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For the dying and their loved ones, the pandemic has changed the process of death and grieving

Valley News Staff Writer
Published: 4/3/2021 9:38:32 PM
Modified: 4/5/2021 11:57:33 AM

CLAREMONT — After Natalia “Natasha” Brodeur died in a collision with a truck on Interstate 91 in late January 2020, friends and loved ones gathered to mourn her loss at the Holy Resurrection Orthodox Church.

“Being together was just such a powerful experience,” Irene Kacandes, Brodeur’s friend and a fellow congregant at the church on Sullivan Street in Claremont, said in an interview last week via Zoom. It was “such a way to honor her, but also to wrap our minds around ‘What does death really mean?’ ”

The funeral for Brodeur, a 56-year-old registered nurse from Claremont who worked at the White River Junction VA Medical Center, was the last the congregation held before the COVID-19 pandemic, which hit the Upper Valley shortly thereafter, Kacandes said.

The “church has not been packed in that way since,” said Kacandes, who lives in Lebanon and teaches German studies and comparative literature at Dartmouth College.

As the pandemic increased the number of deaths in the Twin States and beyond, it also has reshaped the way people experience death, dying and grief, increasing fear and isolation for some in their final days and for others coping with loss.

There were 6,177 deaths in Vermont last year, up 520, or more than 9%, from the year before. Similarly, in New Hampshire, which has more than twice the population of Vermont, there were 13,510 deaths in 2020, up 1,101, or just under 9%, from the prior year.

Some of these deaths were COVID-19-related — about 150 in Vermont and 812 in New Hampshire — but others were not.

Regardless of the cause of death, the pandemic affected the process, in some cases preventing loved ones from saying final goodbyes and leaving medical providers to act as surrogates or to help families connect via digital device.

“I think that more people have died not surrounded by family,” said Dr. Kathryn Kirkland, the section chief and director of palliative care at Dartmouth-Hitchcock Medical Center, in a video interview last week. During its tightest restrictions, DHMC limited dying patients to two visitors, Kirkland said. Now, since mid-March, dying patients who are negative for COVID-19 are allowed three visitors per day, and they can be different people on different days.

Those limitations have weighed on relatives and health care providers alike, said Gayle Robertson, a chaplain at DHMC: Many hospital workers are exhausted from a “yearlong experience of being surrogates.”

While that experience can lead to a sense of loss, trauma and depletion for workers, it also can inspire creativity, Kirkland said. She hopes stories of facilitating connection or bearing witness to the end of life will be the stories they remember in the future.

In some instances, employees at D-H’s Jack Byrne Center for Palliative & Hospice Care bundled up patients nearing the end of life and rolled their beds outdoors so that families could say goodbye, Robertson said. In other cases, family members gathered outside a loved one’s window or connected via video technology.

For the patient and their families, the time between a terminal diagnosis and death is a time for collecting memories and experiences in conversations with loved ones, Robertson said. It’s a time to say what needs to be said, express love, gratitude and hopes for what happens next whether in the metaphysical sense for the person who is dying or for those who remain.

“Some people haven’t been able to do that,” Robertson said. “There’s a loss of a very special time of life for them.”

Increased demand

Demand for bereavement groups run by the New London-based Lake Sunapee Region VNA & Hospice has increased during the pandemic, said Cinnamon Blomquist, one of the organization’s spiritual care coordinators. The organization, which moved the sessions online, had so much interest that it added two new groups, Blomquist said.

“It kind of works well to do bereavement virtually,” she said. “Because people get to be in the comfort of their home, (it) doesn’t take that emotional energy to go out and be with people.”

She said she thinks the increased demand for bereavement support will continue into the future.

“I feel like we’re only scratching the surface of the need,” she said.

Many of the people in the group simply want the opportunity to share memories of their loved ones.

“Other friends and family don’t know how to engage that,” she said. “They just really benefit from sharing things.”

Most hospitals and long-term care facilities have reopened to visitors, especially at the end of life, in recent weeks. But when families come in to see a dying loved one after months apart, it can be jarring to see the physical and mental changes wrought by the pandemic and related isolation, said Cynthia Stadler, a nurse and community liaison for the hospice arm of Bayada Home Health Care’s Norwich office.

“By the time the family gets there, they’re seeing a completely different person,” Stadler said.

Blomquist said that some family members have been afraid to visit their dying loved ones for fear of bringing COVID-19 with them.

“Even though the patient may just have months to live, the family members don’t want to be the one to cause their death,” Blomquist said.

Adaptations to the pandemic have brought people together in new ways, however. Stadler said Bayada’s annual “Hope for the Holidays” event honoring people who have died in the past year is normally held in person at the Norwich Inn, but last December it was held virtually, and the number of participants doubled.

“People from all over the country could come and share and speak,” Stadler said. “It was powerful.”

The human touch

One thing that cannot happen via Zoom is touch. Being limited in her ability to get to know and hug “the people who love the patient,” Kirkland said, “has been huge for me.”

Because of that ongoing need for touch for those who are ill or dying, the Cornish-based The Hand to Heart Project — which offers massage to people with life-threatening cancer and their caregivers — has expanded its territory amid the pandemic, said Steve Gordon, the organization’s executive director. In addition to the Upper Valley, Hand to Heart now also serves part of southwestern Vermont and the Keene, N.H., area, and is working to expand to Brattleboro, Vt., he said.

Early on in the pandemic some patients asked the massage therapists to stop coming, but Gordon said some have since asked them to return.

Gordon, who co-authored the bookLet’s Talk About Death: Asking the Questions that Profoundly Change the Way We Live and Die with Kacandes in 2015, said that coming to terms with a life-threatening cancer diagnosis and undergoing necessary treatment such as radiation and chemotherapy is “horrific anyway,” but doing so in isolation adds stress to an already challenging situation.

It “has made things much harder on a lot of people,” Gordon said.

Both Gordon and Kacandes said they hope one effect of the increase in death amid the pandemic would be to spur more conversations between loved ones about their own mortality in advance of a health crisis.

“Imagine that you are going to be more isolated than you expected,” Gordon said. “If you’ve already had some of these conversations, maybe the groundwork is done to deal with the crisis.”

For Kacandes, the value of touch extends beyond life. She is a member of a group at her church that in normal times cares for the bodies of church members who have recently died by washing and anointing them.

“For a long time, I have been convinced that literally being with the dead is very, very important,” she said.

The group was able to tend to Brodeur’s body in that way, but that work has been put on hold during the pandemic, Kacandes said.

“I hope one day we can get back to more of us doing that,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

Correction
Dr. Kathryn Kirkland is the section chief and director of palliative care at Dar tmouth-Hitchcock Medical Center. An earlier version of this story misstated her first name.




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