Relatives of dying Covid-19 patients are having to make the agonising decision between being with their loved one as they pass away or attending their funeral.
n one of the cruellest aspects of the pandemic, people across Northern Ireland are being denied some of the most basic end-of-life rituals to help them come to terms with the trauma of losing a loved one.
The harrowing reality of end-of-life care during the crisis has been laid bare by nurse Sarah Arthur, patient client experience facilitator at Antrim Area Hospital, who has described the devastating toll on families and staff as a result of Covid-19.
She said: “When you go home, you don’t leave it behind, you can’t. You still think of the families and the patients because you have built up a relationship.
“We often say that we’re there during the day, but at night we just really pray for our families and our patients because that’s all we feel we can do. It’s absolutely devastating and heartbreaking.”
Safety measures to stop the spread of Covid-19 mean visits to intensive care units are heavily restricted, forcing countless families to stand at a hospital window and watch as their loved one passes away.
For those Covid-19 patients at end-of-life who are not being cared for in a ward where aerosol generating procedures are happening, relatives can visit as long as they wear full personal protective equipment and they must agree to self-isolate for 10 days afterwards.
This means that it is not possible to attend their loved one’s funeral.
Such visits can only take place where the person does not have Covid-19 themselves, is not displaying symptoms and is not supposed to be self-isolating.
As a result, people who have travelled from abroad to see their loved one must self-isolate for 10 days so it may not be possible to visit before a loved one dies.
Where it is not possible for a person to come to the hospital, staff facilitate Zoom calls to allow patients’ relatives to be virtually present when they die, which Sarah described as “like watching it on television”.
She continued: “Yet families are so gracious and accepting and understanding and often we wonder where they get the strength from to really cope with this totally alien situation that none of us are used to and it’s totally heartbreaking.
“At end-of-life, you want to be present, you want to be there in person and say those private messages yourself to your loved one. The best we can do is offer a visit at the window where the family come up and view the end of life through a window, which is absolutely just not normal, or we can facilitate it over Zoom calls, which again for some families, it is like watching it on television, which is really distressing.
“Yet it is the closest we can get the family to their loved one and families do say that just being there at the window, because they are so accepting and understanding, that they know that’s the best that we can do and they are amazing and they just accept that.”
The family liaison service was set up when visiting restrictions were implemented and it aims to bridge the gap between the patients and their loved ones.
Sarah continued: “When a patient is first admitted to ICU, we would make the first contact with the family, tell them abut the phone line and let them know we are there for them throughout their journey, which can be very difficult and challenging.
“In normal circumstances we would promote the families to be with the patient and encourage presence at the bedside, but with Covid-19 and the restrictions on visiting, that just can’t happen.
“This is a totally terrible journey and we are there to support the families equally as much as the patients, so we offer that connection through mobile phone calls and Zoom calls, which are an option and a choice for families, especially ICU where patients are sedated. However, it can sometimes be a one way conversation and that can be really, really hard, so we try to warn the families and explain that may be the case.
“It’s absolutely heartbreaking for the families because they are used to being present in hospitals and whenever that’s removed, it leaves them feeling totally vulnerable and helpless and even for us as nurses, we are absolutely amazed at the families because we don’t know how we would react in these circumstances.
“It has been a real privilege to be involved in the family liaison service, to be a small part of supporting families through this challenging and traumatic experience.
“Sometimes the families trust us with the most personal and private messages, they are the sorts of things that people would ordinarily only say to each other, yet they’re trusting us which is such a privilege.
“This wave of Covid has made us more fearful of the virus as we’re seeing more members of one family getting sick and more younger people too. It affects old and young and it’s really scary.”