As a young girl, one of my favorite books was “Love in the times of Cholera” by Nobel Prize winner of Literature, Gabriel Garcia Marquez. “Love in the times of Cholera” is a romance novel that takes place in Barranquilla in the middle of the 1900s when a Cholerae pandemic killed 20,000 people in Colombia (Quevedo Velez, 2017). Garcia Marquez masterfully narrates the lives of ordinary people in their attempt to live and love while fearing to die from dehydration and shock. Fast forward to 2020 and I can’t stop thinking about “Love in the times of Cholera” and how it applies to my experience working as a hospice nurse during the times of Covid19. I’m one of the ordinary people Garcia Marquez talks about in his book, I’m attempting to live and love while fearing Covid19.

At home, a lot has changed, I have become a schoolteacher to my children and a counselor to family members who are afraid of contagion.  At work, I follow strict guidelines to keep patients, colleagues, my family and myself safe. We have kept the virus out of the facility by limiting the number of visitors. Family members are not allowed to visit their loved ones unless they’re actively dying. Actively dying means the patient is unconscious. The patient may be able to hear what’s been said to him (at times) however, he is no longer able to interact. No end of life reminiscing, no cultural practices to support the dying patients and families, no forgiveness conversations, no I-love-yous, no goodbyes. We have been successful keeping “good deaths” out of our facility.

According to Abd, Fearday and Safdar (2010) patients in isolation precautions have a higher incidence of depression, anxiety, fear, anger, hostility and loneliness. Due to Covid19 restrictions, regardless if the patients were positive or negative, they were kept in isolation and only essential personnel was allowed into their rooms. No chaplains, social workers, visiting volunteers could visit patients. One facility resident stated, “I don’t have any physical symptoms, I just feel very lonely.” Nursing staff was unable to provide comfort to patients hoping for companion. Nurses felt over-worked, scared about the unknown, and many of them unable to cope with the number of new guidelines and responsibilities presented to them in a daily basis.  

Although nursing staff knew patients were suffering and were craving physical contact, they couldn’t provide assistance due to isolation guidelines. Nurses were distressed having to tell patients they couldn’t hug patients anymore, and one nurse was concerned because her patient with hearing deficit couldn’t see her mouth due to the mask which increased the patient’s inability to read the nurse’s lips and increased the patient’s feelings of isolation.

Due to the restrictions, families could only see their dying family members through windows or through the use of technology such as tablets and cell phones. Unfortunately, technology did very little for patients’ needs of human touch, hugs, kisses, physical contact. Family and patient were reunited in the parking lot only after the patient’s passing. Family members wailed and nurses suffered but no displays of emotional support were allowed.   

Nurses began to advocate for clearer COVID19 guidelines, improved nurse to patient ratio and availability of protective personnel equipment. Hourly rounding was increased. Nurses advocated for themselves and made sure every nurse felt supported, and many of them worked overtime to cover open shifts. No positive Covid19 patients were ever transferred to the hospice facility only suspected cases. No nursing staff has tested positive for Covid19.

Nursing staff supports isolation guidelines however, they understand it’s very important to consider dying patients’ special needs and family needs. Patients are dying alone, and families are distressed about their inability to be present, provide comfort and physical interaction during loved ones last days of life.