The COVID-19 dilemma: how to maintain physical distance without sacrificing pastoral closeness
RELATIONSHIP and presence are at the heart of all pastoral ministry. Many dimensions of God’s grace and care are expressed in physical and embodied ways through the person of the pastoral minister. The onslaught of COVID-19 in recent weeks has posed an enormous problem for pastoral care under these conditions and has challenged us – chaplains, clergy and the church in general – to think of new ways to connect and to care in physically isolated and distant ways. How can we minister when we cannot be physically present?
Healthcare chaplains face particular challenges in caring for patients, loved ones and staff who are in the COVID-19 vortex, where patients are at their most vulnerable and require high levels of medical support, especially when struggling with distressing symptoms. The most disturbing challenge to pastoral care is the puzzle of how to remain pastorally close while physically distant from patients with suspected or confirmed COVID-19. The impact of restrictions associated with this virus has disrupted the physicality of our pastoral and caring relationships. The natural use of touch to bless, to comfort, to pray, to anoint, to celebrate eucharist, to come alongside, has had to stop. This necessary withdrawal of our physical selves from those who need us most in their time of greatest need is utterly counter- intuitive for people working in pastoral ministry. This agonising separation is felt not only by ourselves but more importantly by those who look to us for support at times such as this. This raises a number of challenging issues for chaplains. There is the personal risk of contracting the virus, despite the availability of personal protective equipment (PPE). This puts the chaplain at personal risk as well as becoming a risk as a potential vector of the virus, thereby placing other vulnerable patients and her/his family members at risk. In most situations the practice is that only staff providing essential care are in direct contact with infected patients. But what of spiritual need? In a number of cases, spiritual and sacramental need (at least from the perspective of a patient) is considered an essential part of their care. For patients in isolation, if their condition starts to deteriorate (particularly in terms of respiratory function), difficult conversations will be necessary concerning a possible need for intubation and ventilation. It is perfectly understandable that patients in such a situation will be scared and will want spiritual support and accompaniment; but for all patients, this is a key time for sacramental and pastoral support, given that it may lead into an end-of-life conversation with all the attending sensitivities attached thereto.
Family issues
It is also a time when people often ‘lean into’ and need their pre- existing support structures and resources. This is further compounded when family members are prevented from visiting to minimise their exposure to the virus. This truly is a Gethsemane time for the patient and their loved ones, both of whom experience acutely the pain of separation at a time when ordinarily we draw close to our nearest and dearest. This is gut-wrenching stuff. Studies from previous viral epidemics highlight the presence of spiritual and psychosocial issues for patients arising from isolation, powerlessness, stigma, uncertainty, fear, loss of connection etc.1
In recent weeks, chaplains have been preparing for this reality, locally, nationally and internationally, and have worked alongside healthcare colleagues to provide new ways of connecting with both patients and their loved ones. These new ways of communication have evolved in many places through the use of technology such as video calls between patients and loved ones, facilities for families to send in photographs and letters. In a number of cases these conversations have been the final conversations before death. Chaplains have also been involved with legacy work to create memories and mementoes for families of their loved ones’ care and final moments. For this writer, this has, in similar situations, involved writing a letter describing how care was provided, who was there, what happened afterwards (e.g. was a prayer said, hand held, blessing performed, personal message relayed?) In some cases technology has also enabled family members to say their final good-byes and to join virtually in the final prayers at or after death. For some patients though this is not comfortable, so it is important to be sensitive to the needs and wishes of all.
Overcoming PPE depersonalisation
The experience of patients being faced with staff wearing full PPE is not to be underestimated. It has a ‘contagion’ feel to it and once again the sheer barrier that hides (and protects) the healthcare professional is a stark reminder of the gravity of this illness. Staff of course also feel this and it goes against the natural and primal instinct of medicine as a supremely relational and human endeavour. Once again, the importance of human relating at the heart of pastoral ministry has brought forth new ways to provide ministry. Amongst many examples of personal sensitivity, is the printing of our faces and attaching them to the front of our PPE; in this way, a patient sees our whole face and knows what we look like. I vividly recall an elderly man at the early stages of this pandemic who was in distress and in isolation and was referred to me for support. As I was unable to enter his room, we explored the possibility of using an iPad so that I could speak with him. I was outside his room and when we connected and said ‘Hello’ he cried and cried . . . this was the first ‘face’ he had seen and spoken to since his admission. The impact of isolation alone was immense. He died two days later. I recall another young couple where the patient was very unwell and general visiting restrictions meant that no guests could attend their wedding. Once again we used video technology to facilitate the virtual presence of their guests. Both experiences provide examples of overcoming physical distance with pastoral closeness.
As well as caring for patients and their loved ones, chaplains have also been providing care for staff colleagues. The impact of a pandemic and the level of mortality associated with COVID-19 has well documented the moral distress and injury for healthcare staff in the published literature. Staff providing direct care experience a considerable personal and professional burden, especially in intensive care and high dependency units. The challenges for healthcare systems, to care for their staff and to manage mental health challenges associated with such a virus as this are considerable and crucial to the overall provision of care. There is an understandable sense of fear amongst staff and sadly some have died as a result of contact with the virus. This fear is also experienced by the families of healthcare staff – chaplains included. Initial studies of staff wellbeing from Wuhan indicate that almost a third of staff there suffered moderate to severe psychological disturbances.
Chaplains have been working alongside other healthcare colleagues such as social workers and employee assistance programmes to provide support for staff colleagues. In turn, chaplaincy educators and supervisors in the Association of Clinical Pastoral Education (Ireland) Ltd have been providing support and clinical supervision for chaplains.
The follow-on care of loved ones of patients who have died is a considerable challenge for parish communities and society at large. The restrictions on funeral gatherings are felt at a deeply visceral level in Irish society. The work of grief is not optional and so, in time, this work which could be characterised as ‘suspended grief,’ will resume when restrictions are lifted. This will be an important time for faith communities to once again connect physically and to hold the tears of God’s people. In the meantime, immense credit is due to churches and communities for the innovative ways they have devised to maintain connectedness, relationship and a newly experienced ‘Body of Christ’. Much is yet to be captured and written about this care and its importance in the ongoing story of isolation and connection in these pandemic days. In these times the Church is called to be her best and truest self without the props of buildings and physical gatherings. These are challenging and uncertain times. We are in a very long Lent but we do have an Easter message where the risen Christ still comes to us when we are gathered behind locked doors in fear saying “Peace be with you” (John 20:19-20).
Words from Ecclesiastes often heard at funerals now have an poignant resonance:
For everything there is a season, and a time for every matter under heaven:
a time to be born, and a time to die;
a time to plant, and a time to pluck up what is planted;
a time to kill, and a time to heal;
a time to break down, and a time to build up;
a time to weep, and a time to laugh;
a time to mourn, and a time to dance;
a time to throw away stones, and a time to gather stones together;
a time to embrace, and a time to refrain from embracing;
(Ecclesiastes 3:1-5)
* Full article available in printed copies.
Daniel Nuzum
is a Healthcare Chaplain and CPE supervisor at Cork University Hospital and Marymount University Hospital and Hospice Cork, Lecturer at UCC College of Medicine and Health, and a priest of the Diocese of Cork, Cloyne and Ross.