NEW BEDFORD — After 7 a.m. on Thursday, it was time for a palliative care nurse at St. Luke’s Hospital to help a husband, children and grandchildren say goodbye to their elderly matriarch.
Under the coronavirus pandemic, visitors often aren’t allowed. As a loved one gets closer to death, one or two people are allowed to visit, but for some people the risk of possibly being exposed to the coronavirus is too great.
“I start describing mom,” said nurse Darlene Friedland, recalling her morning as she talked to a child of the patient, who was on the phone. The child started to cry, she said, and she reassured that the mother was comfortable. She said she also told the child the mother looked peaceful.
Friedland, 56 of New Bedford, used to be an oncology nurse but is now specializing in palliative care, which according to the World Health Organization is care that improves the quality of life for patients and their families by focusing on the relief of suffering.
Next, Friedland read messages from family members to her patient who could no longer verbally respond and whose eyes were closed. She had congestive heart failure and acute respiratory failure, Friedland said.
She relayed a message from the husband which said, “Thank you for all these wonderful years, putting up with all the days and nights that I was working and couldn’t help with the family. You did a great job and they turned out fantastic. I will love you all my life until we meet again.”
“I just burst out into tears,” Friedland said.
The three-person palliative care team at St. Luke’s Hospital has taken on more patients who have varying illnesses, including COVID-19.
The pandemic has brought on new challenges such as the limitations that come with personal protective equipment and the need to conduct meetings with families or healthcare proxies over phone or video. They also relay messages that loved ones would rather say in person, but aren’t able to.
The palliative care trio manages pain and symptoms which could be physical, psychological or spiritual in patients who have serious, chronic or progressive illnesses. The staff members focus on the needs and wishes of their patients and ways to improve quality of life. They don’t necessarily just help people in their last days, but can assist at any time during an illness.
“It’s very difficult for [family members] to make these decisions when they’re not face to face with their loved ones,” said Joseph Furtado, a 59-year-old nurse practitioner in palliative care, like whether to use a ventilator if their loved one experiences trouble breathing. It’s hard to pick up on nonverbal cues; “Seeing the person helps you make that connection,” he said.
But video calls can at least bring some comfort to the patient and their family, even if the patient is unable to talk.
Their patients tend to be older with various illnesses. Friedland rattled off a list of ages from 43 to 93 and with illnesses including subdural hematoma, alcoholic cirrhosis, congestive heart failure, lung cancer, diverticulitis with gastrointestinal bleeding, and suspected COVID-19.
The biggest challenge for Friedland during the coronavirus pandemic is not being able to caress the hair of a COVID-19 positive patient or hold their hand as she normally would because of all of the necessary personal protective equipment.
“I like that physical touch of my patients,” said Friedland who has worked on the palliative care team for about a decade. “Or even to hug the loved ones, just to give them that support and contact.”
Masks and face shields also get in the way of patients being able to see a smile or empathetic expression, which encourages them to open up, Furtado said. “You have to spend a lot more time in the room and on the phone,” he said, in order to build a rapport with patients and families.
“It’s really all about the rapport that we build with them in a really fast time frame as well as a short time frame," he said.
Friedland makes sure patients don’t forget why they haven’t gotten any visitors. “I remind my patients when I see them that we are going through COVID and this is why their loved ones are not here visiting,” she said. “It’s easy to forget and just think that you’re there by yourself.”
Palliative nurse Kristen Nelson, the third member of the unit, said she worries about patients who aren’t able to properly say goodbye to their loved ones and the possible long-term effects of that.
“It puts a tremendous burden on them,” said Nelson, a 52-year-old Mattapoisett resident. She’s seen family members “really breaking down” in dealing with their loss, she said.
Due to the coronavirus, she estimated that the unit has seen a 30-50% increase in patients, although some days are busier than others.
They start their day by meeting and going over the list of patients. They prioritize and strategize patient needs and how to address them. They often work with other staff in the hospital, such as nurses who help identify their patients.
Despite the additional challenges they believe that their work is important.
“I have always looked at it as the end of life is always as important as the beginning of life,” said Nelson who is also chemotherapy certified. “Helping families navigate that is a very important part of nursing.”
How do they handle the emotional toll?
“I think we rely on one another a lot to provide support,” Nelson said, adding they help each other decompress. They’ve worked well together, she said.
Years of experience “really helps us absorb the impact (of) seeing more patients,” Furtado said. And the feedback from families provides a big morale boost. “That’s what just keeps recharging our battery,” he said.
As for Friedland, “Sometimes I say a little prayer and I leave this work at work,” she said.