At a time when many hospital patients crave the comfort of family as they struggle with COVID-19, the crisis is keeping their loved ones at a distance.

Hospitals and long-term-care facilities have been forced to drastically limit visitations to mitigate the spread of the virus.

As patients battle the illness, they also must cope with isolation, of not being able to see their loved ones up close, hold their hands or hug them.

The distance is equally tough on family members, and medical workers feel the stress of the new rules.

As the pandemic continues to take a toll locally, hospital chaplains are stepping up to provide patients, families and staff with the support they greatly need.

The chaplains also must follow new rules, with distancing and protective gear now being important parts of their jobs. But they’ve come up with new ways to help those hit hardest by the virus and other patients.

Mission unchanged

Relationships and connections are crucial to everyone, and particularly to those who are sick, said the Rev. Mary Cole, director of pastoral care for St. Luke’s University Health Network.

“It’s how we find meaning in the world, so any way we can help facilitate that, we are,” she said. “This is unprecedented, but we’re figuring it out.”

As the cases have grown, hospitals in the region have added chaplains and increased their presence because of the growing demand for that support.

In most cases chaplains also are staying out of patients’ rooms, particularly those of patients with COVID-19, and instead speaking and praying with them by phone or video conferencing.

“We’re used to being there face to face with them, so it’s a big change not to be in the room,” Reading Hospital chaplain David Troxler said.

But while the work has changed, the mission to provide peace to those who need it remains the same, said Reading Hospital interim director of spiritual care Tom Adil.

Most patients understand the visitation rules, Troxler said. And almost all the coronavirus patients he’s spoken with asked for prayers that their families stay healthy.

“I’ve heard that from people across all different religions, and from those without a religion, that more than anything they want their families to stay safe,” he said.

While patients see the need for the restrictions, that doesn’t make the isolation any easier. But the phone calls and video chats do, Cole said.

“Any form of connection helps, so we’re working diligently to connect them in other ways (than visits),” she said. “It’s really meaningful when they can speak to each other. It seems to be a real lifeline to the outside for our patients.”

The chaplains said their talks with family members also are helpful.

“If they’re people of faith, we say their loved one’s name together in a prayer,” Cole said. “They can’t hold them in person, but we’re helping them to hold them in their hearts.”

Nurses, doctors and other medical staff realize the value of those connections and have been helping to make them happen, she said.

“It takes a lot of teamwork and coordination,” she said.

When the chaplains feel the weight of all the sadness and trouble they’re helping others to deal with, they lean on one another.

At Reading Hospital, that starts with their morning prayer, which the chaplains now do together from their individual offices, Adil said.

“We lift each other up,” he said.

Not alone

Reading Hospital has long had a No One Dies Alone program in which unaccompanied patients have someone stay near them for support until they pass, and that policy remains in place, Adil said.

The hospital has seen nearly 70 COVID-19 patients die during the outbreak.

Reading chaplains, wearing protective gear, still go to the bedsides of some patients who aren’t able to speak by phone.

But when that’s not possible, they offer prayer vigils and liturgies or otherwise support them by phone in their final hours.

Even when the chaplains visit a patient in their room they usually keep some distance, but in one case Troxler couldn’t resist moving closer. He shook the hand of a 100-year-old patient whose wife of 72 years was dying in the hospital and whom he couldn’t be near in her final moments.

“My heart just ached for him,” Troxler said.

Understanding the loss

Penn State Health St. Joseph chaplain Joyce Martin said her conversations with COVID-19 patients have been eye-opening in terms of the toll has taken on them.

“I always knew that this was no joke,” Martin said. “But I understood that on a whole new level when I heard their voices and how hard it was for them to catch their breath even from just talking.”

She’s spoken with patients of various ages, and some were more openly anxious than others about whether they’d survive. Because they couldn’t know how the virus would progress, all were extremely relieved when they turned the corner, she said.

Martin understands their concerns because she had a family member with the virus who had a fever for two weeks. Even when that fever broke and she knew she’d get better, she was worried about whether she could still pass the virus on to others and whether she could get it again.

It’s also a tough time for patients who don’t have COVID-19, whose loneliness can build as they also go without visitors, Troxler said.

He spoke about a young patient who was already missing much of his senior year of high school, his prom and graduation, and now sat in a hospital bed without visitors.

“Those are meaningful losses,” he said. “He is just as much a victim in this.”

When possible the chaplains arrange for patients to talk by phone with their local faith leaders.

And even when patients are unconscious the chaplains will pray with them or arrange for families to speak with them. Many believe that hearing is the last of the senses to go, so there is hope that those talks help them in some way.

Leaning on other skills

When chaplains are no longer able to visit the rooms of patients, it allows them to practice other skills so important to their work, said Deacon Thomas Devaney, director of spiritual care for Penn State Health St. Joseph.

Unable to notice body language during phone calls, they instead rely on verbal clues and voice inflection to measure how someone is coping, he said.

“It’s taken active listening to a whole new level,” he said.

Patients need compassion and unconditional love, so that is what the chaplains provide, he said.

“Man is a social creature,” he said. “They need relationships. Not having them only adds to their suffering.”

For patients unable to speak because of their illness or because they’re on a ventilator Devaney will still pray with them, he said. For one patient whose room he couldn’t enter, he blessed him through his open door with holy water.

Devaney said compassionate care has always been important and that has become even more clear during the pandemic.

“I think that once the virus is contained that a byproduct of all this will be that spiritual care is much better,” he said.

Supporting the staff

The stress on hospital staff is enormous, Adil said.

During their shifts they’re helping people who are severely ill, lonely and who are uncertain about what’s next, he said.

The staff must deal with seeing people die of the virus, such as a nurse who recently had to take five bodies to the morgue in one day, he said.

And when their shifts are done, they worry they may unknowingly take the virus home to their families, he said.

The support they receive from the community — a delivery of pizzas bought for them, a donation of protective masks or kind words from a patient — gives them a boost, he said.

Martin said the St. Joseph staff has been remarkable in doing their work despite all the risks and stress.

But she said she and her fellow chaplains already are planning for when the crisis ends because those who have been through a difficult time often struggle more emotionally and psychologically after things slow down.

“We’re talking about how we can be available to support them in the aftermath,” she said.

'Calming presence' 

The state reports that two-thirds of the COVID-19 deaths in Pennsylvania are occurring in nursing homes, personal care homes and assisted living facilities, and much of the Rev. Ty McMillan’s counseling is with those who live and work in such facilities.

McMillan works full time as a chaplain at Holisticare Hospice in Berwyn, Chester County, and part time as a Reading Hospital chaplain. In recent days he has counseled several health care workers on the front lines of the crisis.

“They are people who are overcoming their own fear and exhaustion to do the job they are called to do,” he said. “I call them my heroes. But it definitely is a strain on them.”

Residents and staff in long-term care settings are scared they’ll catch the virus, he said.

For the workers it can be almost overwhelming as they try to keep residents safe while worrying about their own health and that of their families and co-workers, he said.

And because residents cannot rely on family visits to help them cope, McMillan tries to bring them peace during phone calls and visits, listening to their anger and frustration and offering reassurance.

“It’s really hard on everyone,” he said, “so I want to be a calming presence.”

The residents often have cognitive issues that make it hard for them to understand how the pandemic is hitting the world, but it means a lot to them to know their families are staying safe, he said.

What seems to mean the most to residents are their video chats with their families, he said. One elderly woman who is usually only minimally responsive changed her entire demeanor when her loved ones came on screen to talk to her, McMillan said.

“It was amazing,” he said. “She just lit up. To see that brought so much joy to my heart.”

McMillan is concerned about his own safety when he visits a facility, a patient’s home or the hospital, but he takes precautions, and said his faith helps him control his fear so he is better able to help those in worse distress.

He provides grief counseling to some family members who feel guilty about not being present when a loved one died, and encourages them to look at things differently.

He speaks about the love and care they provided to them while they were alive, and assures them they’ll live on in their hearts.

When his patients die, he takes his own advice, as tough as that can be.

“I love all my patients, but some stand out,” he said. “And seeing one of my favorites die is really hard.”

And on a personal level, two people very close to McMillan died of COVID-19 within a week, which hit him hard.

But it also left him better able to relate to his patients.

“They know that when I’m talking to them that I genuinely believe what I’m telling them,” he said. “I can feel their pain.”

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