BOSTON – In the last moments of life for a COVID-19 patient at Beth Israel-Deaconess Medical Center in Boston, the patient’s daughter was about to go to the hospital to say goodbye. Because of coronavirus restrictions, no other family members could be at the patient’s bedside. Nor could the hospital’s Jewish chaplain, Nancy Smith. Yet through virtual technology, Smith was able to help the family and the patient.
With the daughter and a nurse in the hospital room, two separate phone connections were made – one with the patient’s father, and one with Smith, who has had to work remotely throughout the pandemic. On the call, Smith recited the Viduy prayer – traditionally said before a person dies –on behalf of the sick patient.
“It’s certainly very difficult, yet also very effective,” Smith told the Jewish Journal about providing spiritual care virtually to patients and their families during the COVID-19 response.
Smith said nonverbal expressions and touch are critical in the communication process – which is missing when a sick person cannot speak to someone in the same room. “A lot is constantly communicated through people’s faces,” she said. “The opportunity for touch – such as whether it would be appropriate to place one’s hand on someone’s shoulder, or hold someone’s hand – is no longer available. It’s certainly a big difference.”
Still, she is happy patients still have the opportunity to speak to a chaplain. “Frankly, I’m glad something could be offered. I felt like I could be engaged for the patient, and particularly for their families, at a very, very difficult time.”
A chaplain at Beth Israel for 12 years, with over 35 years of experience as a clinical social worker, Smith is seeing the pandemic test hospital patients, their families and the staff in unimagined ways. Working remotely, she tries to help all of these diverse constituencies.
Her primary responsibility is to serve Jewish patients and their families at the hospital, as well as staff. She also provides spiritual care to patients of other faiths and to people who have no religious affiliation.
During the pandemic, she has assisted with Jewish calendar events such as Passover, when patients were able to receive Seder plates and ritual items. Yet she has also had to provide spiritual care to patients at the end of their lives, as well as to their families.
Smith remembers one couple who had contracted COVID-19. One died in the hospital, and the other recovered. “I’m having ongoing phone conversations with her,” Smith said of the latter, “in an effort to both be able to support her through her grief and sort of being involved [in] processing both of their illnesses.”
She also remembers speaking with a family member of a very ill patient. As she recalled, this family member was choosing a burial plot for their loved one at a cemetery and “really [wanted] to share some of the origin stories of their and the patient’s families.”
In general, family members tend to be the vast majority of Smith’s calls, she said, noting that many of her coronavirus patients have been quite ill, with some intubated and on a ventilator.
While Catholic priests are allowed to enter the rooms of COVID-19 patients, and offer the Sacrament of the Sick, or last rites, chaplains are not permitted to go into rooms with COVID-19 patients.
This barrier has caused a change in communication. “It’s a shift in thinking about how we can provide spiritual care in a meaningful way,” she said. “We’re trying to get to know patients and their families, understand their values, understand what holds meaning for them, particularly around end-of-life issues. We think about decision-making, goals of care … we ensure that patients’ and families’ values are fully respected and understood by the team.”
Yet there are also coronavirus patients at risk of dying without anyone to bear witness to their existence.
“Maybe we do not know their family members,” Smith explained. “If we have determined it is important [for them] to have someone by their side, the staff makes every effort to ensure it happens. Maybe it’s a physician, maybe a nurse.” This can happen when a patient is dying, or following their death, she said.
Smith and her fellow chaplains also provide spiritual care for the medical professionals on the front lines, who must deal with illness and death on a constant basis.
“Certainly, the pandemic has had a deep impact on the front-line staff,” Smith said, adding that chaplains have marshaled resources ranging from inspirational teachings to music. Even a spiritual care Instagram account is regularly updated.
For all involved, there may be some comforting news: The number of COVID-19 cases at Beth Israel-Deaconess is “significantly down,” Smith said. “Certainly not [what it was] a couple of months ago. I think there is some sense – I would not say of returning to normal, but beginning to move in that direction.”