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Grief, Hope, and Unforgettable COVID-19 Conversations

EDITORS’ NOTE: The following post by Alba Cabral, Ph.D., first appeared in MedPage Today.

The COVID-19 pandemic has revealed the human capacity for extraordinary courage and resiliency. It has also showed us our fundamental need for hope and connection. As a clinical psychologist working in integrated care at Montefiore, one of the largest health systems in New York City, I’ve seen both the fragility and fortitude of our healthcare workers and the families who have lost loved ones to the virus.

In late March 2020, I joined more than two dozen pediatricians, nurse practitioners, and psychologists in the expanded Quality in Life Team (QUILT), a palliative care program at the Children’s Hospital at Montefiore (CHAM). At that point, the health system had created a 40-bed adult COVID-19 treatment unit within CHAM in order to meet the unprecedented influx of patients.

When I joined QUILT, I became part of the grief callers’ team, offering grief support to families of patients who had died of COVID-19 at CHAM.

Can I Do This?

On April 6, my first day of deployment, I woke up in a state of alert, fearful of the unknown. In front of me I had my new daily task of reviewing the list of patients who had died at the hospital in the last 4 days. I was to review the deceased’s death note and identify the next of kin who had been notified of the death so I could offer grief support.

Before I made my first support call, I heard my children giggling and playing in the background, and I felt grateful for that in the context of what I was about to do. It was a cloudy day; the air felt heavy, and my heart felt heavy. Would I be able to do this? For 20 years, I had been helping people cope with emotional pain and trauma, but I knew that what I was about to encounter was different.

For 6 weeks I was privileged to share the intimacy of grief with dozens of families. It was also one of the most painful professional and life experiences I have had. I am still trying to make sense of what happened during those terrifying weeks, feeling anger, numbness, and disbelief.

Before my deployment, part of my job as a psychologist for the HealthySteps program at Montefiore was to help parents track their baby’s development and build healthy parent-child emotional connections. In a matter of days, I went from writing infants’ progress notes to reviewing death notes of deceased COVID-19 patients.

Initially, the transition did not faze me; the grief work I was doing provided me with a sense of control during a time when many of us felt powerless. There was also little time to reflect — only time to act.

Looking back, those days of reading death note after death note were one of the most difficult aspects of the experience. Where do you find strength to support people facing the death of their loved ones in such an unexpected way?

I compartmentalized my emotions, took deep breaths, and at the end of the day held on to hope.

Still, it became difficult to continue to face the deceased list. The anticipation of calling families when you did not know their response or mental state was often harder than the call itself. Would they be angry? Would they cry? We were told to listen — but would they want to be heard? After all, what could we do for them?

Conversations I Will Remember Forever

The first call I made was to Gloria. Her 31-year-old sister, Silvia, had died a few days before. Gloria last saw Silvia walk out of their Bronx apartment with a fever and a cough. Silvia never came back. Gloria firmly asked me not to talk about her: “Silvia’s coat is still hanging from the dining chair. I don’t want to think she is dead. I am not ready to talk about her, but yes, please keep calling me. I like knowing you will listen even if I don’t want to talk.”

For weeks, Gloria feared she had the virus and would die too, and she worried how she would pay her rent. I listened and gave her suggestions on ways to get her tested and take care of herself.

I spoke with Jessa, who lost her mother, a Filipino woman in her late 50s. She told me that she received a text from the funeral home with a photograph of her mother’s upper body so she could identify her before they cremated her; the funeral home was so overwhelmed that families were not allowed to come in to see the bodies. “She had such a peaceful smile; now I can be at peace too,” Jessa said. She received a box with her mother’s ashes the next day.

I think of Minerva, a Colombian lady who lost her husband of 30 years. Her pain was palpable, yet her hope and resilience still resonate in my heart. She spoke of her last hours with him before he went to the ER, the way he made her laugh, and how they would dance together at the end of a hard day. She told me about their struggles as immigrants and expressed their pride in their children. She described their lives so vividly that by the time we were done with the conversation, I felt had been in her living room sitting with her having a cafecito (a small cup of coffee).

I remember reading a death note about the lullaby a mother sang over the phone to her 30-year-old son seconds before he died. I think of the humanity of the medical staff who held that phone while witnessing this intimate moment. I think of what it took for so many nurses and doctors to face death in these ways. And I often wonder how they are coping now as we see a new surge in cases this winter.

Healing Together

“Grief is ugly,” I was told by Sarah Norris, MD, the courageous palliative care physician who led us during this deployment. It has been almost 10 months since that morning of April 6. And many more families around the country and world are experiencing grief as the pandemic rages on. The start of the vaccination rollout is giving us new reason to hope and allowing us to see glimpses of light at the end of the tunnel.

While the memories of my deployment bring up uneasiness and pain, I am also grateful for the connections I made with the families I spoke with and the colleagues I met.

This experience is undoubtedly informing my approach in HealthySteps as I return to my work helping parents build healthy connections with their children.

How curious and how hopeful that death has the potential to be life-affirming. When I think of Silvia, Jessa, Minerva, and that last lullaby, I hold on to the hope that what we did in our role as supportive grief callers was meaningful.

And I continue to hope that we can all find emotional healing in our collective experience.

*Gloria, Silvia, Jessa, and Minerva are pseudonyms.

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Alba Cabral, Ph.D.

Alba Cabral, Ph.D.

Dr. Cabral is assistant professor, pediatrics at Albert Einstein College of Medicine and a pediatric psychologist with the Montefiore Health System.

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