#8 Dying Alone must be OK
Published in Doximity Op-Med April 2020
This piece was published near the beginning of the Covid-19 epidemic and I think it deserves another look. Layered on top of the unknown is now what we know. Some of our patients are actually choosing to forego vaccination and placing themselves at potential harm and even death from the highly contagious Delta variant. Family members must still be isolated from their ill and dying relatives. We have to accept this difficult situation.
Published with title: It’s Ok to Die Alone
by Joan Naidorf DO
As the Covid-19 pandemic rages on, it becomes more important than ever to manage our minds and to consciously choose thoughts that serve us. Media attention designed to increase readership and drive clicks has fostered a tremendous wave of fear, scarcity mentality, and anxiety. Worry and anxiety only pretend to be useful and necessary. Awareness and determination to serve our communities produce actions of compassion and protection. Our thoughts about the current pandemic create our feelings which drive our actions and produce our results.
Several opinion pieces featured on major news sites have featured various thoughts about the facts reported from the pandemic. Most of these notions share one thing in common in that they resist the reality of what is happening. Statements like “this shouldn’t have happened” or “we should have been more prepared” do not serve us in the short term. Yes, it is sad that relatively young people are decompensating and dying. Yet even before the Covid-19 pandemic, we know that children and adults die unexpectedly. Thoughts like “young people shouldn’t die” cause an additional layer of pain and suffering on top of the already alarming death toll from the pandemic.
Professionals on the front lines could benefit from understanding this common way our brains operate. Personalization is a cognitive distortion that occurs when we take things personally. We either take too much blame or too much credit for what happens when there is no objective reason to do so. Everyone will die and one of us will inevitably be the last physician, nurse or paramedic who takes care of the dying patient. We must resist the tendency to take on the blame or responsibility for bad outcomes in our patients, particularly during the current pandemic.
One situation getting enormous attention in the media is the fact that many of our patients are, by the necessity of this highly contagious virus, dying unattended by their family or friends. This circumstance draws highly sentimental and passionate responses reflecting the widespread belief that people should not die alone. Families want to be present to comfort the dying as if they could somehow alleviate their suffering. The physical isolation required to minimize the rapid spread of the disease strips away the familiar end of life rituals cherished by many cultures and religions.
This notion that people should not die alone masquerades as a useful and compassionate thought. The belief that loved ones should be with the dying person when they clearly cannot be, is one of the most painful thoughts we can hold on to during this pandemic. It would certainly be wonderful if friends and family could attend the final moments of their loved ones dying of Covid-19. That is not the reality of our current best practices with physical separation recommended to protect the living people left behind. Again, we can resist reality but reality will always win.
I have already seen articles and news segments bemoaning that fact that many ED and ICU physicians and nurses are now the last people holding the hands of dying patients and not their beloved family or friends. One of our colleagues lamented that he was the only person holding the hand of a 93 year old Navajo grandma as she declined intubation and went on to die away from her family. He painfully pondered as to whether she would have wanted her death in this isolated way.
My answer would be: yes, this is exactly the way she would have wanted it and the way it was meant to be. I believe that the Navajo Grandma would never want to make her family sick. Our end-of-life rituals likely serve the living people left behind rather than the dying. I have been present for hundreds of deaths and clearly most people are not even conscious near the end of their lives.
I have so much compassion for third year emergency medicine resident Dr. Kamini Doobay, whose opinion piece was recently published in the New York Times. “So often a patient will be on their deathbed, dying alone, and it’s been incredibly painful to see the suffering of family members who I call from the ICU, hearing the tears, crying with them on the phone," said Doobay, 31. “Too many people are dying alone with absolutely no family around them," she said. “This is one of the most horrific things."
That last sentence there is a thought that we do not have to believe. We do not have to believe that dying alone is a horrific thing. I would like to offer some alternative thoughts that could just as likely be true for our dying Covid-19 patients. I believe that our dying Covid-19 patients would never want to infect their loved ones or their caretakers. Our patients will increasingly die without family members, chaplains, or clergy, and that’s OK. We will be the ones left holding the hands of dying strangers, and that’s the best we can do. Dying alone is not the same thing as dying lonely. The living can continue to feel love and compassion for their dying relatives before, during and after their deaths.
Beating ourselves up about isolating friends and families from the dying only adds a painful layer of suffering to the already difficult reality at hand. Health care workers, children, the immunocompromised and the elderly will die during this pandemic. We can quite appropriately feel the sadness and pain of these losses. Please let us not take on the additional burden of anguish over people dying alone. That extra burden serves no one and makes the pain of grief even worse. Our loved ones will understand that we are doing the best that we can. None of us ever knows when we will die, as this equal-opportunity pathogen so clearly points out to us. Many will die alone and that’s OK. We need to strap on the PPE’s that we’ve got and help our sick patients.
