A volunteer of the canadian Red Cross is entering a tent, a mobile hospital at the arena Jacques Lemaire in LaSalle, on April 26. Areas of “hot” and “cold” have been furnished.
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July 4, 2020 16h08
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Life and death in a hospital fighting against the COVID-19
Hillary Kaell
Professor, Concordia University
Julian Menezes puts a gown, gloves and a protective mask, then enters the room of a patient. His / her work ? Be there, simply, to accompany the sick.
The Royal Victoria Hospital (RVH), where works of Julian, has treated more than 300 confirmed cases of COVID-19 from the month of march. It is one of the centers of the busiest of Montreal, city wiping by far the largest number of cases in Canada. In all of this, Julian has a very important role to play. He is the only one involved in spiritual care in the “hot” of the hospital, where the patients with the COVID-19 are treated.
Stakeholders, spiritual care — also known as chaplains, provide emotional support and spiritual people of all religions or no religion. Although more than 10,000 stakeholders in spiritual care work in facilities across North America, their role often becomes visible with the media in times of crisis.
The Royal Victoria Hospital is part of the Glen site of the McGill university health Centre in Montreal
The canadian Press, Graham Hughes
During the first wave of coronavirus, different organs of the press, from the New York Times to ABC News, talked about their work. The articles focused on the panic and the pain of the first weeks, especially for patients in isolation in hospital and their families, to which the chaplains were then to act as “messengers” or “substitutes”.
A room of the Royal Victoria hospital reserved for patients with the Covid-19.
Provided
Barriers
As the pandemic continues, the persistent themes of physical barriers, masks, and social distancing are becoming common. This reconfiguration of the body and the space is especially visible in hospitals, such as the HRV.
Julian, who has co-authored this article, remembers the anticipation before the arrival of the first case of COVID-19.
Troubled and tense, the hospital staff was waiting. The wave would she move quickly ? Would there be implications related to the care given to patients with the COVID-19?
The hospital has organized the “hot zone” to look forward to. The staff has had to revise its way of dividing the space and move in it. At the RVH, for example, internal medicine and surgery rooms have been transformed into floors COVID-19, which were quickly occupied by patients coming of residences for the elderly in Quebec.
Following the instructions early to limit exposure, only the staff who provide life-saving health care was in contact with patients with the Covid-19. However, a few days after the arrival of the first cases on 12 march, it became clear that the patients were in need of other types of health care workers, including those providing spiritual care.
Unlike other Montreal hospitals, the RVH has maintained its team of four stakeholders in spiritual care on-site. At the beginning, the small team covered the floors of COVID-19, but avoided to enter the rooms of infected patients — considered to be hot zones. Then, on may 4, the hospital has strengthened the separation between the hot and cold zones. As well, the team had to choose between one or the other. After deliberation, it was decided that Julian would cover the hot zone, while his colleagues working in the cold zone.
Hot and cold
Cold spots have made their first batch of surprises. The patients of the COVID-19 and their families expected that visitors cannot enter the hot zone. But patients cold areas, admitted to the hospital for other health reasons, were shocked to learn that they would also cut off from their loved ones. On 16 march, the policy of visiting the hospital had indeed changed. Adult patients could now receive visitors, unless they are on the verge of dying.
The implementation of these barriers to limit exposure to the virus has been very costly on the emotional level. The chaplains of the areas heavily affected United States have noticed : already omnipresent, the fear of dying only intensified during the pandemic.
In warmer areas, some patients, particularly older ones, are too sick to interact. Others are pleased with the visits of Julian. Then again, other barriers stand, however, because it must be in the protective equipment each time it enters a room. The faces are masked, and the physical contact cut.
“These interactions,” says Julian, we help to reduce our own exposure to the pain, suffering and death… Now that there is a barrier, I can’t be with these people the same way”. By dint of being in the hot zone, Julian was even more realized that the boundaries are permeable — in the literal sense and emotional of the term — that help support people through such experiences. It is much more painful to be close to and observe, without being able to touch or be touched.
Support staff
A large part of the media coverage has focused on the work of chaplains with patients and their families. However, as the pandemic progressed, their support for the hospital staff also proved vital. In the days prior to the arrival of the first patients of the Covid-19 to the HRV, the staff members were largely concerned with the risk of transmitting the virus to their family. Since then, other challenges have become apparent.
The gowns and the masks offer no protection against the exposure of emotional life and death.
The canadian Press, Graham Hughes
In the hot zone, the nurses, who attended each year to a handful of deaths in the surgery rooms, see now several patients die each day. They told Julian that they feel powerless, and not only because there is no treatment against the COVID-19. Like Julian, they are unable to provide the type of care that drives them ; they can’t really get to know the patients behind their protective equipment, or give comfort by their touch.
Normally, doctors and nurses rarely stay with the patients during their last moments of life. This has also changed, as families can no longer stay at the bedside of the sick. Recently, Julian has attended a scene in which a nurse of the intensive care unit held the phone to the ear of a patient so that his wife and his children can tell him goodbye — they were in the hallway, just outside the room.
The wife of the patient then asked the nurse to caress the head, as it had been in the habit of doing, whereas he made the soul. After the last breath of the patient, the nurse came out to sit with Julian, and the widow, in tears. Later, she confides to Julian that she had participated in a scene that exceeded anything she had imagined. There was no curtain to pull or door to close ; no barrier to protect it from the sentence.
“The chaplains were in the habit of being present at a death and to attend to something very private,” explains Julian. Now, his job is in part to help other members of hospital staff to recognize — and to try to accept what they are exposed to on an emotional level.
Exposure
While hospitalizations related to the COVID-19 are on the decline, we are entering a new phase of the pandemic. Even if the hospital staff, including the team, stakeholders, spiritual care, is preparing for a possible second wave, there are for the moment of time to breathe — and, at the same time, time to think.
When it is located in the heart of the hot zone of the Covid-19 in Canada, ” said Julian, “we wonder : what is living ? What is a die ? Death is the worst outcome ? At the hospital, everyone is exposed to these questions in a general way. We are talking here about people who have decided to work with people that nobody else wants to see. In a sense, the sick and the dying are already in quarantine and kept away.”
However, even within the hospital, ” continues Julian, many workers are finding ways not to see death. “There is this strange juxtaposition in the hot zone, where we are all covered in a combination that protects us from dangerous substances, but at the same time much more exposed than before to this degree of intimacy, of sentence.”
Maybe is this the entry point, the question that guides us towards further reflection : what does this virus we has he exposed ?
Julian Menezes, of the McGill university health Centre, has co-authored this article. He is a professional in spiritual care.
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This text first appeared on the website of the franco-canadian of The Conversation. Reproduced with permission.
