a massive undertaking and at times, overwhelming.
“Normally, we have 33 wonderful spiritual care volunteers helping us. They can’t be here right now because of COVID-19 precautions and we miss them so much,” says Carlisle.
Their dedication and personal sacrifice do not go unnoticed.
“Pirjo and Patrick view their work as chaplains as a true calling and this dedication to their practice drives them mentally, physically, emotionally and spiritually,” says Brad Giafaglione, director for patient experience at UCI Health. “They make themselves available at all hours for our patients, families, and staff members.”
Comforting the caregivers
The chaplains see that the challenge of caring for critically ill COVID-19 patients fighting for their lives has been hard on doctors, nurses and other care providers, leaving them in dire need of support, too.
“There is a high level of stress; there is fear, and there is a sadness that people aren’t taking COVID-19 seriously,” Carlisle says. “But our staff are also resilient. They still go in despite this. They are so brave. It touches me deeply to see their commitment.”
Throughout each shift, she visits the nurses’ stations at the hospital to see if anyone needs help. Often, staff members stop her or visit her office to unload or shed a tear.
“Others sit in the meditation room where they can pray or light a candle. Some take a walk in the Healing Garden at the front of the hospital to receive a moment of sunshine therapy,” she added.
Carlisle recently surveyed medical center staff members, asking what would help them de-stress and heal. Some suggested lunch-hour musical interludes to help them relax and forget for a bit. Others proposed asking UCI’s Claire Trevor School of the Arts for music or dance performances or art therapy sessions.
Meanwhile, the Healing Garden is more welcoming. Additional chairs, umbrellas and trees have been added to the expanse of grass and fountain, where care providers and families alike can be seen taking quiet moments in the sunshine. There have even been a few pet therapy sessions.
Hope for the future
Both chaplains are seeing profound changes in patients, families and employees.
“I feel people are connecting with their faith far more than before and I hope it continues — that they can be more open about who they are — and allow that kindness to come from deep in the soul and enrich our environment,” Carlisle says.
Thompson also sees fellow employees bonding on a deeper level.
“This pandemic has called on us to be more supportive of each other,” he says. “Sometimes we might not have all the right words, but we are still here to listen to each other.”
Thompson felt that support firsthand when he recently returned from quarantine after being exposed to a patient who had tested positive for COVID-19. And, despite having an autoimmune disease, he still chooses to continue his healing work during the pandemic.
“They are two of the most selfless individuals I have had the honor of working alongside,” Giafaglione says. “We also realize they have personal lives and we try to ensure that they receive time for themselves and time to be with their loved ones.”
Reflecting on the effects of the pandemic on the UCI Health community, Carlisle believes that the medical teams will evolve into something new.
"We will need to figure out who we are after this — how we can use this experience to better care for each other and our patients, and make us an even stronger, better hospital,” she says.