Tag: Meditation

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The Pandemic Broke End-of-Life Care

In a Boston ICU, staff members orchestrate goodbyes over Zoom and comfort patients who would otherwise die alone.

by Sarah Zhang

When the coronavirus came to Boston, doctors at Brigham and Women’s Hospital noticed how silent certain floors became. Any patients who could be discharged were discharged. Anyone who could stay away stayed away. “The hospital had this eerie quiet,” says Jane deLima Thomas, the director of palliative care at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. But in the intensive-care units set up for COVID-19, machines beeped and whirred in room after room of the sickest patients. Those patients were sedated, intubated, and isolated. Many of them would die.

Palliative care is about providing comfort—physical and emotional—to patients who are seriously ill, including those who may be close to death. Before the pandemic, deLima Thomas’s team worked with patients with kidney disease or cancer or heart failure, but this spring, they all switched to COVID-19. They embedded themselves in the ICUs. Palliative care is a field especially invested in the power of a hug, a steadying hand, and a smile. In other words, palliative care is made especially difficult by a virus that spreads through human contact.

The first day the palliative-care doctors walked into the ICUs, Thomas says, “we felt like tourists.” They were dressed in business casual, while their ICU colleagues raced around in scrubs and masks. But the palliative-care team—which includes physicians, nurses, chaplains, and social workers—found ways to integrate themselves. In the early days of the pandemic, when protective gear was scarce, no visitors were allowed. Palliative caregivers, along with ICU nurses, held iPads cocooned in plastic bags so families could say goodbye on Zoom. They were sometimes the only one in the room when a patient died, otherwise alone. I interviewed several members of the Boston-based palliative-care team, and their stories, which have been condensed and edited for clarity, are below.

Samantha Gelfand, Fellow

In the ICU, the most immediate thing is the personal experience of walking down the hall. Nearly every patient’s room, the door is closed, and the patient is alone. And they’re often on their bellies for prone positioning. You can’t even see their faces often.

Seeing anyone who is critically ill with a breathing tube, lots of monitors and beeping, it’s not easy. When we facilitate Zoom calls with family, I say, “Listen, it may be alarming to see that your loved one has tubes and tape and monitors on their head.” They may have soft wrist guards on their arms to stop them from trying to take out their own tubes.

It doesn’t always work. I did a Zoom call with seven family members. The patient was a man in his 50s and he had seven kids, and they ranged from 18 to late 20s. I told the siblings what I could to prepare them, and still I’m holding the iPad and they start wailing. There’s a visceral experience of just devastation.

As someone’s who lost my own parent, I think wailing is appropriate. I let them. I actually think holding the silence and bearing witness is the right thing to do first. It’s very uncomfortable to watch, but I think it’s misguided to try to hush or try to shorten it. How do you comfort someone on Zoom? It sucks.

Our department has a reflection conference on Tuesday mornings. In COVID-19 times, we’re still doing this, but now we’re doing it by Zoom. One clinician will read the names of patients who died last week in our care. It’s very, very eerie to hear the list of names and have worked with probably half of them and not have seen their faces.

Usually when we sit in that room and we remember the dead, we are remembering what it felt like to talk to them, what they looked like. And this, it’s like we’re remembering what it felt like to think about the patient or what their family members’ voices sound like. I really missed the times when I could think of a face the patient made or a comment that they said. It feels like a new way of grieving.

Ricky Leiter, Attending Physician

COVID-19 doesn’t just affect individuals. It’s affecting families. I’ve had a couple cases where a married couple is in the ICU, next to each other. I was talking to a daughter whose parents were both intubated in the ICU. They were in their 70s to late 80s. Her father wasn’t doing well, and we were asking, “Should we try to resuscitate?”

I remember her saying, “I can’t think about the hard stuff right now. This is all too much right now. I can’t do that.” And of course she couldn’t. How could she? Her parents were relatively healthy before they came in. It was the suddenness of all this. In my normal palliative-care practice, those are patients who have been sick for a while. They have been diagnosed with a serious and life-limiting illness. A lot of COVID-19 patients are otherwise pretty healthy; maybe they have high blood pressure. This is an entirely new universe.

One of our fellows did five or six tough conversations like this with families in one day. I had a day like that early on. Our team walked back to our office, and everyone there asked what happened to us. We were so shell-shocked, and it felt like we were having the same conversations over and over. I don’t normally have six conversations where it’s the same disease, the same coronavirus.

Reverend John Kearns, Chaplain

My brother died 30 years ago this September. It was a life-changing experience and really oriented me into the life of loss and grief. He died of AIDS, which seems so similar now with the fears surrounding an illness that wasn’t well understood. People then were afraid to touch him or hug him. My parents were very dedicated to his care. He died at home in our bedroom that we shared as brothers.

It’s natural for people to take care of their loved one when someone’s sick. Being present for someone is part of what helps people get through it. They’re participating in some way. During this, the families have none of that participating. The first few weeks of COVID-19, we didn’t go inside the patients’ rooms. Now that we have more protective gear, they’ll let us go in, and the department has developed an iPad ministry to connect patients with family who can’t be at the bedside. Sometimes the family will email photographs and we’ll print them out and hang them in the room—photographs of the patients’ kids, wife, spouse, partner. Whether these sedated patients can see or hear is questionable, but the family gets to see, or the family gets to speak to them.

I’ve spent as much as two hours in a patient’s room. I’ve gently wiped the forehead of a patient. I’ve led prayers with the family over the patient. And they will ask us to hold their loved one’s hand. Often there’s a hope to see there’s a response, whether it’s a simple squeeze of a hand, a blink, the movement of the head—anything that gives them hope that their loved one is going to make it.

When the family wants to be seen by the patient, then you have to do the reverse camera and then hold it in such a way that they can see the patient’s face. You’re trying to orchestrate this intimate moment and sacred moment, and you’re fumbling with this iPad. Where is the camera lens on these things? And at first, we were putting these iPads in plastic bags, like a Ziploc bag, to keep it from getting germs on it. So now it’s sliding around in this bag that’s a little too big. You also have the problem of fogging up your glasses and fogging up the shield. At times, it is hard to see the face of the person or to read something or to manipulate the iPad.

There was a Muslim patient who was dying. We have a couple imams. One is actually out of the country; he has not been able to get home since COVID-19 started. The other imam wasn’t available. When the patient took a bad turn, I got called in by Ricky Leiter. As an interfaith chaplain, we also visit everyone. I had an iPad with 20 or so family members who were all over the globe. They were reciting prayers. At one point it reminded me of church bells. All those voices all over the world, coming together at the same time.

Stephanie Brook Kiser, Fellow

I’ve had family members say to me, Just please go in person and tell them in person that I love them and promise me that they won’t die alone, that you’ll be there at the bedside.

A patient I took care had been sick with COVID-19 and in the hospital for two or three weeks. He was 80 years old. His wife was just a few years younger. They had been together since they were teenagers. You can just tell in her voice that it was so hard for her to be apart from him. She said, “I can’t remember a time I’ve been apart from him for this long. I think this might be the first time since I’ve known him.” At the same time, she was living in fear in her home because she knew she had been exposed to him. Because of her age and other medical problems, she was at high risk to be at the same place he was: really sick in the ICU, with a breathing tube, not getting better at two weeks or three weeks.

It was pretty clear medically, no matter what we were doing, he was continuing to get worse and worse and worse. We had a really difficult conversation over the phone about what his wishes would be, and it was clear to her and to their children that the biggest thing we could do was transition to focus on his comfort. We knew what that would mean is he would die pretty quickly.< With the hospitals’ changing policy, if someone is actively dying, we can now allow for a family member too at the bedside. My experience in the ICU when that’s offered, more times than not family members actually say no, that they don’t actually want to come to the ICU. There’s a real infectious risk to them, and I’ve had a lot of family members say, “I don’t know that I want to see them again the way they are now. I want to remember them the way they were before.” The wife was in such distress and despair over the idea that she was so physically close in Boston but it wasn’t the right decision for her to come into the hospital. I spent a lot of time and I was even grasping at things: Can I arrange a Zoom call? Maybe I can record a video and send it to you guys? And the family was saying, We want to remember him in a different way.

They said, We just want you to go to his bedside and hold his hand so that he knows he’s not alone. And I did that over the course of about 15 minutes. He died pretty quickly.

I’ve been part of a lot of deaths of patients in palliative care. We don’t see a lot of death like this—without any family members present. We aren’t used to being that person at the bedside, trying our best to provide the comfort that a family member’s presence would provide and feeling inadequate in that at best. Afterwards I gathered his nurses and respiratory therapist and we talked. Everyone agreed it was unlike anything they had been part of.

It was the first time I had touched him. And in the ICU, probably one of the only times I’ve physically touched the patient.

Natasha Lever, Palliative-Care Nurse

I’ve been a nurse practitioner for seven years, and I was hired at Brigham to do heart-failure and palliative care. Literally the week after I started, COVID-19 happened. They had this whole very carefully planned out 12-week orientation, and I got a phone call from our director, Jane, and she said, “Either we’re going to keep you at home for the next few months or we’re just going to put you in the ICU.” I kind of got thrown into the deep end.

I went into nursing because I love to be at the bedside and with patients. Not having families and loved ones at the bedside was probably the most difficult part of all of this. It felt so wrong to us that families were having to make decisions about withdrawing care when they haven’t seen their loved ones.

I remember the one that hit me the most was a woman whose son had given her COVID-19. He had been quite ill himself, and he had recovered. The immense guilt that he felt was so profound. He kept saying—he’d obviously been watching the news—“Please, don’t throw her in a body bag if she dies.” He kept talking about how they had been so excited they were going to move into a house together and he was going to buy his first house. He had plans for her and just wanted her home so badly. She passed away and it was very difficult.

That was one of my first cases. And this was week two of my job as a palliative-care practitioner.

I remember the first day I was in the ICU, it was completely chaos. It was very loud, lots of people. Almost this adrenaline rush you felt. A couple of weeks in, things sort of settled down. Now the ICU numbers are down. I had a really strange feeling when they were closing down the COVID-19 ICUs. I walked down the hallway and it was dark and all the rooms were empty and clean and there was no one there. Two weeks ago, this was one of the most busy, chaotic places in the hospital and there was just this silence. No alarms, and no people. It was almost as though, Is this a dream, did that really happen?

Now I have just started doing the orientation that I was supposed to be doing. I’m going back to the hospital. I’m extremely excited to be at the bedside. I have never been so excited to talk to a patient in real life.

Complete Article ↪HERE↩!

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Coronavirus reminds you of death

– and amplifies your core values, both bad and good

Gustav Klimt’s ‘Death and Life’ suggests the way many people are unaware of death’s ever-present influence.

By &

There’s nothing like a worldwide pandemic and its incessant media coverage to get you ruminating on the fragility of life. And those thoughts of death triggered by the coronavirus amplify the best and worst in people.

The results of this psychological phenomenon are all around: people hoarding toilet paper and hand sanitizer, hurling ethnic slurs and attacking Asian Americans, heaping praise or scorn on President Trump, hailing new political and health care heroes. Sheltering at home has drawn some families closer together, but is a crucible of domestic violence for others. For many, social distancing has increased feelings of isolation, boredom, anxiety and despair.

What’s behind these attitudinal and behavioral shifts?

Back in 1986, we first developed an idea called terror management theory that explains how people double down on their essential beliefs, without even noticing, when confronted with their own mortality.

Hundreds of psychology experiments from the past 30 years have explored how people react to the thought of their own death. These reminders bolster people’s core worldviews, making racists more hateful, the religious more devout, the charitable more giving and constituents more suportive of charismatic leaders.

At a moment when the idea of death is front and center for many people, this psychological tendency has important implications for everything from how grocery store cashiers are treated to how people will vote in the upcoming presidential election.

No one gets out alive

Terror management theory acknowledges that human beings are animals biologically predisposed to try to survive. But at the same time, people also realize how dangerous the world is, how vulnerable we are and that ultimately the quest for continued existence is doomed to fail.

Knowing that we will all die, and it can happen at any time, can give rise to potentially paralyzing terror. To manage this fear, people work to see themselves as valuable contributors to a meaningful universe. Viewing yourself as an important worker, entrepreneur, teacher, artist, scientist, lawyer, doctor, parent, spouse and so forth allows you to feel like you’re not just a material creature who will disappear upon death.

Rather than dwelling on that disturbing thought, you can believe in things like immortal souls, in your offspring carrying on your genes and values or in your work having an enduring impact. It’s comforting to believe that some part of you will continue after death, through your connections to your family, profession, religion or nation.

Thoughts of death lead people to cling more tightly to these soothing beliefs. Such thoughts can be triggered by simply reading a news story about a murder, being reminded of 9/11 or even glancing at a funeral home sign.

Death reminders first trigger immediate, front-line defenses – you want to feel safe by getting death out of your mind right away. Then subconscious downstream defenses work to fortify the protective bubble of the symbolic reality you believe in. Researchers have found that these downstream defenses include more punitive reactions to criminals, increased rewards for heroes, prejudice toward other religions and countries and allegiance to charismatic politicians.

Pandemic provides nonstop reminders of death

Because of the coronavirus, death reminders are all around. Front-line reactions range from efforts to shelter at home, maintain social distancing and wash hands frequently to dismissing the threat by comparing it to the flu or calling it a political hoax meant to undermine the economy and thwart President Trump’s reelection effort.

People who are more optimistic about their coping skills and have confidence in health care providers are prone to react constructively. They typically follow the recommendations of health care experts.

But people prone to pessimism and skepticism regarding health care authorities are more likely to deny the threat, ignore recommendations and react hostilely to expert advice.

These first-tier defenses banish death thoughts from consciousness, but do not eliminate their influence. Instead the thoughts linger just outside your attention, triggering downstream defenses that reinforce your valuable place in your world.

One way to enhance your value is through contributing to and identifying with heroic efforts to defeat this threat. That can happen via your own behavior and by lauding those leading the charge, such as first responders, health care workers, scientists and political leaders. Even those who inhabit social roles not usually given their due are recognized as heroes: grocery cashiers, pharmacists and sanitation workers.

At the same time, many people question their value more because of the pandemic. Earning a living to provide for one’s family and connecting with others are fundamental ways to feel valuable. Pragmatic health and economic concerns and impoverished social connections can combine to threaten those feelings of meaning and value. In turn they can increase levels of anxiety, depression and mental health problems.

Existentially threatening times also tend to create heroes and villains. American scientists, like Anthony Fauci, and political figures, like New York Governor Andrew Cuomo, are more widely admired. President Trump’s approval rating temporarily increased. In times of crisis, people typically turn to their leaders, and put additional faith in them.

At the same time, people also seek to assign blame. Some turn their fear and frustration about the coronavirus that first emerged in China into hate toward Asians and Asian Americans. Others, depending on their political leanings, blame the World Health Organization, the mainstream media, or President Trump.

Even if the coronavirus abates, thoughts of mortality will linger on the fringes of consciousness as the November election approaches. If President Trump is perceived as a heroic wartime president who got the country through the worst of this invisible enemy, such death reminders could work to his advantage.

If, however, the president is viewed as an incompetent bungler responsible for the virus spreading and the economy collapsing, the same death reminders could undermine his chances.

We’re all in this together

If you’re interested in trying to short-circuit some of these unconscious defenses, our research suggests a few promising possibilities. Maybe the best approach is to consciously acknowledge your mortal fears. By doing so, you can gain some reasoned control over their influence on your judgments and behavior.

We also suggest keeping in mind that all human beings are one interdependent species sharing the same planet. Recognizing that the coronavirus poses the same existential threat for all of us helps underscore that humanity is a group we all belong to. It’s by working together and not turning on each other that we will be able to recover our economic, physical and psychological vitality.

Complete Article ↪HERE↩!

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How Dying Taught Me to Live

By Brad Dell 

His little ribs rose, then fell, then rose, then fell, then stayed still. The spark left his green, curious eyes — I swear it wasn’t a trick of the light. They were dull … dead.

I loathed myself for letting my first cat be put to sleep without me by her side. I swore I’d be there for my second when he passed less than a year later. I swore I’d look him in the eye, even if it meant nothing to him. And so I did.

The odd thing was that he wasn’t afraid. He was calm. He’d spent a good life of hunting, cuddling, and lounging. He knew his place in nature’s cycle. I didn’t understand that. Not then.

But my time came.

Sepsis destroyed me. As my soul ripped loose from my bones, I gasped to my girlfriend that I loved her but I would soon need to die. Then I pissed the bed. I realized that dying isn’t romantic like in the movies. I stank from rolling around in a soiled, sweaty bed, and my voice was hoarse from begging for an end.

While death isn’t romantic, it can be peaceful. In my time, I’ve known many who have passed — they’re either ready or they’re not. I wasn’t yet ready. I was ugly and bitter in my death, outraged by the unfairness of this world.

Somehow, I survived.

The paradox of death is that it teaches you how to live. The tragedy of death is not everyone gets a chance to apply what they’ve learned.

I woke up in an unfamiliar world. All details seemed illuminated and emotions felt overwhelmingly potent. I cried a lot more, hugged a lot more, prayed a lot more, loved a lot more.

Former priorities fell away; ambition, money, and comfort lost their gleam. Each day during recovery, I composed an obituary in my head: “Boy dies of cystic fibrosis. He had caustic humor, good grades, and a decent savings account.” I craved depth and vowed to thrive with passion and weave a legacy of compassion.

Did my old friend know I’m sorry for calling him fat in fifth grade? Did my sister know I look up to her? Did my parents know I regret every single time I lashed out at them? Did everyone know that I mostly only pretended to love, yet always yearned to learn its power?

I lay in my soiled bed and tried recalling instances in which I’d helped people out of love rather than for the potential of a self-serving debt. I sobbed at the realization that I’d lost myself long, long ago. In prayer, I begged for redemption, for help with becoming the Brad I was designed to be.

It’s been 47 months since that prayer. I’m nowhere close to perfect, but I’m far from who I was. Today, my joy comes from expressions of vulnerability, wide smiles and belly laughs, the bonds forged through struggle, the light in people’s eyes, the warmth of another body, the tears poured in prayers, the little acts of love and the big acts of love, the feet that tap along to music, the winding conversations over meals, the exhilaration of adventure, the richness of sharing nature and sunsets with strangers.

I am ready to die, when that time comes again, though I’d love to learn even more about life with a third pass. Death is liberating, driving me to be fully present and live intentionally for the things that truly matter.

Like my old cat, I know my place in nature’s cycle. Mine is to love and be loved in return. Maybe that seems sappy to those who haven’t yet died. But one day you’ll understand, too.

Complete Article ↪HERE↩!

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How to prepare for death

By Peter J. Adams

The main challenge in reflecting on one’s own death is the way the various aspects of death and dying are intertwined which make it difficult to discern personal mortality.

First there is the prospect of me dying; of me entering whatever is in store at the end of my life. How long will it last? Will there be pain? What will I leave behind? How do I say goodbye? Next there is the prospect of other people dying, particularly the death of loved-ones and the painful absence their loss leaves behind. How would I cope with the death of a close friend, a partner, a child? But thinking about my dying and other people’s deaths are different. Dying is an event in life, admittedly an important event, but still one that happens within the course of life. Similarly, coming to terms with the loss of a loved-one is an important process, but it belongs to a different domain than my death.

Another temptation is to think of my death as though it is like the death of others. I imagine myself in the shoes of someone as they approach their death. Maybe it would be my soul that is absorbed into a zone of endless tranquility. Maybe it would be my body lying motionless in the coffin. I conjure up images of love-ones with shocked expressions as they are told about my death, I visualize their forlorn looks as they watch my coffin descending into the grave and I picture their reactions to constantly interacting with the spaces I now no longer occupy.

But thinking about my death in terms of what happens when others die does not fully capture what happens when I think about my own death. When I die, looking at myself from the outside, my brain will stop working, my senses will cease to operate, I will no longer have any voluntary control of my muscles, and my body will lie limp and lifeless. This is undeniably what will happen.

Looking at this from the inside is more complicated. If my brain and my body cease to function, then it makes sense to consider my emotions, my consciousness and all those aspects that make up my subjective world, as ceasing to operate as well. My consciousness surely relies on input from my senses plus the processing power of my brain, so without them it is hard to think of how consciousness might persist. I might reassure myself that my consciousness will continue in some form in another realm, but I can’t be sure. It makes more sense to say that when all the conditions for consciousness are no longer present then my consciousness will no longer be able to function.

But this is a terrible thought; a horrifying realization with alarming consequences. My consciousness is always present whenever I look out at anything in the world. I never experience anything around me without being conscious. When I am unconscious, such as when I am asleep or knocked out, I assume the world continues under its own steam, but this is an assumption which I can never fully trust. What I can be surer about is that the world and my consciousness are always paired; they are always together, each interacting with and enabling the other, and participating together in allowing what is going on around me to continue to take place.

What this throws up is the possibility that without my mind the world, and all that it contains—objects, animals, people, loved ones—will cease to exist. In other words, from the standpoint of how I experience things, when I die the conditions that enable the existence of both my consciousness and the world around me will, most likely, no longer be present. In this way, the prospect of my own death highlights the possibility of the end of everything.

The unthinkable and unspeakable nature of my death forces me to walk repeatedly down a conceptual dead-end; a dead-end which discourages any further attempts to think along the same track. Even if we were to consider it important to form some sort of relationship to my death, there is no identifiable object to connect with, there is nothing to cling on to; it stands there as a conceptual black-hole; an emptiness which we can only approach with insecurity and foreboding.

Here lies the true challenge of reflecting on my death; the idea of it as an unthinkable, unspeakable nothingness. But, despite this, thinkers, poets, and artists have, over the centuries, still had a lot to say about personal mortality. It is just too big a part of the rhythm and structure of life to be ignored.

It is, similarly, important for each of us not to turn our backs on death and, despite its unintelligibility, to seek out ways of engaging with it. What is needed is some sort of provisional handhold that allows each of us to reach out and grasp onto something that can enable us to pursue a lifelong relationship with personal mortality.

Complete Article ↪HERE↩!

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At New York hospital, a friar watches over those dying

‘The miracle is to let go’

Brother Robert Bathe, a Carmelite friar, outside of Bellevue Hospital in Manhattan.

By Kevin Armstrong
The morning after he turned 52 last month, Brother Robert Bathe emerged from the Millennium Hotel on West 44th Street. He ambled half a block into Times Square and reflected on the emptiness. A street cleaner’s whoosh broke the silence.

Dressed in a brown robe, the traditional garb of his Carmelite order, Bathe began his daily walk down Broadway. At 28th Street, he hooked left and continued to Bellevue Hospital, where he is a Roman Catholic chaplain and bereavement coordinator.

“Welcome to ground zero,” he said before a nurse trained a thermometer gun on his forehead and scanned for a reading.

It read 98.6. The nurse nodded.

“Normally,” he said, “the family is there with me bedside at death, and when we say the Our Father it is very emotional. Now I stare at a person that is taking their last breaths. I’m with a doctor and a couple of nurses. We’re saying goodbye.”

Bathe is the friar on the front line of the coronavirus pandemic. A native Tennessean who was a soil scientist before entering religious life at age 27, his Southern accent is the first voice many patients’ family members hear from the city’s oldest hospital when he calls to inquire about special needs.

Each morning, he reviews death logs. He then walks through the emergency department and intensive care unit, where he stands behind glass and cues up music on the smartphone he keeps in his pocket. “Bridge Over Troubled Water” is a favorite selection. On Funky Fridays, as he calls them, Bathe mixes Benedictine chants with James Brown. If patients are awake, he flexes his biceps or pumps a fist — encouragement to stay strong. He takes precautions when praying over the intubated, slipping on an N95 mask and face shield. In all, he ministers to more than 25 patients daily.

“Music gives a little more sense of sacredness so I don’t get distracted by nurses and doctors screaming,” he said. “I am focused on that patient, looking at that face. I know who that person is, imagine what it is like for them to be alive.”

Bathe speaks with a man across the street from Bellevue Hospital. He says he was called to become a friar more than two decades ago after witnessing a man die in North Carolina.
Bathe greets people in the Mount Carmel Place courtyard near the hospital. The coronavirus continues to paralyze New York and stretch the limits of its hospital system.

His pager pulses with death updates. It is programmed to receive alerts for cardiac emergencies, traumas and airway issues. Whenever a coronavirus patient on a ventilator needs attention, it comes across his screen twice. When a nurse who worked in the neonatal ICU died of covid-19 recently, Mary Ann Tsourounakis, Bellevue’s senior associate director of maternal child health, called pastoral care for help. A group of nurses grieved. First to arrive was Bathe, who led them in prayer in a small hallway.

“One of the most healing and loving I’ve heard,” Tsourounakis said. “People think it has to be a big production. Sometimes those moments are the moments.”

The virus continues to paralyze the city and stretch the limits of its hospital system. Confirmed cases have surpassed 185,000 and more than 20,316 deaths had been recorded, according to the New York City Health Department.

Bathe’s path to New York began in Knoxville, Tenn. He grew up around his grandfather’s cattle farm, went on frequent hikes as an Eagle Scout and eyed a career as a forest ranger while a teenager. His mother, Linda, worked at the University of Tennessee, and she consulted with faculty members about her son’s future in forestry. Prospects were slim, and alternate paths — archaeology or agriculture — were suggested.

He didn’t see himself traveling to Egypt to unearth tombs, so he dug into agricultural studies and toiled with botany and geology as well. Following graduation, he worked for the Buncombe County environmental health agency in North Carolina. Hired to protect groundwater, his release was to drop a line in honey holes for catfish, pitch a tent and listen to bluegrass songs after dark.

One day, Bathe was sent to meet a man named Robert Warren to evaluate his soil so he could build a house. When Bathe arrived, he saw Warren slumped over in his truck. As Bathe approached, he said, Warren grabbed his hand and asked, “Would you pray with me?”

They recited the Lord’s Prayer, he said. Moments later, he was dead, Bathe recalled. Bathe accompanied him to the hospital and attended the memorial service and funeral.

Bathe joined the Carmelites soon after, and in 1997 was assigned to Our Lady of the Scapular and St. Stephen’s Church, two blocks from Bellevue. Lessons followed.

One day, he said, a woman fell from her window in a neighboring building and through the church roof. Bathe was sent up to investigate.

“First dead body I ever smelled,” he says. “Life is tender.”

long his almost two-mile walk to work, Bathe’s appearance and demeanor have become well known and appreciated.

Transfers are part of the friar life. He taught in Boca Raton, Fla., and served as the vocation director from Maine to Miami before returning to Manhattan two and a half years ago.

In ordinary times, Bathe receives a monthly allowance of $250, lives in the St. Eliseus Priory in Harrison, N.J., and rides the PATH train. He fell ill in January, experienced the chills, registered a temperature of 101 and lost weight. He believed it was pneumonia then and self-isolated, using a back stairwell to his room. His brothers left meals outside his door, and he returned to Bellevue after convalescing. He has yet to be tested for covid-19.

Since March 30, the hospital has facilitated his participation in a program that provides free or discounted rooms for front-line workers, first at a Comfort Inn on the west side of Manhattan and now at the Millennium, to limit his commute. Along the route to work, his bald head, eager gait and hearty laugh are known to mendicants and administrators alike.

He carries on the tradition of the Carmelites, who have ministered at Bellevue since the 1800s, through periodic epidemics, saying Masses from the psychiatric ward to the prison unit. Colleagues include a new rabbi and a 20-year-old imam.

When a Catholic dies, he performs the commendation of the dead, a seven-minute service. His responsibilities range from distributing Communion to finding prayer books for patients across faiths to leading memorial services for staff. He is “staunchly against” virtual bereavement, which has become common amid the pandemic, insisting on providing a physical presence.

“People are looking for a miracle when the miracle is to let go,” he said. “Call me too practical, but I don’t pray they leap out of the grave like Lazarus. I think we’re meant for better. We’re meant for God.”

Hospital staffers are processing what has happened since the pandemic first gripped New York, and they’re bracing for a potential second wave. Since Lorna Breen, medical director for the emergency department at NewYork-Presbyterian Allen Hospital, died by suicide last month, Bellevue has increased its support services for employees. Questions about closure come from all mourners.

“Families ask, ‘Are we going to be able to have our loved one go to Mexico?’ ” Bathe said. “How are we going to do the next step, to bury our loved ones?”

long his almost two-mile walk to work, Bathe’s appearance and demeanor have become well known and appreciated.

On a recent Sunday, Bathe stepped outside for a breather in what some people call Bedpan Alley, the east side neighborhood that includes hospitals and a shelter on First Avenue. He checked on a homeless woman who sits in a chair facing Bellevue each day, rubbing his thumb against hers as she slept. A shoeless man was prone on the sidewalk. Bathe inquired about a can collector’s economic concerns. Business was slow.

“Are you a priest?” a woman on a bench asked Bathe.

“No, ma’am,” Bathe said. “I’m a friar.”

She introduced herself as Shonda. She was anxious about a meeting with her manager.

“You want to say a prayer for me?” she said.

“Put the phone down,” he said.

Bathe closed his eyes and prayed.

“Breathe,” he said.

“I’m going to breathe,” she said.

As he walked back to the hospital, his pager went off. “Cardiac Arrest,” it read, “10 West 36.”

“Somebody’s dying,” he said.

Bathe makes his way to the hospital from his hotel in midtown Manhattan.

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