The day that my 82-year-old mother was scheduled to receive her first COVID vaccine, she was admitted to the intensive care unit, critically ill with COVID pneumonia.
In late January, 2021, my siblings and I hadn’t heard from her in a few days, and we were worried. She was a die-hard Democrat and CNN junkie who was sure to be watching gleefully as the Trumps helicoptered from the White House for the last time. I phoned her from my home in Vermont, expecting her to pick up, thrilled to chat about Biden’s inauguration. I called several times, but she didn’t answer. Alarmed, I called my sister Laurie in Texas, and my brother Tom, who lived near her in Ohio. When he went to check on her, Tom found her weak, dehydrated, and confused. In the emergency room, she tested positive for the SARS CoV-19 virus.
Twenty-three days later, the virus had ravaged my mother’s body. She was unconscious but still clung to life—just—at St. Elizabeth’s Hospital in Youngstown. Death was an inevitable, imminent, formality.
Ironically, she no longer tested positive for the virus. My three siblings and I could gather in her room in the hospital’s medical intensive care unit. We were “lucky.” Legions of other families never had the chance that we were given to be with their loved one when they died of COVID-19. Hard as it was, we were grateful.
My mother’s passing from COVID was not swift or merciful. It was slow and horrifying.
My mother lay strapped to a bed, alone in a single room falsely bright with cold, stark fluorescent light that reeked of urine and antiseptic. Ties threaded her wrists, securing her hands to the bed. A nurse told us that our mother had been agitated and kept pulling the nasal ventilation prongs out of her nose. The restraints stopped her from removing her only oxygen source. The ventilator forced her breath. Its loud, precise rhythm hissed the only clue that my mother was still alive. Her body told a different story: cheeks wasted to skin over bone, eyes sunken, dirty hair matted against her bruised temples, a catheter bag muddied with blood. And then her mouth, horrific and gaping, its inside blackened like gangrene.
Laura Joan “Joanie” Sewickley, died on February 12, 2021. Hers was one of 3,013 lives claimed by COVID-19 in the United States that day. At this writing, this modern plague has now claimed 802,969 of our loved ones and fellow citizens.
Witnessing my mother’s death was traumatic, not just for me and my siblings, but for her caregivers. For the staff at St. Elizabeth’s, my mother’s passing that day was one more in a seemingly endless parade of death and misery. What psychological price has my mother’s passing extracted from them? How do they continue to suffer in what is now, at this writing, our fourth wave of COVID death?
As a clinical psychologist, I worry that our collective recovery from the trauma of the COVID pandemic will be complicated. The research on pandemic mental health in the general population has revealed increases in anxiety, depression, substance abuse, and posttraumatic stress disorder. Perhaps this iteration of complex trauma – pandemic trauma layered over underlying developmental trauma – may prove more difficult to treat because of the toll complex trauma exacts on an individual’s mental and physical health. Untreated complex trauma will likely prevent untold numbers of us from fully experiencing physical, emotional, and relational well-being.
During the lockdown of the pandemic, it was challenging for most of us to access the well springs of our usual support systems—extended family, friends, communities of faith, neighborhood gathering places, creative communities, schools, and workplaces. Trapped in our homes without our normal social supports, we lived with the fear of an unknown future.
We know that we are nourished and become more resilient emotionally when we have others upon whom we can rely. This remains true even at the end of life. Speaking to the New York Times Magazine, Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai Hospital, suggested that we crave existential and spiritual connections to ward off the isolation of what many of us fear even more than pain – dying alone. Our human connections envelope us in a psychological safety net, one that may provide some measure of immunity from the trauma in our lives.
The task of caring for individuals, families, and healthcare providers will be daunting, because none of us have been spared by this pandemic. An already overwrought mental health system will need to find a way to care for individuals who experienced a new or worsening mental health or substance abuse condition, or the death of a loved one to suicide. And in our communities, we will need to care for those who suffered the trauma of economic and occupational loss and food insecurity, and families who suffered an increase in domestic violence. These losses did not occur in isolation. They occurred in parallel with fear, uncertainty, and isolation during the lockdown of the pandemic.
My mother’s preventable death from COVID-19 was tragic and traumatic. But I consider myself lucky in many ways. As a psychotherapist, I have spent decades helping my patients work through their trauma. I have the requisite clinical expertise and skills to manage my own trauma. But even still, after enduring the isolation and anxiety of pandemic lockdown, I was not prepared to witness the ravages of my mother’s death from COVID pneumonia.
Even my sister Laurie, a take-charge pediatrician who rarely shows her feelings, was visibly shaken as we stood at the bedside of our dying mother. Seeking to restore a measure of dignity, Laurie gently tried to close our mother’s gaping mouth, but her jaw was locked and immobile, vulgarly exposing her black, shriveled tongue. I leaned over her too, pulling a comb fitfully through the sticky gels in her hair. Joanie would have been mortified, I thought, to be seen in this condition. Gray roots nearly an inch long? She never left the house without lipstick or a fresh manicure.
A gold chain strung with my mother’s favorite cross lay trapped in the fold of her neck. I wondered if it was choking her and untangled it, knowing my mother would be glad to have it on when Monsignor Shiffrin arrived to give her last rites.
My mother’s doctors removed her ventilation. Laurie and I sat vigil on opposite sides of her bed, sleepless as we considered the mournful reality before us. My mother breathed with irregular, jagged breaths. They were the only sound in the room now. Time felt frozen. There was no ability to move back or forward, like labor before delivery. Chelsea, the nurse who cared for my mother on the overnight shift, floated in and out like an apparition. As sunrise came and went, I stood at my mother’s bedside and rested my palm on her forehead. Chelsea stood opposite me. We were nearly mirror images of one another, touching my mother, crying as I said goodbye. Seventeen hours after her ventilator was removed, my mother finally stopped breathing.
As I write this nearly ten months later, I remain deeply in the moment of my mother’s passing. I wonder now if the experience of intense trauma, such as being with a loved one when they die, heightens one’s perceptions. Because even though I was heartbroken to say goodbye to my mother, in that moment, my attention was divided. Despite my grief, I was also keenly aware that my mother’s passing from COVID had grown routine for Chelsea. During the pandemic, she and other frontline hospital providers had been through this ritual of needless death countless times over many months. My tears were partly for them.
Later, Chelsea shared that the early days of the pandemic were the most difficult time for her. “It was a very hard time…very depressing. Patients would just take a turn for the worse, and we would have no idea what was going on,” she said when I talked to her by phone months later, “I mean, you would have a 40-year-old that was healthy that would die, just like that.”
The nursing administration at Chelsea’s hospital provided a counselor and opened a “Lavender Room,” a quiet place for nurses to reflect and take a break. Even with this support, Chelsea said that some of her colleagues took mental health leave. The hospital also provided written material on coping during the pandemic, but Chelsea hadn’t had time to read it.
How will Chelsea and other healthcare providers endure all of the lives lost to COVID under their care? How will it be for society when caregivers, who are tasked with guiding us to physical and mental health, are burned out? The research tells us that in addition to increases in depression, anxiety, posttraumatic stress and substance abuse, there have been a number of healthcare provider suicides. Many providers have also left clinical practice or plan to leave in the near future.
So, what can we do in the face of our current crisis? There are no clear answers or easy fixes. We easily have a decade of significant policy work and capacity building ahead of us. Even before the pandemic, the gap between the need for mental health services and the availability of providers was extraordinary in underserved areas. Today, demand has only grown, as have waitlists. As providers, we must endeavor to do what we teach our patients: in an out-of-control situation that we cannot change, we can only control how we respond to our own fear and trauma, and, for us therapists, that also means the secondary trauma we experience as a result of our work.
In the hours before my mother’s death, I experienced competing feelings of hope that she would die quickly so that her suffering would end, and sadness sparked by the grim reality that we were losing her. Chelsea looked at the clock, then looked directly at me as she called the “time of death.” Laurie, who had not been present in the moment of my mother’s death, came back to the room from the cafeteria less than a minute later, after she had received my pleading texts noting a rapid drop in our mother’s numbers on the pulse oximeter. Within a few brief moments my texts read “59, 57, 52, Lar come back, breathing has really slowed, 50, 49, 48, Lar come back.”
Many of the nurses from the unit, some of whom I’d never met, descended upon the room. I wasn’t sure how I was supposed to receive them. I was grateful that they were there, but it was strangely surreal that this private moment had become a community gathering. I imagined that they honored the moment of her death feeling helpless. Perhaps there was a moment of gratitude toward my mother, who had also spent her working life as a nurse at this very hospital. But in reality, the nurses were just marking one more life lost to the plague that has ravaged so many lives. As quickly as they descended, they left. They had to get back to work.
Photo © in-future
Judith Markey, PsyD, is a clinical psychologist in private practice in St. Johnsbury, Vermont. She also consults to the Vermont Department of Health on mental health and wellness issues for staff working on the state’s COVID response. Dr. Markey recently graduated from Harvard Medical School’s Effective Writing for Healthcare Program.