Hospital chaplains offer solace from the sidelines, as patients ask them: 'Am I going to die alone in here?'

• As the coronavirus sweeps across the United States, medical crises are the new norm, and hospital chaplains are playing a critical role.
• But the pandemic has introduced social distancing rules that have forced chaplains to rethink the way they interact with patients and their families as well as hospital workers who are struggling.
• It's no longer possible to sit by a patient's bed or hold a grieving relative's hand, so phone calls and video chats have become more critical than ever.
• Two hospital chaplains at NYU Langone Health talked to Business Insider about the fear, grief, and isolation they've seen.
• Visit Business Insider's homepage for more stories.

Kaylin Milazzo is haunted by the panic and uncertainty in the eyes of a coronavirus patient she helped in March.

In a matter of days, the elderly woman went from being surrounded by her children and grandchildren to being hospitalized at NYU Langone Health, completely alone. That's where she encountered Milazzo — a friendly face on an iPad screen.

At the end of a "good conversation," the woman "looked around the room nervously, then back at the camera and said, 'Am I going to die alone in here?'" Milazzo recalled.

The patient has since recovered from COVID-19, but Milazzo hasn't been able to forget the terror in the woman's gaze or her own "helplessness to do anything about it."

The US is home to the largest coronavirus outbreak on the planet: 1.18 million patients and nearly 69,000 deaths as of Tuesday, according to Johns Hopkins University. New York has been hardest hit with 318,953 confirmed cases and almost 25,000 deaths.

Hospitals have employed strict measures to keep both patients and their families safe, such as quarantining coronavirus patients in separate wards and limiting the amount of contact they have with family and friends on the outside. Those interventions have radically shifted how patients, medical staff, and hospital chaplains interact. And it's forced hospital chaplains — who provide invaluable spiritual care to patients in need — to maintain a physical distance from the people to whom they're ministering.

In her four years as a hospital chaplain, Milazzo has supported thousands of people — patients and their families alike — but the pandemic and ensuing social distancing guidelines have thrust a new normal on her and her colleagues. Gone are the days when the 32-year-old Queens resident could sit in a chair by a hospital bed or hold a patient's hand; now, it's all about phone calls and video chats.

"That's been painful," she told Business Insider. "There's this human urge to go and stand next to someone who's in trouble, and it's really difficult to not be able to do that."

No more holding patients' hands

Pre-pandemic, Milazzo worked in palliative care, with patients who were dealing with advanced illnesses, including cancer, cardiac arrests, and kidney failure.

In March, that "mixed bag" was replaced with an influx of only COVID-19 patients, but Milazzo's aim to "alleviate suffering, be it physical, emotional or spiritual" hasn't wavered, she said.

Her fellow chaplain, Elizabeth Kitamura, echoed the sentiment.

"We're listening for sources of comfort, of hope, of strength, of meaning, and then we try to be with people and meet them where they're at," Kitamura said. That can involve praying with people in their tradition, getting them a Bible or other religious item, and exploring the topic of mortality.

Social distancing hasn't affected the "why" of hospital chaplaincy, but it has forced administrators to rethink the "how."

"Right now, we're relying a lot on talking, whereas before we would talk maybe, but also sit in silence while somebody cries," she said. "Holding their hand was very much part of our practice, and we can't do that now."

Finding beauty in painful moments

At NYU Langone, hospital chaplains have provided a critical bridge between patients and their families both during a patient's illness, and sometimes in the days following a patient's death.

At the start of the pandemic, chaplains worked remotely: calling into a patient's room, while standing outside the door, and building relationships and trust with their families on FaceTime. In recent weeks, some, including Milazzo, have chosen to suit up in personal protective equipment (PPE) and go into patients' rooms so they can interact with them in person.

"We've born witness to a lot of deeply painful, but also very meaningful conversations," she said. "People have had to say goodbye to their family members over video, and expressed things that need to be said at the end of life, like 'I'll miss you,' 'I love you,' and 'We'll be okay.'"

Since Kitamura works in the ICU, where most patients are intubated, she has asked their family members to email over photos, which are then printed out and put up in the hospital room. That's helped the medical team, too, she said.

"Usually, a family member [is] at the bedside the whole time, and we get to hear stories about that person, and we're missing that," she said. "These interventions help us get to know who we're caring for."

Kitamura remembered a poignant experience with a patient whose wife relied on her spiritual beliefs to deal with the trauma of her husband being critically ill with coronavirus.

"She couldn't be with her husband … so we would have pretty regular phone calls, and then I would go up to the floor, and I would pray outside of his room," Kitamura said.

Kitamura arranged to have a Bible placed near the man's bed, "opened up to one of his favorite psalms, and that brought his wife a lot of comfort." Since he loved gospel music, she also asked a nurse to pull up a YouTube playlist "so that he could be surrounded by some of his favorite music in a very unfamiliar setting."

Unfortunately, the man's health declined. As he was nearing his death, his nurses asked Kitamura to be present.

"It was just a very beautiful moment — the staff knew this was so important for the patient and the family — so I was able to pray outside of his room shortly before he passed away," she said.

The next day, Kitamura reconnected with the man's family, answered their questions, and prayed with them as well. And that's a connection that's stayed with her, she said, "even though I never met any of them in person."

'You really can't overstate the role that isolation has played in this illness'

Through it all, one aspect of the pandemic has risen above the rest, at least for Milazzo.

"You really can't overstate the role that isolation has played in this illness," she said.

Patients aren't used to being alone in their rooms, interacting solely with doctors and nurses. And their families struggle with being forced to let them go almost as soon as they enter the hospital.

"They can't go past the waiting room, and that's really scary," Milazzo said of NYU's new protocol. "I've been offering support to family members in the waiting room, as they say goodbye to their loved ones. They don't know if it's for the last time, so having someone there has been helpful."

The pandemic, Milazzo said, has caused "a more universal experience" that she described as "fear compounded by isolation."

"Almost every patient is feeling lonely and afraid and anxious because of this virus," Milazzo said.

Milazzo has found that family members are also wrecked by the separation and leap to answer her call on the first ring.

"I've spoken to so many family members who are just waiting by the phone, hanging on every word that the team utters because they can't be here in the hospital, and they so badly want to be with their spouse or with their parents," she said. "We have this human urge to be close to the ones we love in their time of need, and being forced to stay home is incredibly painful and traumatic."

Kitamura and Milazzo's care extends to medical staff. They'll minister to staff, be it in person or via Zoom support calls. The goal, they said, is for hospital workers to know they're not alone.

"This disease has unfortunately taken a lot of people from us, so we're supporting staff who've experienced bereavement in their personal lives," Kitamura said.

'Be present with them in their suffering'

An internship at NYC Health + Hospitals/Bellevue while she was in seminary school led Milazzo to a full-time job as a hospital chaplain.

"People have a need for someone to join them and be present with them in their suffering" instead of turning away from it or trying to solve it, she said. "The medical system is understandably designed to take care of people's bodies. But a medical crisis so often triggers spiritual and emotional crises as well because we're not just a collection of our physical parts — we also have minds, hearts, and spirits."

Chaplains can guide them as they try to find meaning in their suffering.

Milazzo had the chance to do that for the family of a coronavirus patient whose doctors had been trying unsuccessfully to save for weeks.

The patient's children weren't able to say goodbye to their mother because they were all quarantined after being exposed to the coronavirus. So, her medical team got suited up in PPE and each one called a child on a different iPad before gathering around the bed and turning the cameras toward the woman.

As her family watched, the hospital workers laid a hand gently on the patient's hands and arms.

"Her children could see that there were people who cared about her and were holding her in their place," said Milazzo, describing how everyone was moved to tears.

People on the frontlines of the pandemic have seen so much death and devastation that they often feel as if their efforts are not enough, but Milazzo said, "in that moment it felt like we were doing the right thing. The woman wasn't going to live, but what we could do was not let her be alone."

'A feeling of fatigue as the grief is catching up'

At the outset of the pandemic, Milazzo noted a thrum of "adrenaline and energy" among frontline healthcare workers. But, she said, "as the weeks have gone on, the reality of what we've gone through, the deaths that we've seen, and the accumulation of loss and fear is starting to build up," Milazzo said. "There's a feeling of fatigue as the grief is catching up."

Acknowledging that being a chaplain can be a fulfilling but harrowing experience, Kitamura underscored the need for self-care.

For her as a Catholic, that involves going to mass and praying regularly for her patients and their families. Yoga has also played a critical role because she is a person who "holds a lot of emotions in her body."

For her part, Milazzo said that she misses having a set routine and knowing what to expect at work.

"We knew it was going to be difficult and that we would see sad things, but we were prepared and we could separate work from the rest of our lives," she said.

But now, there's no part of her world that isn't consumed by the pandemic.

"People on TV are talking about it, my friends are talking about it, my family is talking about it — it's everywhere," she said. "It's affecting all parts of our lives and is no longer just what we deal with on the job. That's really challenging."

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