Moral dilemmas in hospice
I never imagined the nightmare that hospice nursing has become since COVID-19. Our philosophy of care is to support the entire family unit, and hospice nursing before the pandemic looked much different than it does now. Only 6 months ago, families were able to sleep at the bedside of their loved one in my inpatient hospice unit - where the most symptomatically sick are cared for by an interdisciplinary team consisting of a nurse, physician, hospice aide, social worker, chaplain, and volunteers - and there was no such thing as visiting hours. All hours were for visiting. We conducted weddings in the garden, arranged for a patient's horse to visit her one last time, were visited by music therapy volunteers whose cello and guitar melodies spilled into the halls.
My days on the COVID hospice floor are much different. In layers of reusable PPE, I carefully observe the clock while in my patients' rooms as I try and balance good nursing care with personal safety. Did that bed bath take too long? How can I leave this crying patient all alone?
Families, desperate to see their dying loved ones, beg us to make exceptions to our 2-person visitation policy. "But there's 3 of us kids - how can we choose between us?" Staring longingly at their dying mothers, fathers, sisters, and brothers from outside the hospice room's door, in the rain, they wish in vain to talk to, to touch their family member one last time. I do my best to offer facetime and zoom calls to the families, but it's not a replacement for a real embrace.
What hell is this in which we now find ourselves? My holocaust survivor of a patient who lost everyone he loved in the death camps now must die alone. I am unable to get a priest to offer anointing and sacrament of the sick - instead it's completed over facetime. The wife of a patient who sobbed to me that she hasn't seen her husband in 6 weeks while he was hospitalized with COVID-19 - and that's the longest they've been apart in 65 years of marriage. And now he's unresponsive. I hold myself together as I offer support, but later I fall apart: my head in my hands, sobbing. "I can't do this, how are we supposed to do this?"
It feels good to cry, to loosen the grip of all this grief. But it also feels like trauma - for us, but mostly for the patients and families, and I'm sad for everyone who won't be able to say their goodbyes at the bedside, who won't be able to participate in death traditions and rituals that help move us through the cycle of grief.
Most people don't understand what we see and do at work every day and it's difficult to translate in a meaningful way. I know you all "get it". I yearn for a better tomorrow, but I'm plagued with doubts about a viable vaccine, or ever working without an N95 mask again.
I am coping by riding horses every day I'm not at work. The barn is my happy place where I can be alone and recharge. I am working on art projects, reading more, and finding appreciation in the small things. It's been a really, really hard time to be a nurse; harder than I ever imagined, but I know this is where I'm meant to be, in the right now of the pandemic, even if I have moments when I feel like I just want to give it all up.