COMMENTARY

Losing Both Parents During COVID: A Physician's 'Unwitnessed Grief'

How a Pandemic Stole the Comforts of Mourning

Melissa Walton-Shirley, MD

Disclosures

April 19, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

On a recent walk with our labradoodle, a woman standing outside her door caught my attention. Despite the mask and cane, I recognized her as the mother of a high school friend. I stopped for a yard visit, staying at a safe distance. She gingerly came toward me, searching with her cane for places in the soft ground that would not betray her. "I miss your parents so much," she said, tears welling. I swallowed hard. Her words and the comforting whispers of others forever suspended in the darkness and space that COVID-19 brings to grieving.

The author with her parents, Betty and Stanley Walton

The conversations meant for funeral visits, memorials, and wakes must now occur on the occasional lawn, across the grocery aisle, or by text and social media. Despite these attempts to wrap us in kindness, the essence of unwitnessed grief feels like the south pole of a magnet that searches for, but cannot find, its north. Our planet's deaths from COVID number over 3 million, but not everyone who died in 2020 succumbed to the viral infection. Those of us who lost loved ones to other causes share one thing with those who mourn COVID deaths: the absence of our traditional mourning rituals.

There are no lines at the funeral home or packed memorial services where mourners can feel the love and support of a sea of friends and acquaintances at our backs. There are no tables crowded with food where we can commune in honor of those we loved. We will never get that back; our grief cannot be postponed until the pandemic is over. But that's not all. This era has also robbed many elderly people of a good death.

A Socially Distanced Death

My husband Tony and I flew back to the United States in March 2020 from a trip to Israel. We connected through JFK when New Rochelle, New York, was on fire with the viral outbreak and the country was starting toward the height of COVID uncertainty. We quarantined for 14 days and then visited my elderly mom and dad on their side porch—a door between us. Their aide and near-constant companion helped my parents get situated near enough to the door to see our faces, and we used our phones on speaker. For weeks the cool Kentucky spring did not gift us enough warmth to visit outside.

Betty and Stanley Walton (behind the door) visit with their granddaughter Allie.

In early May, I would get the closest to my father that I would ever be again—6 feet away as he sat on the swing on their front porch. It was there that he told me what I already knew: he was dying. There was no hug to follow.

I offered to take Dad to the hospital, but he declined. He was 88 years old and afraid of contracting the virus. He survived this long because of the many magnificent devices that cardiology has to offer, but the ravages of neuropathy and congestive heart failure had taken his mobility and his will.

A week later, he was febrile and bedfast. His carer raised the bedroom window so that we could speak through the screen. Tony and I spent the day. Seeing how weak Dad was, we went home to pack a bag so I could sleep on the porch underneath his window. I needed him to know I was there just in case. As I threw my things into the back of our car, I received a text. It was a video of my father sent by the night sitter asking me if he was "okay." He had obvious agonal respiration, an image that no amount of time will erase. He was gone by the time I arrived.

The sitter added that he had asked for "Missie," not knowing that this was his nickname for me. One of the daggers that is permanently lodged in my heart is my inability to convince him to go to the hospital. It's wedged between the "what ifs?" and the "why didn't I's?"

Dad's funeral was not the big New Orleans–style brass band sendoff he'd always wanted. He was the former song director of a church congregation. He was a well-known tobacco warehouseman with scores of friends and a large family. Before COVID, we would have stood for hours in a receiving line of hundreds. Instead, there were 10 funeral attendees and no contact allowed.

Our immediate family wore masks seated under a tent. We stepped far enough away from the casket to allow the attendees to file by for their final good-byes. Each stood for a few moments at Dad's open casket, some covering their hearts or crossing their arms to simulate the in-person hugs that could not be felt.

My Mother Will Not Die Alone

Weeks later, my mother fell. Her shoulder x-ray looked as if someone had reached in and snapped the head of her humerus clean through. Her orthopedist, my friend, advised no surgery given Mom's age and advanced dementia. Hospitalization and rehab were offered, but there would be no visitation allowed. I could not do that to my mother. I requested a hospital bed and everything else I could think of and took her home.

We had no choice but to defy social distancing rules since she required all hands on deck. My family, the local hospice (Hosparus), and our team of carers worked hard trying to get Mom back to baseline. Between the constant pain, her inability to remember what had happened 2 minutes previously, her constant searching for Dad, the loss of appetite, and inability to drink well … I was not optimistic.

We used every gadget, hold, and trick I'd ever learned from my college job as a nursing assistant at Cardinal Hill rehab hospital in Lexington, Kentucky. I bent my knees and hoisted my mother from bed to commode. We stood her with a balance belt and walked her as best we could, but the pain drove more confusion. The sitters, her grandchildren, and my husband fed her. The Hosparus techs bathed her. The nurse orchestrated a Zoom visit with her physician. She had one good day that resulted in a wonderful visit with family, but then she was lost in confusion. The care team asked if I would consider hospitalization or a hospice house 40 miles away. I would not allow a viral pandemic to damn my mother to die alone. Soon we could barely hold her in bed—this was it, the dreaded phase of terminal agitation.

Masked family visit the bedroom where Betty Walton and her mother were born. She passed away a few days later.

We delivered enough morphine and Ativan to calm a T-rex, but Mom continued to see her deceased parents and my father standing at the foot of the bed. She reached for them, seemingly tormented that she could not touch them. On September 2, 2020, with family gathered around, I cradled my mother, my index finger on her pulse. It began to slow, its amplitude decreased, and then it faded to nothing. Instantly my heart was untethered as my first love, one of the greatest loves of my life, floated away. I remember consciously acknowledging that my brother and I were now orphaned adults, parentless.

Second Guessing and Regret

Months later, I regret not going into my father's bedroom to hold him. I reason that I might have infected him with COVID-19, or the sitters could have infected me or Tony, who has a paralyzed diaphragm. I question taking my mother home. Did I do the right thing denying her a rehab center? Was my mother's death hastened by the escalation of her comfort medications? Should I have allowed that? Will God forgive that?

COVID robbed so many of their last few precious moments together, whether days, weeks, or, in many cases, years. Our planet is still in anguish. The suffering is so great that on some days, the weight of it brings more tears and pain than we think we can bear.

Then, the Facebook post of a friend. "First time I've been able to hug mom since March of 2020" read the caption as she stood grinning beside her elderly mother. I celebrated with them. They made it to the other side of this pandemic. Scenes like these made possible by a vaccine have allowed us to exhale and to hope again.

I have learned that there is one thing worse than losing the people we love, and that is losing them without the grief support to which we have long been accustomed. Thanks to our successful vaccination efforts, the need for distanced mourning may finally be coming to an end. In that, we can all take some measure of comfort.

Melissa Walton-Shirley, MD, is a native Kentuckian who retired from full-time invasive cardiology. She enjoys locums work in Montana and is a champion of physician rights and patient safety. In addition to opinion writing, she enjoys spending time with her husband and daughters and sidelines as a backing vocalist for local rock bands.

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