The Calm Before the Storm

Reflections of a hospital chaplain
awaiting the coronavirus “surge”

The calm before the storm. . . . That's how I'm hearing the atmosphere of my work place being described in response to the growing number of coronavirus infections in Minnesota and across the country. It's an increase that is part of the current global coronavirus pandemic, and it's an infection that can result in a potentially fatal respiratory disease known as COVID-19.

As most of you reading this would know, I work as the Palliative Care chaplain at Mercy Hospital in the north metro of the Twin Cities. This hospital is part of Allina Health, Minnesota's largest healthcare system.

I work with a specialty group of providers; we specialize in palliative care, which involves symptom management of chronic and/or terminal illnesses and end-of-life support and care. Although I'm not part of the hospital's Spiritual Care department (but rather Allina's system-wide Hospice and Palliative Care department), I'm nevertheless based at this particular hospital and work with its chaplains.

In the last two weeks I've been aware of a growing sense of anxiety and dread – in society in general (as restaurants, movie theaters, gyms, sporting events and most stores close down) and in the healthcare world in particular. I feel this sense of unease within myself, my team, the hospital in which I work, and the wider healthcare system of which the hospital is a part. I have friends who work in other Minnesota healthcare systems, and so I'm aware that this growing anxiousness is there too. Indeed, news stories make it clear that it's a nationwide reality.

This anxiety and dread stems from the very real likelihood that the nation's healthcare systems are about to be overwhelmed by a surge of COVID-19 patients. The administration of the hospital where I work is doing all it can to try to prepare for this surge, and different responses have been planned depending on various scenarios. (For instance, we'll be using the first floor of our parking ramp to “provide space for rapid triage assessment during a surge.”)

Yet the reality remains that in hospitals throughout the U.S., there are simply not enough ICU beds or the necessary specialized equipment (such as ventilators) to deal with a large surge of COVID-19 patients. As a result, there are very real and stress-inducing concerns that medical professionals are about to be placed in heartbreaking situations where they must decide who will be treated and who must go without; who might live and who will probably die. As in other states, Minnesota currently has a "stay-at-home order in place. The hope is that this will slow the rate of infection ("flatten the curve") and thus spare healthcare systems from being overwhelmed and making agonizing life and death decisions based on limited resources. Sadly, though, in some parts of the country, hospitals are already being overwhelmed.

I must say I never thought I'd be living through this type of crisis. I realize, of course, that plagues and epidemics have long been part of humanity's story, but I'm still often finding the experience we're going through to be unsettling. I suppose a big part of it is just the sense of not being in control; not knowing how things are going to unfold.

Above: Starting today, all healthcare providers in the hospital, including spiritual health providers, are required to wear masks when in the hospital and interacting with both patients and staff. I started wearing scrubs last week .

A center of peace amidst the rising tide of anxiety

It's currently very quiet at the hospital, due in large part to the heavy restrictions on visitors and a low patient census, the result of a very conscious decision on the part of the administration to cancel all elective surgeries and procedures. Yet below the surface of this calm is a slow-rising tide of anxiety.

As a chaplain, I endeavor to be a non-anxious, grounded, and listening presence to my patients. Now I'm increasingly finding that I'm being called to be this kind of presence for my team and for the hospital staff in general. I'm okay with that, though I must admit it's not always easy being this kind of presence at this time, especially when one can oneself be easily caught up in the rising levels of anxiety.

My little corner of the Palliative Care office helps, however, as here I've created a center of calm and peace; a space filled with beautiful reminders (images, plants, artwork, books, objects from nature) that serve to remind me that I can and must constantly and intentionally ground myself and my work in the Divine Love within, around, and beyond me. Only when I open myself to this Divine presence and allow it to infuse me, can I then go out and be this presence with and for others.

Following is the “Work Day Prayer” I pray each morning before leaving my desk to visit my patients and interact with staff.

As I begin this work day
I open myself to the Sacred Presence within and around me.
May this Presence energize and guide me
as I cross thresholds and connect with others.

May I be a clear channel to do my work with calm and grace,
keeping each and every patient’s deepest reality as primary.
May I provide care with commitment and integrity.

May I remember my connection to the Sacred,
present in all things – the earth, my inner knowing,
my colleagues and patients, and all sentient beings.

May I value time for self-care
to replenish my energy reserves
and to wisely and lovingly direct their flow.

May I be open to trusting that
whoever is referred,
whatever work comes,
and whenever this work happens
are all part of a sacred journey
of transformation.

Blessed be.


Adapted by Michael Bayly from a prayer by
the Penny George Institute for Health and Healing

I conclude this post by sharing an insightful and powerful article by Nathan Gray, a Palliative Care physician. In it he explains and explores what Palliative Care specialists, including chaplains like myself, have to both be and do in the midst of the growing coronavirus pandemic.

________________________

Palliative Care in the Time of Covid

By Nathan Gray, MD
Around the country, hospitals are either feeling the opening barrage of a horrifying pandemic or rapidly scrambling to prepare for an onslaught in their own backyard. Every possible niche of healthcare is bracing for the likelihood of a deluge to come.

You might wonder what palliative care specialists have to do amid the rising toll of this viral pandemic. After all, this is the realm of ER doctors, ICUs, and infectious disease experts, right?

Palliative care specialists are used to guiding people through frightening health landscapes, but this pandemic poses a level of uncertainty that most of us have not known in our lifetime . . . and threatens many of our most fragile patients.

The pandemic means that we will be drawn into countless conversations with families who are suddenly having to make difficult decisions about life and death. It means we may be helping deliver awful news that [the measures being taken for] someone’s mother, father, sibling, or spouse [are no longer working]. If this outbreak gets as bad here as it has in many other countries, there will be more of these conversations than our small teams can handle.

This pandemic also means that many of these hard conversations will be had behind the dehumanizing veil of plastic gowns and respirator masks. Some of these awful moments will have to happen over phone when families are not able, or not allowed, to be present at the hospital. In the midst of an outbreak, there are people who will die in relative isolation from their family and friends. For those of us who have built our careers around the idea that people should be able to find peace, meaning, and connection in their last days, that prospect is gut-wrenching.

For us, this pandemic means being ready to support our hard-working colleagues as they face risks to their own health on top of the emotional toll that over-stressed resources, death, and tough conversations can bring to us all.

I have heard many doctors and nurses from various specialties wonder aloud whether some of us will be asked to call on our rusty critical care skills if need exceeds supply. But hearing stories from China and Europe, I also worry about how many providers may be required to call on their palliative skills when resources run short.

If the spread of the virus continues unchecked in our own communities, we will ALL be taking part in hard conversations, managing distressing symptoms in the last days, and stepping forward to support the grief of our patients and co-workers alike.

As we take stock of masks, gloves, and ventilators, we must also be ready to dig deep into our reserves of patience, communication, and compassion.

– Nathan Gray, MD
via The Ink Vessel
March 18, 2020

Related Off-site Links:
In Pandemic, Health Care Chaplains Address an “Existential and Spiritual Crisis” – Alejandra Molina (Religion News Service, March 20, 2020).
Hospital Chaplains Bring Hope and Solace to COVID-19 Patients and Staff – Lulu Garcia-Navarro (NPR News, March 29, 2020).
It's Time to Get Serious About End-of-Life Care for High-Risk Coronavirus Patients – Jessica Gold and Shoshana Ungerleider (TIME, March 30, 2020).
Coronavirus: As a Young Doctor in ICU, This Is What Scares Me the Most – ABC News (Australia), March 28, 2020).
Why America Ran Out of Protective Masks — and What Can Be Done About It – German Lopez (Vox, March 27, 2020).
Joe Biden Says Coronavirus’ Impact on Health System Hasn’t Changed His Mind on Medicare for All – Tucker Higgins (CNBC News, March 30, 2020).
Bernie Sanders Just Laid Out a Humane Approach to Dealing with the Coronavirus. Joe Biden Did Not – Miles Kampe=Lassin (In These Times, March 16, 2020)
Doctors Seek Ethical Framework for Prioritizing Resources and Patients Amid Coronavirus Pandemic – Ruby Cornish (ABC News, March 31, 2020).
COVID-19 Model: Minnesota Saving Tens of Thousands of Lives by Staying Home – Dave Orrick (Pioneer Press, March 31, 2020).

UPDATES: Overwhelmed Hospitals Face a New Crisis: Staffing Firms Are Cutting Their Doctors’ Hours and Pay – Isaac Arnsdorf (ProPublica, April 3, 2020).
Albert Camus Helps Us Understand Our Responses During This Crisis – Dave Hage (Star Tribune, April 3, 2020).
The U.S. Was Beset by Denial and Dysfunction as the Coronavirus Raged – Yasmeen Abutaleb, Josh Dawsey, Ellen Nakashima and Greg Miller (The Washington Post, April 4, 2020).

See also the previous Wild Reed posts:
• Hope and Beauty in the Midst of the Global Coronavirus Pandemic
• A Prayer in Times of a Pandemic
• Marianne Williamson: In the Midst of This “Heartbreaking” Pandemic, It's Okay to Be Heartbroken
• Quote of the Day – March 17, 2020
• In the Midst of Crisis, Learning Resistance and Vision-Seeking from the Indigenous and African-American Experience
• An Infectious Disease Specialist Weighs-in on Covid-19
• A Prayer for the Present Moment

Images: Michael J. Bayly.