Coronavirus requires physical distance in end-of-life care. But we won't let isolation prevail.

My job often involves using proximity to bring comfort. Seeing how we forge deep human connections despite the current restrictions is deeply encouraging.
Illustration of minister standing over dying man.
At our best, hospital chaplains enhance a patient’s sense of meaning and their connection to others. Both begin with our own physical proximity to them.Anuj Shrestha / for NBC News
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By Rev. Thomas Ryberg

Hospital chaplains are given the sacred task of attending to the emotional and spiritual aspects of healing. The institutions in which we serve are often state-of-the-art, using methods and technology reflecting the best-available scientific knowledge, which is constantly being refined for deeper insight and better results.

In contrast to the rushing, innovative system around us, the work of hospital chaplains can seem ancient and quaint: We go spend time with someone who needs company. We listen to them, offer encouragement and provide spiritual support. But, mostly, we bear witness to their stories, their needs and their truths. When possible, we support a patient’s loved ones as well.

It’s basic stuff, and it can be deeply beneficial to physical and emotional healing.

Like the rest of the staff at a hospital — and the rest of society — COVID-19 has thrown a wrench into the way we like to do things. At our best, chaplains are workers who enhance a patient’s sense of meaning and their connection to others. Both begin with our own physical proximity to them, and that continues as we join with families and loved ones at a patient’s bedside. Particularly when someone is dying, it feels tremendously important that their loved ones are able to bear witness to their passing and to say goodbye. Gathering with family at a bedside is a most important practice of hospital chaplaincy.

But the risks of transmitting the coronavirus has forced us into new rhythms, changing whether and how we gather with those who are infected. In hospitals all over the country, protecting visitors and staff from the virus now depends on severely limiting in-person contact with all patients. Those restrictions can leave patients who may already be hurting and frightened with the additional burden of being separated from their loved ones, which can be profoundly lonely and painful.

Humans, you see, are social creatures; we need each other to survive and COVID-19 threatens our basic need for connection. Because it is highly contagious and spreads so easily through our contact and proximity with other humans, it turns our desire to be together into a risk factor. “Social distancing” becomes a necessary strategy for survival, but it comes with a high cost: when we can’t be in physical space together, connection is harder and isolation can follow.

As an illness alone, COVID-19 is awful. It attacks the respiratory system, causing a quick onset of inflammation and mucus buildup in the lungs. Those who become sickest go into acute respiratory distress, requiring the use of a ventilator and extensive medical treatment in an intensive care unit.

In facilities that have the capacity, the sickest individuals who are infected with the coronavirus must recuperate in isolation. Where I work, patients are separated by glass walls, a fishbowl feature of ICUs that allows medical staff to observe a patient’s status while minimizing physical contact with them. When staff — including chaplains — do enter the room, we gown up in plastic, don two pairs of gloves, cover our faces with masks and shields and cover our hair, looking more like we’re heading into a nuclear waste site than into a room with a human in need of care.

My heart hurts pondering how scary it must feel to be ministered to in this way.

In New York state, some patients are also receiving treatment in hospitals that are hours away from their homes and loved ones, increasing the stress of the already-necessary physical distancing. We yearn to be with and offer support to the healing process of our loved ones. And, especially if that should become a dying process, we want to feel closely connected to each other as we say goodbye, comfort each other and mourn. But COVID-19 has made it impossible in many instances to do so in person.

Knowing that connection is so fundamental to our wellness, we are all now asking how we can protect ourselves from this virus while also protecting ourselves from isolation. In our hospitals and beyond, we are all being challenged to find ways to strengthen our connections to each other while simultaneously scaling back most forms of physical contact.

I join those who prefer to say “physical distancing” rather than “social distancing,” because I am not ready to concede that social connection is lost to the coronavirus. Far from lost, social connection remains essential to our wellbeing. Even in these most challenging circumstances, I am humbled every day by the combination of skill and heart brought by my colleagues at the hospital. It is sometimes breathtaking the way that life is uplifted and our human connection to one another is able to flower even in the bleakest of circumstances.

I have been awed by a team of medical student volunteers here, who made it possible for patients and their far-away loved ones to easily connect over video, even in the ICU. I have been encouraged to witness the efforts of social workers and case managers to keep far-away family members updated on their loved-ones’ progress.

Even at patients' time of dying, I have tearfully beheld the gentle care given by nurses who gown up and tend to the final moments of their patients with soothing words, song and touch. Paradoxically, when we accompany one another to the point of death, life itself is affirmed. One ICU nurse put it this way: “I’m present with them. I’m in the moment with them so that they are not alone.”

Connection in the age of COVID-19 sometimes looks different than it used to, but essential connection remains not only vital but possible. The caregivers in your community know this in our bones, and we are developing ways of meeting this need in real-time.

We are honored to serve you and your loved ones even in the hardest moments, and whatever adaptation becomes required of us in the time ahead, we will never allow isolation to carry the day.