Death and dying in a time of COVID-19

It’s been over a year since Manitoba first went into lockdown, and hospitals are still feeling the weight of COVID-19. Limited access to personal protective equipment (PPE), visitor restrictions, death, and the looming threat of the virus have all been a part of daily life for healthcare providers in the last 13 months.

It’s not easy to work in palliative care, healthcare providers are caring for patients in the final steps of their lives, trying to make it as comfortable as possible. COVID-19 doesn’t make death any easier. Adding a viral illness to the picture only limits what palliative care nurses can do for patients and their families.

Erin Campbell, a clinical resource nurse working at Health Sciences Centre Winnipeg, says that enforcing visitor restrictions is one of the hardest parts of her job. “It’s definitely been difficult,” says Campbell, “I’d say one of the most difficult parts of the pandemic is denying access for people who want to say goodbye to their family.”

As of March 2021, patients admitted to Manitoban hospitals are allowed up to one visitor as an “essential care partner.” This kind of visitor is allowed on a case-by-case basis and is only allowed if the visitor is deemed essential to a patient’s care. However, patients who are actively dying are allowed up to four visitors. These visitors can only go in two at a time and must be the same people throughout as a safety precaution. Any visitors other than those set four must be approved by senior leadership.

Visitor restrictions in hospitals can be especially hard for palliative patients and their families. (gorodenkoff via Getty Images)

These restrictions, though they are made with everyone’s safety in mind, can put a lot of strain on patients and their families as they try to navigate the end of life.

“It’s just horrific,” says Simone Stenekes, a clinical nurse specialist working in pediatric palliative care. “It’s bad enough when you’re dealing with your kid dying, but if you can’t have your family to support you, then that just makes it exponentially harder for parents. Before COVID, families would have a lot of grandparents, uncles, aunts, staying at the hospital with these kids, but now none of them are allowed.”

Stenekes says that because of COVID-19, parents caring for dying children are also often forced to deal with the risk of their child contracting COVID-19 when asking for additional help from healthcare providers. “We’ve had families that, because their kids are super at risk of [contracting COVID-19], they’ve had no respite help because their respite worker is working at several different facilities and have had to prioritize one job so that they’re not going to multiple different sites. For some of our families, that’s been awful because the parents are it.”

Being a student during the pandemic has its own challenges. Students practicing distanced learning are presented with unique challenges that are still relevant over a year into lockdown. However, the reality for some students who don’t have the option for online practicums is even bleaker. Those who are training in medicine during the pandemic are often tossed in without the specialized training that normal medical practitioners get. These students are trying to juggle their education with the risk of infection to themselves and their families. 

“I didn’t think a woman would vomit on me and die,” said Kaitlyn Howson, a second-year x-ray technician student studying through Red River College. “I don’t think really anything can prepare you for that until you actually see it.”

Because of COVID-19, the humanity of healthcare is easily stripped away. Due to safety regulations, healthcare providers are required to wear personal PPE while interacting with patients. This includes face shields, masks, gowns, and other protective wear.  While these items are worn to protect both patients and healthcare providers, they also put up a physical barrier that takes a bit of humanity away from patient care.

Because of the pandemic, healthcare providers are required to wear PPE which prevents patients and families from seeing their faces. (The San Francisco Chronicle/Hearst Newspapers via Getty Images)

“I can’t even imagine what it’s like for a patient. You can’t see anybody. We’re all wearing gowns, masks, goggles,” said Howson, “I try and put little stickers on my goggles and things like that to make it more personable.” 

Stenekes says that she feels the physical barrier of PPE in every patient interaction. “It’s kind of dehumanizing in a way. It makes you feel like less of a nurse.”

COVID-19 has also had an impact on healthcare providers outside of their day-to-day work. “I think it’s been an overall hard experience for everybody that works in healthcare,” says Campbell. “There’s a lot of frustration and a lot of feelings of just not being heard.”

Although COVID-19 is erasing the bit of warmth nurses and healthcare providers can give to patients – that doesn’t mean they’re giving up. Community support for healthcare workers has provided them with a sense of determination in spite of the challenges they’re facing.

“Local families, companies, and restaurants have been so great to us,” says one nurse. “They have been donating individually wrapped meals, cookies, drinks, pizza, and more, just to thank us for our services during this time, and that has brought me, and my co-workers a lot of happiness because we see that people are actually noticing our hard work.” 

While it is encouraging to see the community rise up to support healthcare providers, it doesn’t change the fact that things aren’t changing.

Manitobans are now getting vaccinated, but not at the speed we need to fulfill the statements the provincial government has made. Every Manitoban vaccinated by August means so little when less than 11 percent of the population above 18 has been vaccinated already. While healthcare workers, both on and off the front lines, are working hard to provide quality care, it will ultimately come to the provincial government to determine where we are when August rolls around.

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