Lies Scaut and Erik de Soir discuss how Covid-19 has ripped apart traditional ways of saying goodbye to a loved one, mourning and grieving processes, with advice for families and care providers
Since March 18, stricter measures have been in place in Belgium and elsewhere to prevent the spread of Covid-19. Life has been different ever since. Unfortunately, so too is dying. Where we have put a lot of attention into being close with deaths in recent decades, this is now not available.
Visitors are not allowed in hospitals and rest homes, which means that people die alone. They have no time to say goodbye to loved ones, no proximity of close family. Caregivers do what they can to assist dying people, but they also suffer from the circumstances. Watching people die alone affects everyone.
We need to find a different way to connect, to search for the invisible bond, for hearts that are connected, even at a distance.
In this guide we try to offer possibilities that can support the connection in a different way, although it will always be different.
Saying goodbye as a family
Bringing a family member for emergency treatment is very scary these days. You can no longer enter yourself, cannot stay with your loved one and must return home immediately. Then you are waiting for a call with news from the hospital. This may take some time while caregivers do what they can. You hope that everything will be alright and that you can pick up your loved one a few days later. Unfortunately, this is not always the case. People die not only from the consequences of Covid-19 infection, but also from other conditions. There is one thing in common, they usually die alone.
This is an unbearable feeling for you as a family member. In normal circumstances you want to spend these last days and hours together as much as possible. Both you and the dying person need this connection to allow the dying person to go in peace and quiet, as well as to say goodbye with dignity. Focus your attention as much as possible on the invisible connection between two hearts that is always there. Wherever someone is, this connection will always be there. It is the feeling that you can experience when you think of someone very strongly. The itch you feel in your stomach, the warm feeling in your heart, the sign you receive that someone is also thinking of you at the same time.
Saying goodbye from a distance will never be the same. It is looking for rituals and ways of connection that suit you with which you can get in touch with your loved one.
We hereby give you some suggestions:
- If you need to bring a family member to the hospital, you can bring a close family or family photo. Inform the nursing staff about the photo so that they can give it a place in the room. This way everyone is visually present in the room.
- Try to maintain telephone or video contact for as long as possible. However, there will come a time when this is no longer possible.
- Therefore, leave a message on the voicemail of the phone of your loved one so that it can be played in the hospital. You can record a comforting and loving message that your family member can listen to endlessly. Also pass this on to the nursing staff so that they can play it when someone can no longer do it themselves.
- In the period when your loved one is dying, you depend on the personnel. For example, you can ask them to place the photo you provided on the body of your loved one. This can be a photo of the whole family or of the sick person's children and/or grandchildren. Have the nurse to say this so that your loved one knows that you are very close.
- Dare to ask if caregivers still want to take photos, with the smartphone that you leave with the patient, both before and after death. These photos can be helpful at a later stage to reconstruct the last days and hours of your loved one.
- Not only can people be with a dying person impossible, being together as a family also is impossible. Search together for a way of connection that suits you. Leaving the video chat open for a long time without having to constantly sit in front of it can help to be together from a distance. Agree on what you can do in common, such as putting the same photo at the centre of the different families, burning a candle, bringing back memories and sharing in a family chat, etc.
The time may come when the bad news comes that a loved one has passed away. From that moment on, it is important to contact the undertaker and find out what the options are for saying goodbye.
In Belgium, the rules of what is still possible and permitted have been laid down by the FPS Public Health and further elaborated by the Funeral Union of Flanders and the Federation of Funeral Directors.
In general, the following rules apply, although they are often applied differently in practice. Ask the undertaker what is possible. Often there will be a difference depending on whether or not it concerns a Covid-19 infection.
- Home rearing and embalming are no longer allowed. Funeral home visits are possible, but should be kept to a minimum (maximum of five persons for no more than an hour). Keep in mind, however, that at many funeral centres the body of your loved one is immediately placed in a closed coffin so that you may no longer be able to see or touch it.
- If you can still see your loved one, it is recommended not to touch, kiss or hug him/her. You can still do this where the body is covered with clothing or sheets.
- Condolences are only possible online
- The farewell service may last maximum 45 minutes. Only 20 people may be present in Belgium, for example, including the staff. In Wallonia, services may only take place in the open air with a maximum of 15 people present.
- After the service a wake or gathering is no longer allowed.
All these limitations make it almost impossible even for the family itself to experience a farewell together. In normal circumstances, people write texts to picture the deceased. Close family, and friends and colleagues tell their story and show photos. You can still ask them to do this even now. One of the attendees can read the text or the writer can record it via a video message which can be played during the service. Some funeral homes are equipped with livestream technology. If this is not the case, you may be able to provide a live connection yourself so that anyone who wants to can follow the service from home. This creates a connection that is different, but tangible. Knowing that the family and others are following from home provides support and recognition. Have the farewell service recorded on video so that anyone who wants to can watch it afterwards.
Commemorative cards are usually distributed at the end of the service – a lasting memory for those present, something to keep. This ritual has now also disappeared. You can still distribute these at a later time, or send them by post. You can even invite people to return a card with a nice memory of the loved one.
Now that the wake is no longer allowed, everyone returns to their own home after the service. We are not used to this either. The gathering after a service often creates a moment of breathing, digging up memories, sometimes accompanied by a smile. You can do this at home as a family, whether or not connected to the rest of the family or friends via messages, telephone, chat or video calls.
For specific attention to children, I would like to refer to the guide: "Involve children in saying goodbye remotely" which you can find here.
Everything will be different, try to find the best possible for you as a family.
The right environment to say goodbye
In the event of death, your surroundings are often of great importance to families. The support, recognition and compassion you give help them through an emotional period. Now that everyone has to stay at home, physical closeness is not possible. Nevertheless, this support for the family is so important just now. Look at what you see yourself doing to support them from a distance so that the connection remains.
You can place flowers or other symbolic objects at the door or driveway of the family.
Do you live in a street where everyone knows each other? Then you can, for example, place the same picture on the window on the street side so that the family can see that they are being thought of.
Maybe leave food at their doorstep. Ask what you can collect from the shops. Preferably don't send messages like 'If you need something, just let us know', but take the initiative to make concrete proposals, such as: “I'll make a fresh oven dish today and put one on your doorstep as well.”
Connect by daring to ask how things are really going. Don't ask yes-no questions like, “Are you okay?” or, “Did you get some sleep?” Rather ask open questions in which you give the grieving person space to really answer and reflect on their own emotions: “How do you feel today?” “How did you sleep last night?” “How are the children dealing with it?” “What do you particularly need right now?” or “What can I do for you now?” And so on.
Have children make drawings or craftwork to put on the door or to post. Children's work usually brings a smile and a hint of cheerfulness.
Is the coffin or urn driven to the cemetery by the undertaker? Then you can line the street with wider family, friends and colleagues, provided the distancing rules are respected.
Don't be just there in the first few days but also in the days and weeks following the loss. The social isolation in which we now live will continue for a while and will create a different mourning process. A grieving family will continue to need this support from a distance. Keep sending messages regularly, make phone calls more often, and send supportive messages. If, for example, you come across a photo of the deceased in your photo album, or of you as friends, send them along with a nice memory or anecdote.
As a wider family or environment (friends, colleagues, ...) you not only have the need to be there for the immediate family, but you probably also need to say goodbye for yourself in one way or another. Dare to think about your own needs and what you can do in this respect. For example, it can help to have your own moment of remembrance, to seek support from friends, to share memories through chat, etc. Dare to ask your immediate family if it is possible to follow the service remotely or at a later time. Don't just let the deceased go and arrange a farewell as dignified as if everyone could be there. Share your memories, photos and possibly video recordings with your immediate family. In this way you can mean something to them on the one hand, but on the other hand you also pay attention to your own mourning process. The mourning together from a distance creates a connection again.
Saying goodbye as a caregiver
Whether you're a nurse, carer or doctor, every death affects you. Under normal circumstances, you will see your patient surrounded by his or her immediate family until the moment he or she dies. As a caregiver, you are often more likely to stand at a distance and give the family all the time they need to be together and stay with the patient as much as possible. You take care of the patient's comfort and the emotional support of the family.
However, Covid-19 measures mean that people in the rest home or hospital are no longer allowed to receive visitors and that you are the only person with who the patient still has contact. Whether it is a coronavirus infection or not, people lie alone in their room or in the emergency department.
Family is waiting at home, hoping but, above all, being afraid. Are they going to see their loved one alive or not? You're the only connection they have left.
At the beginning of this guide we offered possibilities and suggestions as to how family members can keep the connection in saying goodbye from a distance. This will certainly not always be possible in every circumstance. Everyone does what they can, in the interest of the patient but also in the interest of the family.
When a patient is admitted to the hospital, you can ask the family if they gave you a picture. If not, you can suggest that they bring one at a later time and drop it off at an agreed place.
Also ask if the patient is carrying a mobile phone and knows how to use it. Does the family have certain photos, video messages or sound clips on it that the patient can view or listen to?
Is it too busy at the time of the admission to hospital? If so, see if you can ask the family about this by telephone at a later and quieter time.
As long as the patient is still able to operate the mobile phone, you can regularly ask whether they have looked at or listened to messages. If the patient is no longer able to do this, play the recording yourself so that the patient can still hear the voices of the family.
The most difficult moment follows when the patient is dying and family members are not allowed to be there. Therefore, you can only assist the family by assuring them that you will do everything you can to offer them as much comfort as possible so that the person can die peacefully.
If possible, you can ask the family if they have certain wishes. For example, you can put the photo of the family on the body of the dying person and inform them about this action. Tell the dying person that their family is with them from a distance and they are thinking very hard about him or her right now.
Hold their hand and talk to the dying person as much as you can. The pressure of time will not always make this possible, everyone is aware of that. Maybe the family wants one last phone call, even if the dying person can't talk anymore. It can be very meaningful for the family to say one last message and let the loved one know that it is ok to go. You often see that once these words are spoken, the patient can let go of life.
If you are able to take pictures in these last moments and just after death, this can be very helpful for the family in the mourning process. You're the last people who saw them alive...
Emotionally, this is a difficult task for you. No one is prepared for this. You are, first of all, a caregiver, but don't forget to take care of yourself. Dare to ask for care within your hospital if you feel that emotionally it is no longer possible and don't stay alone with it. In any case, remember the following saying: Who you keep in your heart, you won't lose.
Lies Scaut and Erik de Soir at De Weg Wijzer – Expertisecentrum voor Trauma- en Rouwbegeleiding, Expertise Centre for Trauma & Grief Counseling. English version written in close collaboration with Nathalie Ramaekers & Ross McEnzie
Main image: Lightwise / 123rf