Karen Brannon, director of spiritual care at SCL-Saint Vincent, stands in the hospital’s garden area. (Photo by Darrell Ehrlick of the Daily Montanan)
Sometimes, Jesus sounds a lot like Elvis Presley.
More specifically, like Elvis’ “Blue Christmas.”
Spiritual Care Director Karen Brannon at St. Vincent Healthcare in Billings remembers providing a different kind of spiritual care to a patient who was hospitalized in intensive care with COVID-19. The patient loved Christmas music and Elvis, but during the holidays was isolated in a hospital bed.
Brannon found a way to pipe in Elvis with a CD player and ironclad will.
“One of the staff members asked if I had earplugs so they wouldn’t have to listen to Elvis all day,” she said.
That’s what spiritual care and being a chaplain means in the time of COVID.
The disease has changed how chaplains across healthcare have done their job and, at times, even who they minister to, but the mission is still the same: Take care of the spiritual needs while the medical staff attend to body.
Most of the time, in life-threatening or trauma cases, Brannon and other chaplains are there to support families who gather around loved ones. But with COVID, patients are in quarantine, and chaplains are helping take the place of families. They’re also supporting overworked, stressed and exhausted medical staff who have been battling on the frontlines of the disease for nearly a year.
“For our staff, it hasn’t been a problem working around death because we do that normally,” said Rev. Karl Guhn, who is the director of spiritual care at St. John’s United in Billings. St. John’s is the largest senior living community in Montana with campuses across the state, as well as skilled nursing facilities, assisted-living centers and senior housing projects. ”The staff has struggled with isolation — no visitation, not being able to move around during quarantining, and not seeing their own family members in order to keep everyone safe.”
He said medical staff working where people live creates a special bond like family that has been broken at times.
Communal dining doesn’t happen anymore, and family visits have been limited. Even religious services, which can still be broadcast directly into resident rooms, have changed. Gone are the communion chalice and loaf of bread for Christian communion, and in their place, a single serving of wine with attached wafer, some a fraction of a size of a stamp.
“Staff are afraid, too: Will they give it to their family?” Guhn said.
He knows. He had COVID and had to quarantine. Though he got it from outside the facility and his symptoms were mostly mild, he wondered, worried and was separated from residents and colleagues.
He’s also seen the ravages of the disease. Recently, during a night shift, two people died of complications related to the disease. He donned personal protective equipment as he went to be present in one room, then took it off, and was called to another room, where he repeated the procedure. When he went home that night — or early morning — he stripped in the garage and went into a shower to protect his family.
Initially, when COVID struck and patients started coming in, even less was known about the novel coronavirus.
“Initially it was devastating because we had patients who were experiencing end of life with staff members instead of family,” Brannon said.
Slowly, as the disease became better understood and healthcare centers established protocols, individual family members with PPE could have limited visits. Brannon said that helped, but the barriers remain. For example, one Roman Catholic rite, anointing of the sick, cannot be done without touching the patient.
Other challenges still remain. Telling families coming to visit ill loved ones that they’ll be limited to just one person, or that they may be prohibited in some cases, is difficult and stressful.
For guest services at front-desk entrances, security personnel and chaplains, they deliver tough news when families are already stressed.
“It’s all day, every day,” Brannon said.
When patient conditions turn toward death, that stress is magnified.
“You want to say goodbye. If the relationship is broken or if there are young kids, it’s really tough,” Brannon said.
Technology like cell phones and apps like Zoom have helped. Early on, chaplains took hold of technology to connect patients with their families.
Sometimes, Brannon has to provide support to family members who are shocked to see a loved one they haven’t seen in months, whose condition has deteriorated severely.
“Maybe they’ve been quarantining, and then they got COVID and declined. The last time the family saw them face to face, they looked different and were healthy, and now they’re facing them in a hospital bed, weeks or months later, when they’re critical,” Brannon said.
Sometimes, chaplains during COVID are present for staff as much as they are for patients.
Guhn said that concerns about the staff are shared almost daily. Brannon said that she and other chaplains make the rounds as much to check on staff as patients.
“For our staff, it’s been more intensive during this time of COVID,” Guhn said. “Crises or stuff that staff might have faced in other times of our lives might have been manageable, but because of this are inflated because staff members can’t access their own support systems.
“They can’t just go and talk to Mom. Whatever the issue, it’s just exacerbated.”
That’s redoubled St. John’s approach to employee assistance programs. The organization also has a small help fund for staff when there’s “too much month left at the end of money.”
Yet, even in the times of stress, the staff, Guhn said, continues to show unprecedented generosity even as they’ve become exhausted. For example, a program to help staff members’ families provide Christmas gifts had more volunteers wanting to help than need.
“We haven’t ever seen that response,” Guhn said. “We actually didn’t have enough families in need. People were generous with their time and money and they were generous to each other.”
One of the things chaplains say they’re most worried about is that unresolved issues that come with being isolated for a long time or not being able to say final goodbyes.
“What I fear is the delaying of loss or grieving — that we will have a backlash of delayed grief,” Brannon said. “We didn’t get to see them, and we didn’t get to gather.”
She said as patients die, chaplains often have small prayer services around the bed or brief memorials. That’s not just done for the families, but also for the staff, she said.
“We do that so that the staff, who often stands in place for their family during this time, have some closure, too, “ Brannon said.
At St. John’s United, the disease has meant huge changes for staff and residents who stay in long-term care, assisted-living or even senior living.
The organization has a practice that no patient or resident dies alone. Staff and volunteers provide vigils and their presence in the final hours. However, with COVID, quarantines and lockdowns on the large campus in west Billings, the disease has required modifications for everyone. Guhn said, like other healthcare centers, St. John’s is making accommodations for family members.
“This sounds really odd, but we do death really well here at St.John’s,” Guhn said.
Because it’s a facility that has a wide range of residents almost entirely older, and because they have a hospice program, death is not foreign or necessarily surprising, Guhn said.
“We are attentive to death. We don’t avoid it. We don’t flee,” Guhn said. “We are willing to talk about it with the loved ones or the ones who are lucid and want to talk about it.”
Brannon said that many still have an outdated understanding of what chaplains do — that they’re there to evangelize or proselytize.
“We bear witness. We bear witness to pain and suffering and acknowledge that,” she said. “We are present, and hopefully we support by our presence. Whether it’s listening, praying or talking, it doesn’t matter just as long as we’re here.”
But the dynamic has changed.
Typically, chaplains are with families, and those same families are grateful because they’ve been present throughout the entire healthcare process. But COVID has changed that as families get updates on the phone or may get a video conference.
“They’re angry at us. Typically they’re present and they see it all happen and they see how hard medical staff have tried,” Brannon said. “But if you’re not there, you don’t know. And they’re frustrated because their loved one passed alone.”
In the anger, the hurt, the frustration, and occasional gratitude, Brannon said she and her staff can’t “phone it in.” Presence is the purpose.
And when it came time to answer the question about where God is during COVID, she paused.
“He was before it, above it, behind it and around it,” Brannon said. “He is in the midst of it.”
Guhn uses another Biblical reference when he talks about his job — the one of Moses and the burning bush. He feels like Moses, even though he wears shoes through the corridors of St. John’s and Mission Ridge. Theologically, he’s barefoot.
“All ground here is sacred ground,” he said. “We sit with folks in joy and pain. God’s already present. I am not taking anything into the room that’s not already there.”
One of the aspects that’s been particularly difficult is how COVID strikes the body, Brannon said. Because it often targets the respiratory tract, patients often fight to breathe.
“They’re unable to speak because their main struggle is breath,” Brannon said.
That’s frightening for the patient and for chaplains who watch as the most basic human activity becomes nearly impossible.
“Breathe — it’s the first thing we do and the last thing we do in life,” Brannon said.
Breath — it was also the first thing that God does in the creation story as he creates humans. Breath is also closely linked in theology to the spirit. For Brannon and her peers, watching patients struggle with the disease reminds them that our physical struggles aren’t separate from the spiritual ones.
“There’s so much existential suffering with this. When family members watch as their loved ones can’t breathe and there’s nothing else we can do,” Brannon said.
In those moments, chaplains have to hold the hardest conversations with families about the end of life.
“We have to explain that we have to let them go because their bodies can’t do and we have maxed out what we can do,” Brannon said. “That’s the thing as a chaplain. We used to have those conversations maybe four to 10 times a month — max. Now, we have it four to 10 times a week. Sometimes, there are four or five deaths per shift.”
For others who have to live with the confines of COVID, the social isolation – not the illness – can pose its own serious challenge.
“Isolation for the elderly has caused a failure to thrive,” Guhn said.
Residents don’t eat together, don’t interact, and soon they stop eating altogether.
“Now, when we see it beginning to develop, we almost immediately look for a compassionate visit from family or a friend. We’ll make sure it can happen. And we almost always see a turnaround even from one visit,” Guhn said.
Staff have gotten creative about trying to bridge the social distance. For example, some residents play “Hallway bingo” — sitting in their doorways with a bingo card, being able to hear the numbers and letters, and see friends they haven’t seen even though they live just a wall apart.
During Thanksgiving, TV trays went up in some sections so that residents could dine together, even if in doorways, but closer.
For these chaplains, even if COVID dissipates with vaccines, the stories and the memories of the heartbreak are something they say they’ll bear witness to.
Brannon remembers one man who could not see his wife of more than 50 years because she was in isolation with COVID. Even though he could not see her, he sat in the parking lot every day — just to be close. When it was clear she wouldn’t survive COVID, he was allowed to see her for one final goodbye.
Brannon said she’ll never forget his words.
“He said, ‘You’re my life, and you leaving will leave a huge hole in it. But I am so happy for you. You’re going to paradise. Remember, I am not far behind.”
Editor’s disclosure: Darrell Ehrlick is a board member of St. John’s United’s Foundation.
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