How COVID-19 changed not only our way of life, but our way of death

Business was booming for Cari Hays over the past couple years, though she took no joy in it. Hays is the funeral director at Lafferty & Smith Colonial Chapel, a business that has been honoring Santa Rosa’s dead since 1886.

Hays was drawn to her profession for reasons that would sound familiar to anyone who works with the dying, or the grieving. Empathetic by nature, she believes she can bring a moment of comfort to people staring down the last, and most difficult, stretch of life. But the realities of the COVID-19 pandemic, and the government health orders meant to mitigate it, made her task harder in many ways.

For much of the pandemic, funeral gatherings could include no more than 10 people, and open caskets were prohibited. Mormon elders weren’t allowed to dress a body. Buddhists couldn’t attend ceremonial cremation. People raised in cultures that emphasize physical contact weren’t able to touch the cheek of a departed grandparent.

“How is your job to help somebody and to say no to them at the same time?” Hays wondered aloud. “You can’t do this, you can’t do that, you can’t do this. I mean, that’s a lot of nos for someone who really, really, really wants to give you what you need.”

Life changed in profound ways in the two years (and counting) of COVID. But so did death. Those who work on the front lines of the field had to absorb, adapt and compromise.

And most of them got a lot busier.

According to county figures, there were 294 more deaths in Sonoma County in 2020 than would have been expected from the average from 2017-19 — a leap of more than 7%. Officials don’t have complete data for 2021 yet. But considering the first winter surge tapered in late January 2021 and the winter omicron surge began in December, it’s likely that calendar year will end up with a similarly painful number.

During peaks of the pandemic, it felt overwhelming.

Audrey Munson had worked for a couple years as a float pool nurse at Santa Rosa Memorial, meaning she filled gaps all over the hospital and was usually spared the most intense assignments. That changed March 20, 2020, when the SARS-CoV-2 virus began to pick up steam and Providence Health converted a pediatric unit at Memorial to a COVID ward.

“They threw me and a couple other girls into a lead nurse position for the first time,” Munson recalled, “and kind of said, ‘Here’s this pandemic, we believe in you and call us if you need help. And you’ll be fine.’”

Providence did offer “amazing” free therapy to its nurses, Munson acknowledged. But it wasn’t always fine. Especially during the winter of 2020-21.

“Our unit was completely packed,” Munson said.

‘The saddest thing I’ve ever done ...’

The peak daily census among coronavirus patients at Memorial during the 2020-21 winter surge was 32, a Providence representative said. During omicron, it was 48, though fewer were gravely ill.

With families prevented from visiting the hospital, COVID-19 nurses wound up being vital intermediaries, arranging gut-wrenching conversations via iPad or cell phone.

“We got so attached to these people, talking to patients’ wives and children on the phone,” Munson said. “And one day the patient would be doing great. Like I’d be saying, ‘I think they might go home in two days. I’ll smuggle in that card you wrote.’ The next day, we’d come in to relieve the night shift, and it would be, ‘They coded last night.’”

One scene is particularly ingrained in Munson’s memory. She had a faltering patient who was breathing through a BiPaP mask, a bulky apparatus that fits over the face. His daughter was on a cellphone, saying the big goodbye. But between the BiPaP and the room’s loud ventilation system, they couldn’t hear one another. Munson had to relay messages back and forth.

“The saddest thing I’ve ever done was straight up translating,” she said. “Her telling him she’d be OK, that she would take care of the family. To not only witness these conversations, but to be so intimately involved, is something nurses don’t have to do often.”

The goals have been similar, but the challenges different, for hospice workers.

Hospice over hospitals

For several months after the start of the pandemic, they didn’t see much change to their profession, said Kai Romero, chief medical officer for By the Bay Health, which provides hospice care, home-based palliative care, home health, and a range of bereavement and grief support in five Bay Area counties, including Sonoma. Because while many people were contracting COVID-19, few were dying from it.

That eventually changed, of course.

As fatalities rose and restrictions tightened in the summer of 2020, people began referring seriously ill family members to hospice rather than hospitals, because they wanted a chance to be close to them. At the same time, those being referred by doctors were in steeper decline.

“There was a huge influx of patients, but we had less time to establish relationships,” Romero said. “They declined very quickly, and they died more quickly. So now we had weeks with them, where before it could be months and months.”

Or even years, in the case of Alzheimer’s patients. Hospice workers sometimes become almost like family members to people in memory care, who typically have long slopes of decline. In 2020 and 2021, many of those patients were succumbing to COVID-19.

“When you think about it that way, it’s so sad,” Romero said. “There’s all these people that would have been here. And they’re not.”

Exhausted staff, grieving families

When ICU nurses and hospice workers had exhausted their efforts, it fell to people like Hays to console family members as best they could.

It got tricky as funeral homes had to negotiate what Hays called “the shifting sands” of federal, state and county health regulations. And yes, they were swamped during the surges. Businesses traded PPE and staff and equipment like body bags, and even lent each other a hearse on occasion, Hays said.

“When people say ‘What COVID?’ and I go, ‘We’re at capacity … ,” she said, shaking her head. “When you’re at capacity most days in a month, that’s a lot. That’s not the normal ebb and flow.”

Lafferty & Smith did its best to accommodate mourners and, when required, to serve as a punching bag for their frustrations, Hays said. But she admits she couldn’t provide the same level of care she’d offered before the pandemic. The iconic act of sinking a casket is the example that keeps coming back to her.

“In our mind’s eyes, we have images that we hold onto,” Hays said. “They help us have that closure. So the image we have of this person being alive, and then we don’t see them — if we can’t see it, it makes us not really believe it. It’s just part of grief.”

‘We’re watching people die everyday’

After two years, the funeral industry is getting back to normal, Hays noted. Not so in hospice care, where companies are still seeing high rates of admission and short lengths of stay — with no end in sight.

“The future of health care and medicine for people with serious illness really feels up in the air for me,” Kai Romero said. “I don’t know what comes next, in terms of how we rebuild a robust and gentle landing place for people with serious illness. We may see the impacts for years to come.”

The nursing trade, especially workers in ICUs and emergency departments, also may be in transition. Munson said most of the nurses who started Santa Rosa Memorial’s COVID ward with her have since left for other units, or entirely different jobs.

Munson is standing strong. In fact, she can’t see herself going back to the float pool. She’s too wired for intensity now. Still, she’s just 31. She understands how the pandemic experience might have been too much for older nurses, or those with children.

“For the most part, in nursing you don’t have lot of support,” Munson said. “People see it almost as Florence Nightengale still, where you’re running baths and drawing curtains. But we’re watching people die every day.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.