COVID-19: Encountering Never-Before-Known Suffering

As palliative care providers, we are used to encountering suffering—both physical and nonphysical—in our day-to-day work. While there is much we can do to relieve physical suffering, and at times, nonphysical suffering, many of the intrinsically hard parts of dying call us to sit with patients and their families in their suffering (Rattner & Berzoff, 2016). Pre-COVID, day in and day out, we sat with patients and their families (including chosen family) in what’s hard and unchangeable about living with, and dying from, a life-limiting illness. Since the advent of the COVID-19 pandemic, the suffering I have encountered—the suffering we have encountered, and still are encountering—has felt new, different. Despite our longstanding familiarity with suffering, it feels as though we have met an entirely new depth and nature of suffering never experienced before. In particular, the nonphysical suffering—the grief, worry and fear—experienced by patients and families (Rattner, 2020a) pre-COVID has only been amplified during the course of the pandemic. Such losses, worries, and fears—our patients’, their families’, and even our own, as clinicians—reach beyond what we, and the very discipline of palliative care—a discipline dedicated to the prevention and relief of suffering (World Health Organization, 2020)—have ever known before. There are so many losses that naturally imbue the experience of living with, and dying from, a life-limiting illness. We now know that loss and grief look very different in the context of COVID. While we know that people who are dying have been unable to be with their families in their final moments, and that bereaved individuals are more isolated than ever— both very much forms of suffering in their own right—we hear less about the plight of patients and families in the time that precedes dying and death; the weeks and months spent navigating a life-limiting illness within the limits of a global pandemic. Earlier in the pandemic I was struck by conversations I had with patients who moved into a residential hospice unsure how or if they would see the important people in their life ever again. Over the course of the pandemic,