The author with her parents, Betty and Stanley Walton
How a Pandemic Stole the Comforts of Mourning
By Melissa Walton-Shirley, MD
On a recent walk with our labradoodle, a woman standing outside her door caught my attention. Despite the mask and cane, I recognized her as the mother of a high school friend. I stopped for a yard visit, staying at a safe distance. She gingerly came toward me, searching with her cane for places in the soft ground that would not betray her. “I miss your parents so much,” she said, tears welling. I swallowed hard. Her words and the comforting whispers of others forever suspended in the darkness and space that COVID-19 brings to grieving.
The conversations meant for funeral visits, memorials, and wakes must now occur on the occasional lawn, across the grocery aisle, or by text and social media. Despite these attempts to wrap us in kindness, the essence of unwitnessed grief feels like the south pole of a magnet that searches for, but cannot find, its north. Our planet’s deaths from COVID number over 3 million, but not everyone who died in 2020 succumbed to the viral infection. Those of us who lost loved ones to other causes share one thing with those who mourn COVID deaths: the absence of our traditional mourning rituals.
There are no lines at the funeral home or packed memorial services where mourners can feel the love and support of a sea of friends and acquaintances at our backs. There are no tables crowded with food where we can commune in honor of those we loved. We will never get that back; our grief cannot be postponed until the pandemic is over. But that’s not all. This era has also robbed many elderly people of a good death.
A Socially Distanced Death
My husband Tony and I flew back to the United States in March 2020 from a trip to Israel. We connected through JFK when New Rochelle, New York, was on fire with the viral outbreak and the country was starting toward the height of COVID uncertainty. We quarantined for 14 days and then visited my elderly mom and dad on their side porch—a door between us. Their aide and near-constant companion helped my parents get situated near enough to the door to see our faces, and we used our phones on speaker. For weeks the cool Kentucky spring did not gift us enough warmth to visit outside.
In early May, I would get the closest to my father that I would ever be again—6 feet away as he sat on the swing on their front porch. It was there that he told me what I already knew: he was dying. There was no hug to follow.
I offered to take Dad to the hospital, but he declined. He was 88 years old and afraid of contracting the virus. He survived this long because of the many magnificent devices that cardiology has to offer, but the ravages of neuropathy and congestive heart failure had taken his mobility and his will.
A week later, he was febrile and bedfast. His carer raised the bedroom window so that we could speak through the screen. Tony and I spent the day. Seeing how weak Dad was, we went home to pack a bag so I could sleep on the porch underneath his window. I needed him to know I was there just in case. As I threw my things into the back of our car, I received a text. It was a video of my father sent by the night sitter asking me if he was “okay.” He had obvious agonal respiration, an image that no amount of time will erase. He was gone by the time I arrived.
Q: I live in a close-knit Upper East Side rental building, where neighbors trade phone numbers and collect one another’s packages. The woman who lives below me lost her husband in August after an illness. Since then, I’ve heard her wailing, talking and cursing to herself, clearly in despair. The neighbor below her also can hear the noises, but we don’t know how to approach this. I have offered the widow help with errands when I see her, so she knows we’re here for her, but she declines, and I don’t think that would really help anyway. Any advice on how we can handle this?
A: Grief can be a long, lonely process, made lonelier by a pandemic that has denied us opportunities to spend time with the people we love. At another time, your neighbor may have had more sources of comfort than she does now. Or, she may have a strong support network now, and just needs the space to grieve alone at home.
But you don’t know if she’s OK, and as a concerned neighbor you could certainly offer your support. Even if she has support, she may need more.
You were kind to offer help with her errands, but as you suspected, that may not be what she needs. “People don’t need help, they need company,” said Dr. Katherine Shear, founder and director of the Center for Complicated Grief at the Columbia School of Social Work. “Offering to do some errands or get things, that’s a very reasonable thing to do, but it’s not quite the same.”
Stop by her apartment to let her know that she’s been in your thoughts. Ask if she is OK, and if she has friends and family nearby who spend time with her. Remind her that she is not alone in the building. Ask if she might want some company. The flowers are blooming, the days are getting warmer — suggest taking a walk or sitting outside together.
People who are grieving “are not good company themselves, but they just need the presence of someone” who is willing “to share this very human experience,” said Dr. Shear, a psychiatrist.
Your neighbor may rebuff your initial request, but you can keep trying. The other concerned neighbor could follow up with a similar offer. If you run into her in the lobby, remind her that the offer still stands. “Gentle persistence is what I would call it,” Dr. Shear said. “Let your compassion be your guide.”
The special project “What Loss Looks Like” presents personal artifacts belonging to those who have left us and explores what they mean to those left behind.
Readers submitted photos of items that reminded them of loved ones who died in the past year.
By Jaspal Riyait
As the art director of the Well desk, I’ve spent the last year looking for images to reflect the devastation of the pandemic and the grief it has wrought. As the crisis has stretched on, I’ve thought of all the people who have lost loved ones to Covid-19 — not to mention those who have lost loved ones, period — and how they were cut off from the usual ways of gathering and grieving. Watching the numbers rise every day, it was easy to lose sight of the people behind the statistics. I wanted to find a way to humanize the death toll and re-establish the visibility of those who had died.
To help our readers honor the lives of those lost during the pandemic, we decided to ask them to submit photographs of objects that remind them of their loved ones. The responses were overwhelming, capturing love, heartache and remembrance. We heard from children, spouses, siblings, grandchildren and friends — people who had lost loved ones not only to Covid-19 but from all manner of causes. What united them was their inability to mourn together, in person.
Dani Blum, Well’s senior news assistant, spent hours speaking with each individual by phone. “It’s the hardest reporting I’ve ever done, but I feel really honored to be able to tell these stories,” she said. “What struck me the most about listening to all of these stories was how much joy there was in remembering the people who died, even amid so much tragedy. Many of these conversations would start in tears and end with people laughing as they told me a joke the person they lost would tell, or their favorite happy memory with them.”
The photographs and personal stories, published digitally as an interactive feature, was designed by Umi Syam and titled “What Loss Looks Like.” Among the stories we uncovered: A ceremonial wedding lasso acts as a symbol of the unbreakable bond between a mother and father, both lost to Covid-19 and mourned by their children. A ceramic zebra figurine reminds one woman of her best friend, who died after they said a final goodbye. A gold bracelet that belonged to a father never leaves his daughter’s wrist because she is desperate for any connection to his memory.
For those who are left behind, these items are tangible daily reminders of those who have departed. These possessions hold a space and tell a story. Spend time with them and you begin to feel the weight of their importance, the impact and memory of what they represent.
Museums have long showcased artifacts as a connection to the past. So has The New York Times, which published a photo essay in 2015 of objects collected from the World Trade Center and surrounding area on 9/11. As we launched this project, we heard from several artists who, in their own work, explored the connection between objects and loss.
Shortly after Hurricane Sandy, Elisabeth Smolarz, an artist in Queens, began working on “The Encyclopedia of Things,” which examines loss and trauma through personal objects. Kija Lucas, a San Francisco-based artist, has been photographing artifacts for the past seven years, displaying her work in her project “The Museum of Sentimental Taxonomy.”
“Saved: Objects of the Dead” is a 12-year project by the artist Jody Servon and the poet Lorene Delany-Ullman, in which photographs of personal objects from deceased loved ones are paired with prose to explore the human experience of life, death and memory. And the authors Bill Shapiro and Naomi Wax spent years interviewing hundreds of people and asking them about the most meaningful single object in their lives, gathering their stories in the book “What We Keep.”
As the pandemic continues to grip the nation, the Well desk will continue to wrestle with the large-scale grief that it leaves in its wake. Other features on this topic include resources for those who are grieving, the grief that’s associated with smaller losses, and how grief affects physical and psychological health. As for “What Loss Looks Like,” we are keeping the callout open, inviting more readers to submit objects of importance, to expand and grow this virtual memorial and provide a communal grieving space.
More pregnant women died, experienced complications or delivered stillborn babies during the pandemic than in previous years, according to an analysis of 40 studies in 17 countries published on Wednesday in the journal Lancet Global Health.
Pregnant women face a heightened risk of severe illness and death if infected with the coronavirus. But the researchers, in Turkey and the United Kingdom, wanted to assess collateral damage from the pandemic on pregnancy and delivery, and so excluded from their analysis those studies that focused only on pregnant women who were infected.
Reviewing data on more than six million pregnancies, the investigators found evidence that disruptions to health care systems and patients’ fear of becoming infected at clinics may have led to avoidable deaths of mothers and babies, especially in low- and middle-income countries.
Data from a dozen studies showed that the chances of a stillbirth increased by 28 percent. And the risk of women dying while pregnant or during childbirth increased by more than a third in two countries: Mexico and India. A subset of studies that assessed mental health showed that postpartum depression and anxiety were also heightened during the pandemic.
Nearly six times as many women needed surgery for ectopic pregnancies — in which a fertilized egg grows outside the uterus — during the pandemic than before. Ectopic pregnancies can be treated with medications if detected early, so the results suggest that the surgeries may have resulted from delays in care.
The analysis did not find differences in other conditions associated with pregnancy, like gestational diabetes or high blood pressure, or in the rates of cesarean sections or induced labor.
The rates of preterm birth also did not change significantly during the pandemic in low- and middle-income countries. But in high-income countries, preterm births fell by nearly 10 percent.
The drop may be a result of changes in health care delivery and in pregnant women’s behavior during the pandemic, the researchers said, indicating that the pandemic has exacerbated disparities between low- and high-income countries.
When Tom Belford’s mother died in May, her family was faced with the impossible task of limiting her funeral to 10 people. Belford, who is the owner and funeral director of John. A Gentleman Mortuaries and Crematory, recalled the difficult months leading up to his mother’s death.
“From March until May nobody was allowed in the building, and she was on the second floor. So we couldn’t go up to the window or anything,” he said.
The end of a life is a difficult time under any circumstances, but COVID-19 has made grieving even more difficult.
“COVID is taking people suddenly, and it’s affecting the families that have suffered, that go through a death at a time where maybe they shouldn’t,” Belford said.
Belford said in many cases families are losing people who are in their 50s and 60s due to complications from the virus.
“We’re here to help them make that first step back to a normal life after suffering a loss,” he said.
Chapel, 1010 N. 72nd St location (Real Yellow Pages)
John. A Gentleman has seen a steady number of virus-related deaths since the beginning of the pandemic, from March or April through today. Though numbers in Omaha aren’t what New York City or cities in California are seeing, deaths have risen from this time last year, according to last responders such as Belford.
Though the increase in business has been a change, the way Belford and his staff handle virus-related deaths has stayed the same.
“We practice something called universal precautions. We treat everyone as if they had COVID.”
These precautions, which include personal protective equipment used for both funeral directors and the deceased they are working with, have kept Belford’s staff safe since the beginning of the pandemic.
“We don’t treat anybody differently because they had COVID,” he said.
While the practices in caring for the deceased haven’t changed, funeral services have changed, in some cases dramatically, due to the virus.
“The biggest changes we see in the services is the social distancing,” Belford said. “For a while, the services were limited.”
Casket selection, 7010 N. 72nd St location (Real Yellow Pages)
Many churches and chapels continue to limit the capacity of funerals for everyone’s safety. In response to this, John. A. Gentleman has broadened its focus to include videocasting of services for loved ones who are unable to make it to the service.
“Before this started, we had one or two cameras for filming services,” Belford said. “We have six or seven now.”
Recorded services are helpful to many family members, but one important aspect of support is still missing.
“The families,” Belford explained, “they can’t socialize and get the support from their friends. And that’s probably the biggest disappointment families will see. Our interactions are the same. The care we give them is the same. But the care they get from their friends is different.”
Limiting social contact in a time of grief also directly curtails the level of support families would normally receive at the funeral and beyond. John A. Gentleman had to pause its bereavement programs due to the virus, though they recently started back up.
Many families are postponing memorial services for their deceased loved ones until after the virus is under better control. In March and April, some families planned to postpone services until summertime. But then those were pushed back, too. Some families are now pushing memorial services to summer 2021.
“Everybody’s pushing things back,” Belford said. “Hopefully the shots will come in and everybody will get vaccinated.”
Fortunately, Belford and his staff are currently on a waitlist for vaccinations and hope to receive their first shots in the next couple of weeks. In the meantime, Belford is more careful to protect himself and his family from the virus than the average person.
“I wouldn’t say I’m freaked out, but I would say that I’m cautious.” Belford said. “I’m very cautious about where I go and what I do. I have a big bottle of sanitizer in my car.”
Note of thanks, photo from John A. Gentleman
Being a funeral director is a tradition that has passed down for three generations in Belford’s family. While the virus has changed the way he conducts his services, one tradition that remains is the mortuary’s memorial plantings at Lauritzen Gardens, which Belford said is part of the service for every funeral. But even that has been altered slightly. The dedications are now posted online.
The coronavirus has rendered many aspects of life a moving target, and for last responders, more changes are likely to come. However, Tom Belford is prepared to continue to adapt to support families even as his own family mourns their loss. “No matter what happens to people, we’re here to help them,” he said.
The coronavirus pandemic dramatically changed Ms. Saoui’s work as a home hospice nurse in New York. Safety precautions created a physical distance between her and her patients and even cut some of her hospice colleagues off from their clients’ homes altogether last year. It deprived families and caretakers of ways to grieve together, and confronted hospice workers, however familiar with death, with a staggering scale of loss.
Through all the pressures, Ms. Saoui and other workers continued to provide solace and even moments of happiness to dying patients and their families.
“You sit down and you listen,” she said. “They express their fear, they express their emotions, and you guide them and tell them what to expect.” After a patient dies, she added, “I often want to hug the family members, but I cannot do that now.”
Instead, Ms. Saoui said, “I pray and do the best I can.”
More than half a million Americans have died from the coronavirus, and many have died in pain, isolated from their families. Ms. Saoui contrasted those conditions with what she called a good death: “peaceful, pain-free, at home and surrounded by their loved ones.”
While nurses have continued in-person home visits, some chaplain, social work and therapy sessions moved online because families preferred it. By August, most of that care switched back to in-person visits but with strict precautions, including wearing full P.P.E. at times and keeping six feet apart whenever possible.
Ms. Saoui examining Pedro Torres, while his wife, Gloria, and his son, Darron, look on.
Though a vast majority of Ms. Saoui’s patients in the last year did not have the coronavirus when they entered hospice, challenging restrictions have been placed on all patients and caregivers. Home hospice care can last for many months, and workers often develop close relationships with patients and their families.
But the pandemic has meant fewer occasions for families — and hospice workers — to mourn together in person at funerals or memorial services. For over a year, the size of those gatherings has been strictly limited by many states to try to stem the spread of the virus.
Nurse Hanane Saoui visits Diane Wilcox at her home in Queens.Credit…
When hospice patients die, their caretakers often work through their own grief and loss in weekly staff meetings and gatherings with colleagues who shared the same client. These staff meetings are now online, but the loss of being able to hold each other and shed tears together has deeply affected hospice workers, said Melissa Baguzis, a social worker who specializes in pediatric cases. She has developed her own ways to handle the loss of her young patients.
“I take a moment, light a candle and read their favorite book or listen to their favorite song,” she said. “I have my own time for them. We do become connected with their families, but when I’m in their houses, that is their grief and I’m going to support them. I need to process my own loss outside of that.”
A nurse, Ozail Bennett, dressing in protective equipment before going to see a home hospice patient that has the coronavirus. Mr. Bennett also contracted the virus last April.
The hospice workers in the MJHS Health System, a nonprofit that covers New York and Nassau County, are comfortable around death in a way that many Americans are not. But the pandemic has put an extra weight on them and their patients, Ms. Baguzis said. “We all share in each other’s grief now more than ever,” she said.
The Rev. Christopher Sigamoney, an Episcopal priest who is a hospice chaplain, said he has tried to be there for his patients “even with their frustration, anger, hopelessness, depression and anxiety.”
Father Christopher Sigamoney talks with Joseph Lai.
He often told patients’ family members that it was “OK to be angry at God” over the loss of their loved one. But he said that the death of a beloved cousin from the coronavirus had changed his understanding of his work.
Father Sigamoney and his family were unable to be with his cousin, a retired doctor visiting from India, during the three days while she was on a ventilator in the hospital at the end of her life. He and a handful of relatives said “a few prayers” in the funeral home, he said, but they were unable to have a “proper burial” or ship the body home to India because of virus restrictions.
Father Christopher Sigamoney prays with patient Diane Wilcox at her home in Queens.
“I did not really understand when people would ask, ‘Why me and why my family?’” he said of the time before his cousin’s death. “Now I was asking the same questions. I said to God, ‘Now I’m angry at you, and I hope you can forgive me.’” Father Sigamoney said he was slowly recovering through prayer and helping his patients.
Last month, Josniel Castillo was hooked up to a battery of medical machines and monitors, surrounded by his parents and a multitude of stuffed animals, as Javier Urrutia, a music therapist, and Ms. Baguzis entered his cramped bedroom. Despite his declining medical condition because of a rare genetic disease, this was a happy day. It was Josniel’s 11th birthday.
Mr. Urrutia launched into “Las Mañanitas,” a traditional Mexican birthday song. Josniel’s mother and father, Yasiri Caraballo and Portirio Castillo, joined in. Ms. Caraballo wiped away tears. They were, she said, “tears of joy” because she had not expected her son would live to be 11.
She requested another tune, and played tambourine as Mr. Urrutia launched into “Que Bonita Es Esta Vida.” They sang the final chorus together, part of which can translate to:
Oh, this life is so beautiful
Though it hurts so much sometimes
And in spite of its sorrows
There’s always someone who loves us, someone who takes care of us.
Afterward, Mr. Urrutia said most people are “unaware of what’s happening behind closed doors, both the difficulty and the beauty.”
Melissa Baguzis, a MJHS hospice social worker, visiting Josniel Castillo on his 11th birthday.
This year in countless homes, there has been “a lot of pain and suffering, it cannot be denied,” he said. But in hospice work, he said, “you also see all of the heroes out there doing the simple things of life, caring for each other. The husband taking care of his wife or the mother taking care of her son.”
“Dying is a part of life,” he added. “Only living things die.”
Every time a patient passed away, I’d go to the garden centre and search either for a plant with their name or for a plant I thought represented them
By Katie Hodgkinson
When I started work as a doctor two years ago, I was living alone with one sad succulent and a pot of thorn-filled roses my boyfriend had given me.
I’d always liked plants, but I’d never been able to keep anything alive longer than a few weeks – in fact, my dad had been watering our fake one for years!
On my first rotation, I started on a combined cardiology and stroke ward, which, as you can imagine, sees quite a few patients with life-changing conditions. I’d made friends with one of the hospital palliative care sisters and she often came to help us with patients who were experiencing breathlessness, pain and agitation.
The first woman I met in a hospice, when told she’d have weeks to live, was insistent that the only thing she wanted to achieve in her remaining time was to ‘see the flowers bloom in spring’.
The staff bought her bulbs, and I’m told she lived long enough to see the first ones flower. It really struck me that after a lifetime in this world, the thing that mattered most to her was seeing the colours and life that comes with a new season – I’d never really thought of plants in that way before.
In my first few weeks, I started to develop relationships with some of our longer-term patients. There was one woman who I took blood from every morning and for whom I requested countless tests, scans and meetings.
Her family weren’t local, and we’d often share a giggle over the comings and goings of other women in her bay; I ended up being her most regular visitor.
One weekend I checked her blood results to see what we’d really been hoping not to see – she’d grown a nasty bacteria in her blood, and would need at least a further five weeks of antibiotics.
Sadly, we never managed to get on top of the infection. We gave her stronger drugs, blood transfusions and called her family in to be with her. She passed away peacefully, and that evening I went with the palliative care sister to a garden centre.
It was meant to just be an escape from long days on the ward and my first close patient death, but the centre had named all their plants – and when I saw one with her name on, it felt like some sort of sign. It was a bright and bold Calathea, with vibrant pink stripes that cheered me up instantly. I took it home with me.
Naturally in a busy city hospital, more of my patients died despite our best efforts. We brought in families, arranged a wedding for a terminally ill patient, and I even smuggled in someone’s new puppy inside my jacket (infection control approved, of course.)
I was 24 and seeing more death than most people see in a lifetime – but although it was horrible, it was also an honour to be a part of a team that could help these people have a good death.
No one wants to think of their life coming to an end, everyone wants to be comfortable and surrounded by the people they love, and it was so rewarding to be able to offer that.
Every time a patient passed away, I’d go to the garden centre and search either for a plant with their name or for a plant I thought represented them. I wanted to remember them.
I became better at looking after the plants in my flat. I developed a watering schedule, bought plant food, repotted them into pretty jars I’d found in shops, took them for showers if I thought they were dry – anything I could do to emulate the kind of care I was trying to give to my patients.
Most doctors have something they do to remember the people they’ve cared for – whether it’s lighting a candle, a quiet moment at the end of the day or debriefing with friends. I’ve heard of people planting trees – but I think individual plants might be one of the more unusual coping mechanisms!
When the pandemic hit, I was working in elective orthopaedics and my ward was the first to start accepting Covid-19 patients. Despite all the research, the treatment plans were often simple – oxygen, more oxygen, steroids and if needed, machines to take over breathing when patients became too tired.
We sent patients to ITU, and those who deteriorated we made comfortable. We took over the role of the families who weren’t allowed in, lest they put people in danger.
We held hands with patients while they passed away and we held up screens so their families could be there until the end. It was devastating knowing that pre-pandemic, we’d have had crowded side rooms filled with loved ones, and yet because of the risks they had me in full PPE, unable to even hold a hand without horrible sweaty gloves.
When I started my Covid-19 work I had about 15 plants and a watering can made out of an old sauce jar. Then garden centres closed in the first wave, but I ordered more plants online.
After eight months, I started to run out of room in my flat, and my friends suggested buying one plant per week rather than per patient. It didn’t feel right – not the level of acknowledgement I wanted for these people who had lived such full lives.
I started planting seeds, lighting, candles – anything I could to still feel like I was acknowledging the loss of so many people. I asked for help on Twitter, and people suggested planting trees, donating plants, getting an allotment – but none have felt quite right just yet.
Thankfully I live alone, so the ever-expanding wave of greenery wasn’t too annoying – but I have started letting my fiance choose where we put some of them! It’s lovely to be surrounded by so much new life and I get so excited whenever I see a leaf start to unfurl – I am reminded every time to appreciate it by the woman who wanted to see the flowers bloom in spring. I like to think she’d be just as thrilled.
Now I work in a different hospital, and thankfully fewer people are dying. I’ve been able to propagate my existing plants to grow smaller baby plants for my friends.
I still have a plant for every patient who passed away while I was their doctor; it looks like I live in a jungle, with more than 60 plants, but I’m starting to prune and take cuttings so that other people can share the joy.
For some of my paediatric patients, I’ve decorated pots with stickers of their favourite things – Peppa Pig, octopi, even one covered in fingerpaint.
The time I spend looking after my plants has become the time when I can reflect on everything that’s happened and all the people I’ve cared for.
Sometimes it’s a sad experience, and sometimes it’s a more joyful process where I can think of those that got to go home.
I think of all the things I have yet to learn, how far I’ve come, and how many more patients I will get to meet. I think I’ll always dedicate a plant to a lost patient; I just might need to move to somewhere with a garden.
