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Spiritual Care for Critically Ill Patients

Dr. Safiyyah Ally: You have had a close-up view of patients who are suffering during COVID and also healthcare workers, so I thought it would be interesting for you to tell us a little bit about your work.

Sadaf Jamal: Yes, I am a spiritual care provider and a registered psychotherapist, and I just recently graduated from the University of Toronto with a Master’s degree in Spiritual Care and Psychotherapy. I have had internships at many hospitals and private clinic sites. Currently, I'm working at William Osler Health Systems, Brampton Civic Hospital, and also I have worked at Heart House Hospice, so I have some experience working for patients and clients, providing grief therapy, and bereavement support during the pandemic.

Dr. Safiyyah: Everybody's experiencing the after-effects of COVID in terms of loneliness, anxiety, and stress. However, I'm guessing that patients have very unique challenges. Can you tell us a bit about some of those challenges?

Sadaf: Yes, it was very challenging when the pandemic started. When I was working at Heart House, everything went online, and for some clients online was not as effective as it was in person, so it was a lot of adjustment on their part as well as on our side because it was a new way of working. People were unable to visit their family members at the hospital. There was a lot of fear, loneliness, despair, and patients who were missing their family members. Elderly patients especially didn't like the shift to online and Zoom visits. It was a challenging time and there was a lot of fear among people about not being able to see their loved ones at the end of their life.

Dr. Safiyyah: I guess one of the biggest fears people have is dying alone and during COVID, that was very prominent.

Sadaf: That was real and nobody wants that.

It was a very fearful time. People truly felt what loneliness is like.

Dr. Safiyyah: There is this image that is circulating in the papers and on the news of a nurse holding a cell phone, and there's a pastor, priest, rabbi, or an imam on the other end offering advice or blessings to the person who is sick. In some ways that's great, but in other ways it's hard.

Sadaf: Yes, it was accessible. You could meet family and friends and healthcare providers, but it was very challenging for people to only be able to see their loved ones through a screen. There were a lot of requests for in-person support, but healthcare providers were also feeling helpless. They had to follow protocols and proper physical distancing, which was very challenging. I want to give a shout-out to all the healthcare providers who went through that time and supported patients and staff and everybody else involved. Everybody had their own families too and it was very challenging for nurses to provide that care for patients and also be there for their own family members.

Dr. Safiyyah: For healthcare workers, we don't often think of them needing support too, but I understand from you that you are also treating and dealing with healthcare workers.

Sadaf: Yes, I provide staff support at William Osler, but it's one thing to just talk about it as opposed to going through it and experiencing all the hardships.

Dr. Safiyyah: What are some of their concerns? What are they saying?

Sadaf: When you are in the hospital, it's not that simple. When you say you have to provide care while having PPE on is very challenging. With your mask, shield, gloves, and gown on, it’s very hard. Sometimes you have to stay in PPE for most of your shift. You can't eat and even going to the bathroom is very hard. That is just one basic challenge. On top of that, some patients are desperate to meet their family members and providing that firsthand emotional support to the patient on top of the physical support was very challenging for nurses and other staff members.

Dr. Safiyyah: I suppose they had to play the bad cop sometimes and say things like, "No, you can't come and visit your loved one."

Sadaf: Yes, and they had to hear a lot from patients too. You have these patients and then you go home to your family.

Dr. Safiyyah: The patients' families are probably complaining and arguing with them as well.

Sadaf: That was a very stressful time for people. Some people had this flexibility and ease of staying home and working from home. However, frontline workers didn't have that option.

Dr. Safiyyah: There were also limited resources. There was always this fear that you have to triage a patient and that you may have to take them off machines because others need them. These are some ethical dilemmas that they would have to deal with.

Sadaf: Yes, the ethics department was really busy during the pandemic as well as the spiritual health therapy department.

Dr. Safiyyah: What sort of spiritual care do you think was needed and you offered to the patients, their families, and healthcare workers?

Sadaf: Spiritual care is providing emotional support to people who are experiencing a lot of fear, anxiety, anger, and guilt. There was a lot of guilt. The staff, patients, and the family members of the patients were overwhelmed with the question of if they were good people. For instance, “Am I a good daughter or a good son? Am I there for my family member, for my loved one? Am I doing the right thing? I'm not even able to visit them. They're battling everything by themselves.” There was a lot of spiritual distress among patients and staff. Spiritual care is to provide emotional and spiritual support to people. They re-discover and explore their sense of identity, their purpose, and meaning in life and they look at new ways of forming connections. New ways of forming connections were through a screen those days. It wasn't something that people were used to. Yes, people used to FaceTime all the time, but would that be the only way of communication? People didn't know that. That was a new way of communicating and supporting them, holding space for them so they know how to deal with these emotions of loneliness, fear, and anger. That is part of being a spiritual care provider.

Dr. Safiyyah: Do you think that there will be long-term consequences to the trauma that people experienced during COVID?

Sadaf: I wished I could say that no, but yes. People have been shaken up by what has happened. There has been a lot of trauma that people carry. Many people lost their family members and they weren't able to do proper burial or the last rites of the deceased, and that's a guilt that many people were carrying. Among some cultural and faith groups, they couldn't offer proper funeral prayers. That's also causing a lot of spiritual distress among people. At home, kids couldn't socialize, or meet their friends, and many mothers were doing online schooling and if they were working, they had their work and kids, essentially homeschooling their children. A lot of people also lost their jobs. There's a lot of grief that is out there because of this pandemic and it is going to take some time to recover from all of that.

Dr. Safiyyah: I understand that you were donning all of the PPE outfits and you were going with masks and full gear. So, you've experienced some of that as well. How are you coping with that?

Sadaf: I didn't start with William Osler at the height of the pandemic, but I was there. It was difficult to talk to patients through a mask or a screen, but you have to get used to it. You have to find that courage. I searched for meaning and purpose in my work and it helped me redefine my intention and it made my work more meaningful to me. I'm grateful that this experience helped me discover my own emotional strength. I figured out that I was capable of doing more than I thought I could. So I'm grateful for that.

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