In hospice, big decisions have to be made quickly

The Rev. Deb Vaughn, left, and Rabbi Yaffa-Shira Sultan Photos used by their permission.

As chaplains, Rabbi Yaffa-Shira Sultan and the Rev. Deb Vaughn offer spiritual and emotional care to those in JSSA Hospice and their families.

For them, working in the midst of COVID-19 is unprecedented. “I’ve never seen anything like this,” says Vaughn. “This is just the unknown of unknowns.”

The pandemic has changed how they work, which had included tools like touch, especially for patients with dementia. That’s impossible now.

“That kind of chaplaincy is a little bit different, because it’s typically about affirming their innate worth in the moment with eye gaze and touch,” says Sultan. “The biggest question for me is, how do I convey all of that at six feet distance.”

Or on video or over the phone.

“We spend a lot of time providing active listening,” says Sultan. “We might pray and recite the Mi Sheberach prayer for healing over FaceTime. Whatever feels pressing to the family in that moment, and a lot of validation, normalization and recognizing that this is a unique time.”

The chaplains have had to create new ways of providing spiritual care. “I’ve learned that I don’t always have to be in person in order to make a difference,” says Sultan.

The chaplains are still visiting patients in person, where the facility allows.

“It’s both supporting the patient’s spiritual needs, but also not bringing anything in with us, nor picking anything else up,” says Sultan. “Many of us have been exposed to COVID using full protective garb.”

Vaughn explains that all staff, including the chaplains, wear masks, face shields, gowns and gloves when visiting any patient. “It’s to protect myself if they have COVID, and it’s to protect them from me if I have it. We know for a fact that people are what we call silent carriers.”

For a typical hospice patient, the chaplains and care team often have weeks or months to care for and connect with the patient and their family. The difference with COVID patients is the pace of things.“Patients with COVID are dying very fast,” says Sultan. “I have patients with COVID who are coming in one day and dying within 24 hours. The speed with which people are coming down with it, and then the surprise change of condition, means that with hospice — we get in there quickly as we normally would — but a person with COVID can turn very quickly.”

For families of the patient, it means less time to process and come to terms that their loved one is at the end of his or her life.

“It’s more immediate in terms of what the family has to decide,” says Vaughn. “Big decisions have to be made quickly. It’s this compressed time for us as an agency, and it’s even more compressed for the family because they’re looking at a whole life that is coming to a quick close that they weren’t anticipating.”

In their work, the chaplains take their cues from the patient on how to use their time together. The patients’ interests, needs and desires can run the gamut: religious prayers and rituals, music therapy, showing photos of grandkids, talking about sports and/or discussing fears and regrets that the patient is only comfortable discussing confidentially with a chaplain.

Despite the challenges, compressed timeline and many unknowns during the pandemic, the chaplains continue to provide this deep spiritual and emotional care, even if it looks different. The compassion of the chaplains, and how they make meaning for people during difficult times, remains constant.

“I’ll stand here and be solid for families so that they can go through whatever grieving they need to go through,” says Sultan. “It’s this desire to see people at peace at the end of their lives.”

Anna Lippe is a Washington writer.

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