“A great man was lost today.” Those were my words to my wife at 1 a.m. several weeks ago on the phone, in reference to her father. While she was attending to our younger boys two hours away at our home, I was staying with my mother-in-law, doing the best I could to help my father-in-law struggle with end-of-life issues. He had tragically been diagnosed with metastatic pancreatic cancer just one week earlier. Within a week, a vibrant, considerate, and humorous man quickly declined in health to the point of being bedbound and delirious. Those who have witnessed a loved one go through similar illnesses understand the gut-wrenching anguish. Fortunately, hospice, family, faith, friends, and a small Southern town (with lots of homemade pies) helped us through this.
The normal emotions and conflict one feels with a family member dying are complicated during the stress of a pandemic. My own father had died on hospice less than six months ago, but prior to the COVID-19 outbreak, so I was able to contrast the two experiences. Like much of what we have all dealt with recently, this was unchartered territory. There is no pandemic playbook for handling hospice, grieving, visitation, and funerals. Essentially, we are making it up as we go along. As a medical doctor and with an MPH degree, I am a strong supporter of all validated recommendations to limit the spread of this virus. I have loudly advocated for what we do know: social distancing, limiting the number of persons in a space, hand hygiene, and mask wear. Suddenly, I was thrust into a situation that jeopardized all recommendations I have vigorously, and maybe annoyingly, proclaimed to colleagues, patients, and administrators. How would I cope with this?
After the initial shock of the devastating news, during the drive to see my father-in-law, I started to worry about how to mitigate viral transmission during this time. Coronavirus would be on everyone’s mind, and I knew they would look to me for some guidance. My father-in-law had been a teacher, a basketball coach, a mayor, a pilot, and worked in the school system for over 30 years. Essentially, half of the county knew and loved him. Under normal circumstances, the house would be overflowing as people would visit him while on hospice. But, these were not normal circumstances. So, I developed a game-plan that even Dr. Fauci would have been proud of- I just had to implement it. How wrong I was.
First, I knew that physical separation would be important, so I had to develop ways to stress this to family and friends. However, it was evident within 5 minutes that hugs were happening, and I was not going to enforce any 6-foot interval. This was not practical nor compassionate, I learned. On to my next concern. In order to reduce aerosolized particles, I made sure there plenty of masks available. As you can imagine, loop masks are not conducive to crying, so the use was sparse. I will say the numerous bottles of alcohol gel placed strategically throughout the house were used.
While there was a risk to our family and visitors, there was also an emotional toll that could never be forgotten. People had to grieve, and support each other. So, we mitigated this the best we could. Visits were limited and scheduled in advance, if possible. Hand hygiene was encouraged, and we used outdoors to talk. As well as this went, I think, planning a funeral for a well-known and beloved individual is another challenge. We had limitations on the number of people that could gather which were imposed by the state, as well as the churches and funeral home. Still, several possibilities existed ranging from no funeral at all, having a moderate-sized outdoor funeral, and multiple options in between. Some people had their own strong beliefs. We felt a responsibility to balance public health with also allowing people to grieve and honor the man we all cared for.
Ultimately, we came up with a plan of an immediate small funeral, with a delayed, larger “celebration of life” in an outdoor setting. Our smaller group included close family, and a few long-standing friends. We worked with the funeral home with physical separation based upon seating arrangements. Admittedly, mask wear and physical separation were not followed completely according to CDC guidelines, but it was utilized by several attendees. In order to allow more to be virtually present, the eulogies were streamed on Facebook Live (over 500 views were seen immediately!) While a video funeral may be new for many of us, in the age of COVID-19, it is not surprising. Importantly, we knew not to video the audience. First, no one wants to be seen grieving on camera. Next, some expressed concern over getting “funeral mask-shamed.” It’s a crazy world we live in, but I suppose anything is possible.
I continue to look back and wonder if we could have done anything differently. I’m told that second-guessing ourselves is normal and part of the grieving process. However, after three weeks, we have not heard of visitors with suspicious symptoms, nor that tested positive. I am so relieved and definitely pleasantly surprised.
In the end, I am at peace with what we did. More importantly, the family and close friends feel comforted. For all the unknowns that the pandemic has brought, I do feel confident in a few things after this funeral. The world did lose a great man, and fortunately, he did not suffer long with this horrible disease. I know COVID-19 continues to be a threat and impact us in multiple ways. As a medical and global community, we still have a lot to learn about this virus and how we should react to it. And I know that regardless of the social gathering, mitigating the spread is important. But, at times, I have to take off my doctor’s coat, remove my public health hat, and just be a family member who is allowed to grieve with others. We do the best we can.
Samuel O. Jones is a cardiologist.
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