By Larry Beresford
When New York City became the epicenter of the United States’ COVID-19 infections this spring, Rabbi Edith Meyerson DMin, BCC, of Mount Sinai Health System found herself facing a nearly insurmountable challenge: Attending to the grieving.
As Associate Director of Pastoral Counseling and Bereavement Services at Lilian and Benjamin Hertzberg Palliative Care Institute at Mount Sinai’s Icahn School of Medicine, Meyerson and her team typically support patients and families on the health system’s renowned palliative care service.
The scale and nature of the COVID-19 crisis, however, required an emergency palliative care response. Mount Sinai quickly created an innovative telephonic support line, called the 24-7 PAlliaTive Care Help or PATCH-24, to share palliative care expertise and assistance across the health system.
The program launched March 26. Over the next 4 weeks – the height of New York’s coronavirus outbreak – PATCH-24 would handle roughly 873 cases.
The initial idea was to provide telephonic palliative care coaching for emergency department and ICU clinicians seeing COVID patients. As those departments became overwhelmed, however, the program quickly transformed into a telemedicine support system for families of COVID-19 patients.
When Isolation Adds Extra Layer of Grief
Bereavement fell under that umbrella. Meyerson supervised an army of volunteer chaplains, chaplaincy trainees, and other team members who trained quickly to make initial bereavement calls to families whose loved ones had died from the virus.
The isolation and separation those families experienced exacerbated their grief, Meyerson said.
“I had a group of volunteer chaplains who were no longer able to physically come to the hospital, so we had to be creative at finding ways for them step into telephonic support roles,” she said. “And there was a deep need for family members to (talk with) one of our providers because the family wasn’t able to be physically present (at the time of death).”
On those phone calls, the chaplains offered space for people to express their grief, to cry, and to tell their loved one’s story to someone who hadn’t heard it.
“We facilitated some deeply emotional family meetings on Zoom, with tears flowing down – you could feel the family’s pain through the screen,” Meyerson said. “Yet at the end of the conversation they would say: ‘Thank you so much for being there and for taking care of my loved one.’”
To hear them express gratitude was very humbling, Meyerson said.
Supporting Front-Line Workers
In areas with a high number of COVID-19 cases and deaths, healthcare workers can experience tremendous strain and trauma. Support and self-care is critical.
During the New York outbreak, Meyerson coordinated staff support groups up to several times a week on Zoom, in collaboration with the department’s social work team.
“Sometimes a staff member would reach out to me and say they were worried about a co-worker under the strain of so many deaths,” she recalled. “I’d offer the support so they could continue to do the work that was needed.
“In those moments there was a reminder of where we were in this epidemic,” Meyerson said. “Some of our staff had been separated from their own families. The pain of their isolation needed to be witnessed.”
“Everyone stepped up to do the best they could in this pandemic, but they needed their experience to be acknowledged,” she added. “It needed to be blessed and held up as sacred. Doing that was very powerful and, in a way, healing.”
Under typical circumstances, Mount Sinai’s bereavement service supports families whose loved ones are enrolled in the palliative care service. When a patient on the service dies, the bereavement team makes condolence calls to the family, sends a hand-written card and a booklet of grief information, and offers short-term counseling if needed.
But Meyerson, who has a doctorate in pastoral counseling and board certification in chaplaincy, said attending to grief is an integral part of palliative care at every stage of illness.
“So much of our work of palliative care is helping people to prepare for an impending loss, change or adjustment,” Meyerson said. “It’s not only in the context of death, but also loss of identity, ability or independence. The process of anticipatory grief includes starting to say goodbyes and experiencing all of the layers of that loss.”
She said all health professionals need some level of palliative care and bereavement training, which can help them identify when specialized services are needed.