Month: May 2020

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In the Coronavirus Crisis, I Can’t Visit My Sick Mother

—So I Wear Her Perfume Instead

By Matt Ortile

I woke up terrified last Friday. Or was it last Thursday? Maybe yesterday. Today?

Each day bleeds into the next when in social isolation to hinder the spread of the novel coronavirus. This pandemic brings with it an acrid kind of despair, infiltrating every hour of our lives, every call we make and text we send. It’s this nauseating smog in my home, where I’ve had the privilege of working remotely, shut away from the world.

One morning, the miasma began to suffocate me. Reports said that nearly 4.4 million people were newly jobless in the U.S., some of my friends among them. Dreadful images of overcrowded hospitals appeared all over the news, while the number of those who tested positive for the virus only continued to rise. It was hitting me that people are dying because a president too concerned about his re-election chances did not acknowledge or prepare for the oncoming global health crisis.

I couldn’t breathe. I opened my windows and watched my quiet Brooklyn street. I went to my dresser. Deeply stressed, I did what I’d always done: I put on some perfume.

It’s my mother’s old favorite, a scent called “Thé Vert,” French for green tea. I bought the bottle during my first summer in New York. Overwhelmed by my magazine internship and yearning for a whiff of home, I went to a L’Occitane near Lincoln Center and sprayed the fragrance on my wrist. It’s a clean scent, floral yet piercing—Camellia sinensis with talons. My pulse steadied. My mind went from cloudy to clear. A single spritz was a vivifying hit.

A salesperson came over, eager to assure me Thé Vert was unisex. I didn’t care either way. I marched to the register with 750 milliliters of the stuff and emptied my wallet onto the counter. That evening, I ate dinner street-side (a five-dollar lamb and rice plate), as the oily halal cart aromas mingled with my new perfume.

It’s been a good investment. That was eight years ago and I still have that same bottle to this day. Some of my fragrances have turned bad over time, but Thé Vert, I think, hasn’t changed much. The green tea is still there, though now it smells peppery when it tickles my nose. Ultimately, its effect is the same: Wearing it, I inhale botanical grit, my mother’s eternal fortitude. And then, whatever anxiety I can release, I get to exhale.

L’Occitane launched Thé Vert in 1999. Bitter orange is the primary top note; the middle notes are green tea and jasmine; nutmeg, cedar, and thyme make up the base. Some reviews on the perfume site Fragrantica associate it with “a happy summer day” or “a picnic at the park.” But when I smell it, I conjure other images entirely.

To me, Thé Vert is five o’clock in the smoggy Manila morning. It’s my mother in her blazer and pencil skirt, applying a full face of makeup in the two-hour traffic jam, dropping me off at school en route to work. Thé Vert is me sobbing into my mother’s collarbone, hurt and confused by men in my family who told me to “man up.” It’s her consoling embrace, her reminders that this storm will pass once we beach upon more welcoming shores.

Thé Vert is my mother in her bedroom in Las Vegas, crying on the phone to my stepfather in the Philippines, separated from her beloved. It’s me hugging her, reminding her that we have each other as we restart our lives in this strange new country. It’s us finding solace in beautiful, simple things—in shared meals, in French perfumes, in our mutual trust and friendship.

As time wore on, my mother wore her perfume less and less, until she finally stopped. L’Occitane discontinued Thé Vert in 2013, a year after I first bought it. They replaced it with the remixed Thé Vert & Bigarade. On Fragrantica, a reviewer called the new formula “bitter and sickly,” and preferred the original Thé Vert because it was “penetrating” and “sharp.”

My mother was similar, someone who cut her own path—for herself in the Philippines; for us both in the United States. That’s the woman I try to channel whenever I put on Thé Vert. I imagine walking through a cloud of atomized courage, borrowing my mother’s conviction, her grace. The bloom of it on my skin tells me that, against all odds, all will be well.

“I’m wearing your perfume today,” I told my mother recently. (This Sunday? Last Tuesday morning?)

Daytime in Brooklyn meant nighttime in Manila, where she and my stepfather now live together. Their self-isolation began around the same time as mine. I could hear the television in their townhouse. They were watching a press briefing live on CNN.

She doesn’t wear fragrances anymore, she said, “so it’s your perfume now, anak.”

I said that it still reminds me of her. It comforts me, makes bearable the fact that I can’t be by her side in the middle of what, on the worst days, feels like the end of the world. I wish I could see you, I told her. She smiled; I could sense it over the phone.

“It’s safer that you’re not here,” she said. “But I miss you too.”

I was supposed to visit my family this spring. But between my work schedule and preparing for the publication of my book this summer, I never got around to buying a plane ticket. This procrastination did me a favor, sort of. When New York governor Andrew Cuomo declared a state of emergency on March 7, my mother told me—jokingly, I think—that God had willed my indolence.

Just as well, we agreed. Flying from the U.S. to the Philippines would have meant going through multiple international gateways, potentially contracting the coronavirus along the way, and possibly passing it on to my mother and stepfather. They’re getting on a bit—she’s in her 60s; he’s in his 70s—and the Center for Disease Control states that older adults are at higher risk for severe illnesses from COVID-19. Also, my mother is immunocompromised. This is because she has cancer.

Again, I should say. My mother was initially diagnosed with breast cancer in 2015. Treatment put her into remission by the summer of 2016; by the fall, we were visiting Rome and Paris together for the first time. Then in 2019, last summer, she phoned me with the news.

Through tears, she said, “It’s back.”

The words my brain managed to pick up were stage IV, metastasized, the bones. She would have called sooner, she explained, but she didn’t want to interrupt my work. I was at an arts residency in New Hampshire for the month, finishing my manuscript. So, under sudden pressure and running out of time, I completed the first draft of my book the next day, unsure how to celebrate, unsure if I should.

The rest of my time at the residency, I wore Thé Vert. I wore it when I went to Manila to see my mother that fall—and again over the winter holidays, when it still felt safe to fly overseas. This year, I wore it at my pre-launch book party, when we could still gather in large groups. I wore it on a big date, when it still felt safe to date—to hug hello, to sip each other’s cocktails, to kiss.

I wore Thé Vert when I woke up terrified. Have worn it throughout the pandemic thus far. Even now, as I write this essay, I wear my mother’s perfume.

I’m not sure when I’ll get to see her again. She’s doing fine, all things considered. Regarding her cancer, I can say that there’s no ticking clock—not for now at least. But there’s also no assured end to the coronavirus crisis. According to experts, it could take anywhere from two months to a year and a half before we can reclaim even a few routines of the pre-COVID-19 world.

At the rate I’m going, I’ll run out of Thé Vert by then. I’ve been putting it on every morning in self-isolation. It keeps me calm, for the most part—as have the facts that I live alone; that I can do my job online; that I take a soapy shower after every trip to the grocery and liquor store; that I have books and video games and group chats to keep me entertained.

But that miasma, it lingers. Thé Vert cuts through it on most days, but when friends ask how I’m doing, I mention my ambient unease. My longing for a world we previously took for granted, a world to which we might never return. This fear, one I’ve felt since last summer, of looming death. The Harvard Business Review named my anxiety when it published an article about the coronavirus that said, right in the headline, “That discomfort you’re feeling is grief.”

More specifically, anticipatory grief—the kind we experience when facing an unknowable future. In the case of the coronavirus, there’s an invisible enemy still mysterious to us, shattering our sense of readiness or safety. Everything is going to change, we think, but how? That’s exactly what I’ve been feeling since my mother said, “It’s back.” Her death is around the corner. We don’t know how long we have on this road, or when we’ll make that turn.

To grapple with anticipatory grief, the HBR article says, we must first acknowledge it—the terrifying days to come. Before making meaning out of loss, before mourning too fast, we must first manage the current grief with counteractive thinking. We must focus on the present. Like so: At this moment, I’m fine. I have food and a home, a job and a warm bed. I am not sick.

But my mother is sick. Already I feel the future pangs of loss; time-traveling micro doses of unbelievable hurt. We are already so far apart physically. Yet there will be a day, who knows how soon, when that gulf widens further, when she will no longer be just a 17-hour flight away. I will not be able to reach her by phone. My memories will fade and I will run out of Thé Vert—the ways I summon my mother.

I wore Thé Vert on a date so that this boy I liked could meet her, in a way. I wore it at my pre-launch book party in order to feel her presence too. I wore it in New Hampshire to celebrate with her a milestone in my writing career. All while we still can. These days, I’ve realized, I don’t wear the perfume to borrow her bravery, to emulate her. I wear it to feel her near me, to alleviate the present distance between us, the future loss I dread.

Like many others living in self-isolation, my mother and I find consolation in the little things: phone calls, video chats, the time we do have on earth. I’m getting antsy though. I told her I’ve been looking at tickets to Manila for my birthday in September, to celebrate with her and my stepfather once the pandemic is over.

“One day at a time, anak,” my mother said. “Take care of yourself first. That’s how we’ll make it through.”

She’s right. Though time differences remain and continents still drift, at least the world keeps turning. If we play our cards right as individuals and as communities in this time of certain uncertainty, there’s a future to hope for, to work towards.

I look forward to the day when I see her again in the flesh, when we embrace and hold each other. She will get a whiff of Thé Vert, still sharp and insistent after all these years, and rest easy. She’ll know that, wherever I go—or, one day, she goes—I will carry her with me always, even long after our perfume has faded into the night.

But for now, I must relish the present. At this moment, she’s fine. She has food and a home, my stepfather and a warm bed. My mother is alive.

It’s like another spritz, another vivifying hit.

Complete Article ↪HERE↩!

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Some Deaths Are Lonelier Than Others

The coronavirus has taken away our ability to grieve collectively, forcing us to find new ways to mourn

The writer’s grandmother is pictured holding her aunt as a baby, and the writer’s mother stands next to her.)

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The coronavirus has taken away our ability to grieve collectively, forcing us to find new ways to mourn

I have been carrying around a strange guilt lately: I feel grateful that my grandmother died in November. At the time, I couldn’t have imagined myself feeling anything positive about her death, but the pandemic has granted me an acute case of hindsight—of all the luxuries we had without realizing it.

As deaths go, my grandmother’s was an ordinary enough one for an elderly woman. Her health had been declining during the nearly two decades since my grandfather’s death, and ever since she was hospitalized in early 2019, it had seemed clear that she didn’t have much time left. The end itself happened over the course of a few days, granting her children in other provinces time to travel home to be with her when she died.

Over the next few days, the rest of the family arrived in my grandmother’s small Quebec town and began preparing for the funeral. We picked the music and the readings, cooked big meals in her kitchen, and talked about her late into the night over glass after glass of wine. The service was held in our family church, whose cornerstone my grandfather had placed and where most of us grandchildren and great-grandchildren had been baptized. It was sad in the way a long-expected death is sad, one you’ve had months to grieve in anticipation.

The only moment when I felt unmoored was at the cemetery, way up in the forest at the top of Mount Royal. After we had all commented on the beautiful view, after touching her coffin one last time, after they’d lowered her into the ground and we turned to walk back to the car, I had an urge to run back and grab her out of the grave. It had been snowing for days and it was so cold outside and she was so small and now we were just going to leave her there alone while we drove back to the nice warm house and had dinner together. I hated the thought that she had to be stuck there, freezing and lonely, while I get to keep moving through life.

Now, of course, I can’t help thinking how fortunate we were that she died just before COVID-19 began in earnest. Friends who have lost family members during the pandemic tell me about watching funerals over Zoom or Facebook Live; one Twitter acquaintance described viewing her grandmother’s funeral over video chat as it took place in a parking lot half a world away. The people left living are distraught over what feels like a lack of dignity for the dead. They carry a lot of guilt about not being able to change things.

Valerie Wagemans, from Herentals, Belgium, wishes that when saw her grandmother on March 8 she had known that it was their last chance to be together. When her grandmother was hospitalized in April with what turned out to be the coronavirus, her father and his siblings had to make the heart-wrenching choice of who among them would be the sole person allowed to visit her if her case became critical. Valerie’s father, bundled up in PPE, video-chatted with his siblings from their dying mother’s bedside; that night, she slipped away in her sleep. The family were able to have a funeral, but they had to maintain two metres’ distance from each other.

“Seeing my dad greet his mom for the last time, breaking down as he walked away and not being able to hug him…it was a knife to my heart,” says Wagemans. “Afterwards, we said a few words to each other, from afar, and each got back into our own cars and drove without having that much needed time among family to try and come to terms with it.”

Wagemans knows she’s one of the lucky ones, in that her grandmother was able to have a visitor at the end and they were able to have a funeral, but that kind of luck isn’t much comfort. Like many of the people I know who are grieving pandemic deaths, she speaks of not knowing how to process the loss without the familiar customs.

“Funeral rituals have a benefit to the people who are grieving when their lives have been turned upside down,” says social work researcher Susan Cadell. “They serve a purpose of being a road map at a time when there are no directions.”

Not having that map right now is a bitter loss. Part of what people are struggling with is the fact that, in the middle of all this death, it feels like the script for how we navigate it has been taken away. What do you do when someone dies and you can’t perform the usual rites, which for many have the added complication of also being religiously significant? How do you honour someone’s life right now in a way that feels worthy of them? In what ways can we make individual deaths feel meaningful when they’re just one among so many other deaths?

There are also, Cadell says, cultural expectations surrounding our role in what happens when people we know are sick or dying. We’re accustomed to being able to sit with someone while they are sick and suffering, to comfort and bear witness as they die. Even pre-pandemic, this could be challenging; physical proximity doesn’t change the fact that the dying person is on a journey on which no one can accompany them. I think of Simone de Beauvoir writing in A Very Easy Death that even though she and her sister never left their mother’s bedside in her last days, they experienced a profound feeling of separation from her, that “each [dying person] experiences the adventure in solitude.” The coronavirus has brought many of us to the stark realization that some deaths are much lonelier than others, adding to the powerlessness and fear everyone is going through right now. It’s like that same awful sensation of walking away and leaving my grandmother deserted in her grave, only amplified exponentially.

According to psychotherapist Megan Devine, creator of the online community Refuge in Grief, these feelings are another layer of the grieving we’re experiencing right now. She tells me that coping with it can begin as simply as admitting that things are rough.

“Acknowledgement is medicine,” says Devine. “And yes, it sucks right now.”

For Devine, one of the most important functions that in-person funerals provide is the chance to share bereavement in a way that doesn’t require talking.

“Without being able to gather together, we can’t hug each other or meet in that place beyond words,” says Devine. “Touch is the bridge there. We miss that wordless place.”

In spite of that, Devine emphasizes that our current isolation and social distancing practices don’t have to preclude us from creating new meaningful ways to mark the end of a life. Her view is that there is no expiration date on when a funeral or memorial has to happen; one way we can cope with the present is by planning events for a time when it’s possible to gather in person again. She also suggests looking for ways to make online funerals or other events feel more personal. Families might all separately cook the favourite meal of a deceased person and then log on to Zoom to eat together, or make a shared Google map where they mark the places that were significant to the person who died, or take turns playing songs that remind them of the person they’ve lost. Those who are grieving can also try practicing their own private rituals; Devine says that these can be as simple as setting aside some time every morning or evening to sit with a photo of the dead person, maybe with a candle and a cup of tea. Drawing inspiration from 18th century poet William Blake, who used to have regular conversations with his dead brother, she suggests trying to talk to the person. Having these quiet touchpoints can help you stay grounded in the present.

Both Devine and Cadell emphasize that, contrary to the social messaging we receive, funerals don’t provide an ending to grief. Rituals mark an occasion and give us a structure within which to express our feelings, but they can’t solve the feelings themselves. If we’re looking forward to life (and death) returning to some version of normal as a panacea for these overwhelming emotions, we’re probably going to be disappointed. We will no doubt be working through our collective grief for many years to come. What we can draw comfort from right now is that, even though things are incredibly difficult, we’re already finding new ways to do that.

I’m still grieving my grandmother’s death, even though it happened nearly six months ago. I feel guilty about that, too, because I know that the circumstances surrounding the end of her life were so much more favourable than they would be now. How can I still be sad about such a comparatively good death when other people have much fresher, more awful deaths to mourn? But it’s not a zero sum game, and there’s still room to miss her even with everything else that’s going on.

I’m trying out Devine’s suggestion of sitting with a photograph of her; it’s on the table next to me as I type this out. In it, she’s a little girl in the backyard of her childhood house, her arms thrown around her sister and brother. She’s smiling at someone out of the frame and if I position the picture just right, I can catch her gaze. I don’t know if I’m at the point where I could have an imaginary conversation with her, but her lips are parting, as if she’s about to speak.

Complete Article ↪HERE↩!

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What to do if the coronavirus pandemic is triggering your past trauma

By Kristin Magaldi

Right now, many people are feeling the mental ramifications of the coronavirus (COVID-19) pandemic. While there isn’t yet a comprehensive study on if there’s been an increase in mental health issues within the overall population, early research has found that some people not previously diagnosed with mental health disorders are now displaying signs. For instance, a March study out of China found that health care workers treating coronavirus were more likely to develop symptoms associated with anxiety, depression, and insomnia, and past studies have noted how loneliness and isolation—common experiences for many of us right now—can cause depression.

And for those already suffering from mental health disorders, the pandemic can exacerbate those conditions. People who have experienced varying degrees of trauma (illness-related and otherwise) in the past are especially susceptible to an increase in symptoms. Dr. Matt Grzesiak, internationally recognized psychologist and creator of the Mixed Mental Arts model, tells HelloGiggles that several aspects of the pandemic might be triggering for trauma survivors and potentially cause flashbacks.

“Round-the-clock mainstream news and social media coverage is bombarding us with horrific images of tragedy, suffering, and loss the instant they occur anywhere in the world,” notes Dr. Grzesiak. “Repeated exposure can have negative effects that overwhelm your nervous system and create further traumatic stress.” And that stress, he explains, might manifest as disbelief, fear, sadness, grief, helplessness, guilt, and/or anger.

Normally, outside of a health crisis, trauma survivors may be triggered by experiences or fears that remind them of their trauma, but the pandemic has amped that potential up to a new level. “The COVID-19 crisis has halted our lives, created economic insecurity on a micro and macro level, and completely uprooted many people’s understanding of what their life is,” says licensed clinical social worker and psychotherapist Haley Neidich. “For people with existing mental health issues, especially a history of trauma, this can derail their recovery and cause a major decompensation in their functioning.” As a result, survivors may experience an increase in nightmares or panic attacks, or an inability to go about their days and maintain their relationships.

As Neidich notes, there are quite a few elements at play during the pandemic that can elicit a flashback or halt a survivor’s recovery. With the unemployment rate so high and many people hurting financially right now, for instance, the loss of money or a job can trigger people who dealt with severe instability during childhood. “Growing up with only the minimum to survive [can] activate post-traumatic stress disorder (PTSD), by creating extreme anxiety or fear of going back to those times when we were struggling financially or personally,” explains Talkspace therapist Cynthia V. Catchings.

Another potential trigger can be grief, especially considering that coronavirus deaths stand at almost 70,000 people in the U.S., as of May 5th. Trauma therapist Diana Anzaldua tells HelloGiggles that someone with past trauma might feel grief over the many aspects of normalcy they are losing, including “loss of routine, loss of job, loss of school, loss of friends/ physical contact, in addition to the death losses of friends and family.” People may also experience anticipatory grief as death tolls continue to rise and the possibility of loved ones getting sick remains high. “So much loss at the same time, without a way to process these emotions or cope safely, can lead to mental breakdowns and depressive states,” Anzaldua explains.

Grieving someone who died of coronavirus can also be particularly hard for trauma survivors, says Neidich. “Making sense of any losses of loved ones can be challenging at this time when there is so much in flux,” she explains, but “it is nearly impossible to make sense of things, process grief, or heal from a traumatic event when the trauma of losing someone to COVID-19 is ongoing.”

Trauma survivors need to feel safe in order to process grief, Neidich adds, but that’s incredibly difficult in our current environment. For one thing, with events of more than 10 people banned, survivors mourning losses aren’t able to get adequate closure via funerals or other ceremonies. This can further impede recovery or bring up similar past experiences where they couldn’t find closure.

Isolation and loneliness due to social distancing mandates can also negatively affect trauma survivors trying to grieve. “Many of us lean on our emotional support system to feel safe and loved,” says Nicole Arzt, licensed marriage and family therapist and board member of Family Enthusiast. “While we have technology to keep us connected, it’s not the same as seeing our friends and family.”

Without usual coping mechanisms like hiking, doing yoga, or going to a favorite coffee shop, trauma survivors may feel deprived of the tools they need to handle upsetting experiencing. Add in the complete unpredictability of the future, and no wonder many people are feeling overwhelmed and anxious.

“The fear of the unknown and the uncertainty about the future are the most triggering concerns I am hearing from my clients who have trauma histories,” Neidich says. “This is especially true for folks who are experiencing financial insecurity, food insecurity, or imminent concerns about their health or safety.”

Fortunately, if you are feeling triggered by the pandemic, there are a few things you can do to help work through the stress and anxiety. Dr. Grzesiak advises paying close attention to your thought patterns at the onset of panic. “Start a journal and write down what you are feeling and when your anxiety is the most noticeable,” he suggests. This can help you identify how new circumstances are eliciting familiar feelings from your past trauma.

From there, designate a self-soothing tool you can do at home that you know will work for you, like exercising or listening to music, Dr. Grzesiak says. Apps like Calm and The Tapping Solution offer meditations aimed to soothe you through tapping specific pressure points, if you find that kind of practice helpful. And no matter what, “reach out to your closest friends or family members for support,” Dr. Grzesiak adds. “You do not need to talk about your trauma necessarily, but spending time with them and sharing your feelings is beneficial to your mental health.” This is an especially good idea if isolation has been triggering for you.

If you are currently undergoing treatment for a past trauma, exploring remote therapy options with your counselor is another step to take. But if you haven’t started mental health treatment for your trauma, Niedich suggests checking out online counseling outlets like BetterHelp or Talkspace. “Additionally, some insurance carriers are covering tele-health, so using a site like Psychology Today where you can find a community therapist who takes your insurance and is available for online counseling is another great option,” she says. If the trauma you’ve experienced is severe, finding a trauma center or EMDR practitioner—someone who specializes in treating trauma—could be a good avenue, adds Anzaldua.

Whether it’s loss, grief, uncertainty, or isolation that are triggering memories of trauma for you, there are ways to take care of yourself. Pay attention to your thoughts and feelings, practice self-care, and know that resources outside of yourself are always available.

Complete Article ↪HERE↩!

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What’s Going to Happen to Junior, Now That His Mother Is Dead?

A Manhattan man with autism was sent to a quarantine facility after his mother had symptoms of the coronavirus and died.

Daysi Díaz, an immigrant from Honduras, worked as a seamstress and later as a home health aide.

By Joseph Goldstein

Daysi Díaz, 65, was afraid to see a doctor, despite a fever that wouldn’t go away. If she was diagnosed with the coronavirus, she might have to be hospitalized. Who would look after her son, Junior?

So Ms. Díaz stayed put in her ninth-floor apartment in a public housing project in Upper Manhattan, growing weaker. Relatives called her often to check in. During one such call in March, Ms. Díaz collapsed. In her final words, she called out for Junior. But he was in a deep sleep.

After his mother’s death, Junior, who is 31 and has a developmental disability, was hospitalized and sent to a quarantine facility in Queens.

His stutter has worsened. He has struggled to make sense of his mother’s death, wondering if she is in heaven. And he has wrestled with anxiety, said his aunt, Carmen González, who is Ms. Díaz’s sister-in-law.

“She thought she was going to live to take care of him,” Ms. González said.

The toll wrought by the coronavirus is forcing some families to confront a wrenching question years before they believed it would be necessary: If a caretaker dies, who will care for disabled adult relatives?

“As Covid-19 sweeps across our city and nation, a lot of parents are coming to the realization that they aren’t going to be here forever and they need a plan,” Jonathan Novick, an outreach manager with the Mayor’s Office for People with Disabilities, wrote in an email.

Adults with intellectual and developmental disabilities have been hit particularly hard by the coronavirus, which has torn through group homes. But the virus also poses a threat to adults with these disabilities who still live with their aging parents.

“We are going to see more and more cases like this one,” said Dominic Sisti, an assistant professor of medical ethics at the University of Pennsylvania.

While there’s no indication Ms. Díaz was ever tested for the coronavirus, Junior was recently diagnosed with a mild case of Covid-19, so it seems likely that his mother also died of the illness caused by the virus, Ms. González said.

Initially, that made finding a new home for Junior more difficult. But in recent days, a family friend has taken Junior in.

Junior had lived with his mother for the past decade. An immigrant from Honduras, Ms. Díaz worked as a seamstress and later as a home health aide, before injuring her back lifting a patient.

Ms. Díaz was often vague when describing her son’s disability to relatives. But his aunt, Ms. González, said she believed he was on the autism spectrum. A health care provider directly involved in Junior’s care confirmed that to be the case.

The family did not make Junior available for an interview because Ms. González said it might confuse him and leave him unsettled.

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His father was not involved in his life, according to Ms. González. Junior spent his childhood in institutions after showing aggressive behavior at age 5 or 6, she said.

“He went from one place to another,” said Ms. González, who is a retired teacher. “His mom would go everywhere he went, all the time to visit.”

He returned home around age 21, at which point Ms. Díaz became her son’s caregiver. It was often difficult. Tantrums often sent him onto the floor, where he would pound the ground with his fists. But with his mother’s help, he began to exercise some independence.

He loved to look through coupons and fliers left in lobbies, always searching for a bargain. His mother would send him out shopping, an outing that he enjoyed.

His mother’s daily worry was that he would behave in a way a stranger found inappropriate and that things would spiral out of control.

On March 21, Ms. Díaz developed a headache and then a high fever. Soon she was coughing so loudly the neighbors could hear it.

At the time, hospitals were inundated with Covid-19 patients. The city was urging sick people to stay at home, if possible. Ms. González said she received little guidance after calling 311 seeking help for her sister-in-law. “Don’t go to the emergency room,” Ms. González recalled the operator telling her.

Still, Ms. González urged her sister-in-law to try an urgent care center. But Ms. Díaz was too weak to get anywhere on her own. She wasn’t sure whether she had the flu or the coronavirus, but she was scared to find out.

“Truthfully, she was afraid of having the virus, because she didn’t want to leave her son,” Ms. González said. “What’s going to happen to him, you know?”

On the morning of March 31, Ms. Díaz was on the phone with an aunt when she began to call out for Junior. Then the phone fell to the ground. Ms. Díaz had collapsed, according to Ms. González.

An ambulance crew arrived and tried to resuscitate her but failed. . Hours later, Junior was later taken by ambulance to NewYork-Presbyterian Columbia University Medical Center, near his home in the Dyckman houses. There was nowhere else to take him.

Ms. González, 72, who is raising her 6-year-old grandson and also cares for an older sister, said she wanted to take Junior in, “but my hands are totally tied.”

In early April, Junior tested positive for Covid-19, though he showed only mild symptoms, Ms. González said. He spent several weeks at the John A. Cook Center in Queens, a facility that ordinarily runs programs for adults with developmental or intellectual disabilities but is now being used as a quarantine center for disabled adults with Covid-19.

He passed the time watching documentaries. In phone calls with his aunt, Junior often brought up his mother.

“My mother was a loving mother and took good care of me,” he said, according to Ms. González.

But the conversations also were unpredictable.

“Why don’t they call 911 to put out the fire in hell?” he asked his aunt once. She said she steered the conversation back to heaven, explaining that if he was good he’d end up there with his mother.

In early April, a family friend who has a son with special needs agreed to take in Junior. But Junior’s Covid-19 diagnosis led to a delay of several weeks.

Then last week, with Junior appearing healthier, he moved in with the family friend at her home in Yonkers. So far it has been a good fit, Ms. González said.

In recent phone calls with his aunt, Junior has started to grieve more openly.

“He asked me if it was OK to cry because his mom died,” Ms. González recalled last week. “I told him that it’s OK and that he did not have to hold his feelings inside.”

Complete Article ↪HERE↩!

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How to plan a remote funeral or memorial and grieve during the coronavirus pandemic

If someone you know has died from complications due to COVID-19, these resources may be helpful.

By ,

More than 238,000 people around the world have lost their lives to COVID-19, and the death toll is growing as the full effects of the coronavirus play out in hospitals and communities. The nature of social distancing means patients are denied visitors in their final hours and families can’t congregate in person at funerals and homes to bury their dead and mourn.

Enforced distance during a time of traditional togetherness can deny people the physical comfort of a hug, a shoulder to cry on and a sense of finality that’s part of the grieving process when someone close has died.

Online resources and tools are no replacement for a gathering of loved ones and friends, but they can help families organize online memorials, memory books and donations made in your loved one’s memory. We present some resources to help plan a remote funeral or memorial and otherwise honor those who have died as a result of COVID-19.

Remember that performing a physical act can sometimes help you regain some agency during a situation you can’t otherwise control. Here are additional tips to help manage anxiety during the pandemic.

Have a Zoom, Skype or YouTube funeral or memorial service now

The coronavirus restrictions prevent us from holding a funeral in person to honor the memory of those who we’ve lost. If you’re affiliated with a religious institution, reach out to see what kind of support your organization can supply in the short term — for example, literature on grief, individual video chats with you and your family members or online prayer meetings.

Your family and friends can also hold a memorial service using Zoom (change these settings to prevent unwanted guests) or another video chat service like Skype broadcast, Google Meet or even a private YouTube channel. Sharing a eulogy or other prepared tribute, readings, poems and personal stories — even discussing the hardship of being alone — can provide a chance to mourn together in a virtual community.

You can also record the memorial service to play later or to share with others who couldn’t attend online.

Set up a vigil your community can see from the street

To honor the memory of the family member who has died, you might light large candles on your porch or windowsill and allow others to drive past and honk to offer support. Set up a large box on your driveway for those in your neighborhood to drop off letters, flowers or other items they may want to share as a sign of their support and grief — at a distance from others.

As you collect items, make sure to handle them cautiously, and wash your hands after touching them. If you yourself are in a high-risk group, ask for deliveries, physical mail and email instead. These gestures could mean a great deal to others who never got to say goodbye and who want to support you.

Ask your religious institution for advice

Although most churches, mosques, synagogues and other places of worship are closed to help prevent the spread of coronavirus, they can still be used as a way to help you grieve. If you’re affiliated with a religious institution, reach out to see how they can provide relief during this time.

One church is live-streaming funerals and services for its congregants. A synagogue is also holding virtual prayer using Google Hangouts. One mosque is live-streaming the sermon and prayer, while another outside the United States is broadcasting the prayer over a speaker.

Ask your institution how they’re helping those in need. See if you can speak with the religious leader, like a priest, imam or rabbi when you need someone to pray or grieve with during this time.

Plant something in your garden or in a pot

The act of planting a flower, ornamental bush or even a fruit-bearing tree in the yard could provide comfort as a symbol of life, of hope or even simply as a way you’ve chosen to honor the deceased.

Reach out to online support groups

If someone close to you has died, seek a Facebook or other online group to share your thoughts and experiences, ask for ideas and even just read to know you’re not alone.

Live and Work Well, a website for well-being and behavioral health, suggests looking into online support groups for grief and loss. You can find others in your area that are grieving through websites such as Grief Support. At this time, the groups are meeting online.

Complete Article ↪HERE↩!

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When life support is withdrawn, commitment to care must not end

By Timothy M. Smith

Physicians caring for the sickest patients with COVID-19 sometimes have to make the difficult decision to withdraw life-sustaining treatment. However, that painful choice does not obviate a physician’s obligation to provide supportive care to dying patients thereafter.

The AMA has created an ethics resource page, “Caring for patients at the end of life,” that offers expert advice on the ethical and emotional challenges involved. Citing numerous opinions from the AMA Code of Medical Ethics, the page provides a comprehensive guide to eliciting and following patients’ wishes for how they want to die.

More broadly, the AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 pandemic. Learn more at the AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical Ethics, JAMA Network™ and AMA Journal of Ethics®, and consult the AMA’s physician guide to COVID-19.

A transition, not an end

“A decision to withhold or withdraw life-sustaining treatment is not a decision to withhold or withdraw care entirely,” the page says. It goes on to quote the Code opinion on “Withholding or Withdrawing Life-Sustaining Treatment,” which requires that physicians reassure “the patient and/or surrogate that all other medically appropriate care will be provided, including aggressive palliative care, appropriate symptom management if that is what the patient wishes.”

Citing the same opinion, the page notes the emotional toll this process takes on everyone involved and recommends establishing the patient’s preferences and setting specific goals for care.

Ideally, patients will have already expressed their end-of-life wishes to their physicians or their surrogates. Often, though, patients haven’t given much thought to the care they will want or not want at the end of their lives. In those situations, per the Code, physicians should “elicit the patient’s values, goals for care, and treatment preferences” and capture those preferences in the patient’s medical record.

If the patient lacks decision-making capacity, the resource page notes, his surrogate may make health care decisions on his behalf.

Read the Code opinion on surrogate decision-making.

Understanding advance directives

If, however, the patient has an advance directive, the preferences set out in the directive should govern care decisions.

“Some physicians think advanced directives are only useful for declining care. They’re not. You can say what you want,” said Elliott Crigger, PhD, director of ethics policy at the AMA. “Now, you may not get it—there may be reasons why it won’t work—but you can say what you wish and how you want to die. And that includes either declining care or asking for care.”

There’s a similar misunderstanding around do-not-resuscitate orders, Crigger noted.

A few physicians may wrongly interpret a DNR order as a sign that the patient also is less interested in other supportive care. “But that’s not what it means,” Crigger said. “It means, ‘Don’t resuscitate me.’ It doesn’t mean, ‘Don’t provide every other kind of supportive care you can.’”

Read the Code opinions on advance care planning and the use of advance directives.

When sedation is appropriate

“When it proves impossible to adequately manage symptoms despite vigorous palliative care efforts, for some terminally ill patients an option of last resort is sedation to unconsciousness,” the page says.

Referring to opinion 5.6, “Sedation to Unconsciousness in End-of-Life Care,” the resource page notes that physicians should reserve this option for patients in the final stages of terminal illness and “ensure that options for appropriate, symptom-specific palliative care have been exhausted, ideally in consultation with a multi-specialty team,” adding that the patient or his surrogate must give informed consent before sedation is administered and the decision should be recorded in the patient’s medical record.

Read about a score-based framework for determining priority access to ventilators and other scarce resources.

Complete Article ↪HERE↩!

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Dying old, dying young

– death and ageism in the times of Greek myth and coronavirus

By

The loss of life from the spread of coronavirus has been on an enormous scale. In the USA more Americans have now died from COVID-19 than in the entire Vietnam war.

Notwithstanding some poignant and passionate speeches by particular individuals (notably New York Governor Andrew Cuomo), much of the discourse has focused on the economic, political and policy division, rather than grief for the victims.

This broadly sanguine response might be due to perceptions that it is mostly older people dying from coronavirus, although experts warn younger people can die too. Witness the relief at new reports that children under 10 have not accounted for a single transmission of the virus. The deaths of older people have been comparatively discounted, not the least because many were socially isolated even before the pandemic.

The Greeks of antiquity reflected on the death of the young and the old in some very creative mythical narratives. Greek myth reflects on and reminds us of some of the less attractive characteristics of human life and society, such as sickness, old age, death and war. In the ancient Greek world this made it harder to put old age and death into a corner and forget about it, which we tend to do.

Choosing when

Achilles, the hero of Homer’s Iliad, actually has a choice in the timing of his life and death.

He can have a long life without heroic glory, back on the farm, or he can have a short life with undying fame and renown from his fighting at Troy. The fact that he chooses the latter makes him different from ordinary people like us.

Achilles’ heroism is fundamentally linked to his own personal choice of an early death. But it also means his desperate mother, the goddess Thetis, will have to mourn him eternally after seeing him for such a short time in life. Such is the pain for the loss of a child in war.

A play by the master Athenian dramatist Euripides is even more focused on young and old death. The play Alcestis was produced in Athens in 438 BC, making it the earliest surviving Euripidean play (about ten years before the plague at Athens).

In the play, the king of Thessaly – an appallingly self-interested person called Admetus – has previously done the god Apollo a favour, and so Apollo does Admetus a favour in return. He arranges for him to extend his life and avoid death in the short term, if he can find someone to take his place and die in his stead.

Admetus immediately asks his father or mother to die for him, based on the assumption that they are old and will presumably die soon anyway. But the father, Pheres, and his wife turn down Admetus, and so he has to prevail on his own wife, Alcestis, to die for him, which she agrees to do.

The story of the play is based around the day of her death and descent to the Underworld, with some rather comic twists and turns along the way. Death (Greek Thanatos) is a character in the play, and he is delighted to have a young victim, in Alcestis, rather than an old one. “They who die young yield me a greater prize,” he says.

The light of day

There is a particularly spiteful encounter between Admetus and his father on the subject of young and old death:

Admetus:

Yet it would have been a beautiful deed for you to die for your son, and short indeed was the time left for you to live. My wife and I would have lived out our lives, and I should not now be here alone lamenting my misery.

Father:

I indeed begot you, and bred you up to be lord of this land, but I am not bound to die for you. It is not a law of our ancestors or of Hellas that fathers should die for their children! … You love to look upon the light of day – do you think your father hates it? I tell myself that we are a long time underground and that life is short, but sweet.

The Alcestis of Euripides, and other Greek myths, remind us, should we ever forget, that love of looking upon the light of day is a characteristic of human existence, both for the young and the very old.

Complete Article ↪HERE↩!