“It’s a grief process for us all”: How to care for a mourning nation

When Covid-19 arrived, Alison Robinson was put in charge of a new bereavement nursing service at her hospital. She tells us how death has changed in the time of coronavirus.

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The UK’s coronavirus death toll is 33,614. And those are only the people we know about. There were 46,380 more deaths than would usually be expected in England and Wales in the eight weeks leading up to 1 May, according to New Statesman data analysis. “Excess deaths” suggest the official coronavirus figures are an underestimate, and point to the devastating collateral impact of the pandemic response on access to health and social care.

For every person who dies of Covid-19, and every person who dies as an indirect consequence of the virus’s spread, there is a family and a network of friends, neighbours and colleagues who are grieving. As Nazir Afzal, former chief prosecutor for the north-west who lost his brother to Covid-19, put it to me during an interview for an upcoming issue of the New Statesman:

“Instead of the six or seven of us who were there [at the funeral], I have no doubt there would have been about 500 people if we were able to have a proper burial service – and you multiply that by all the tens of thousands we’ve now lost, there are millions of people mourning.

“And just imagine you’re working in health and social care and you're seeing day in, day out, people dying. We’re all mourning, aren’t we?”

Doctors, nurses and other health and care staff are coming face to face with the shocking death toll every day. Nurse Alison Robinson is one of those workers. The Macmillan lead cancer nurse at Worcestershire Acute Hospitals NHS Trust, Robinson, 52, has worked in cancer nursing for over 30 years.

When coronavirus began spreading in the UK, she was put in charge of a new bereavement nursing service to cover all deaths on the three hospital sites that make up the trust. She is also the Covid-19 bereavement lead for Macmillan. It’s her job to support patients and staff through the bereavement process – familiar for a cancer nurse, but so strange in the time of coronavirus.

“It's been completely different,” she tells me over the phone between shifts. “The hardest thing, I think, is not having families in when you are looking after patients who are really sick.

“It’s unnatural for us, as nurses, not to have families there with you, and having those conversations face to face is very different to having very difficult conversations on the phone and telling a family about how perhaps one of their loved ones is deteriorating.”

Now, she and her colleagues must don protective equipment, which makes them appear impersonal in front of patients, and use the 130 iPads donated to the hospital to connect families who cannot visit dying relatives. In the critical care unit, nurses wear badges with pictures of their faces on them attached to their gowns, so that patients can see what they look like. They also speak to families remotely about what their loved ones are going through.

“We talk through what’s happened, because that can obviously be really difficult for families to come to terms with, when they’ve not seen that deterioration and that care that’s been given," Robinson tells me.

“Even on the ITUs when the patients are ventilated, the staff still use Skype and FaceTime to show relatives how they [the patient] look, because I think it’s important, as part of that grieving process, that they see where they are and how they’re looking.”

A patient at the end of their life can have one visitor in full personal protective equipment (PPE), but people who do stay at home give the nurses messages to pass on. “Even if the patient’s unconscious, we will still encourage families to talk through the iPad or phone – we’ll hold the phone, and pass any messages on.”

Another change in the bereavement process has been the “very rapid” deterioration of patients with Covid-19. “Ordinarily, there has been time for conversations,” reflects Robinson.

“We’ve had to ensure our frontline staff are really prepared and confident to have those conversations; they still must be really sensitive, but time has to be the essence, and the conversations have to be frank and honest with the patient and family,” she says.

“Our staff, more than ever, have had to be very clear about outcomes because of the time of the deterioration, and ensure relatives completely understand what we’re saying.”

Pandemic or not, she urges her staff never to be afraid of using the words “death” and “dying”, while also making sure dignity and respect are paramount.

Each death weighs heavy on the nursing staff, with six per shift working on each 30-patient ward, and approximately 15 deaths over a weekend during the virus’s peak. This is emotionally challenging, particularly as many have been deployed from other parts of the hospital where fatalities are less common.

“If you’re working on a surgical ward, for example, where ordinarily you’d be looking after patients who had perhaps broken their hip or their leg, the chances of you seeing a death on there would be minimal, probably you’d barely have one or two a year,” Robinson explains. “Whereas now, it has changed out of all comprehension.”

Fears for the safety of family members at home are also a daily struggle. Robinson herself lives with her husband and three children, aged 25, 17 and 16. 

“And then there’s the anxiety staff are dealing with every day because of the uncertainty of the virus, and how long it’s going to go on for,” she adds.

A large part of her job is to help her staff through the psychological impact, with several (physical contact-free) huddles per shift to ensure teams are looking out for each other, counsellors on-hand for debriefs and one-to-ones, and two or three “recharge rooms” at each site where staff members can go and sit for five minutes for a rest and a drink if they feel overwhelmed.

“Some people are very vocal about their grief, so they’ll reach out and they’ll really ask for support, but others will cope with things very privately and will be very quiet and introverted, and it’s about identifying who they are and making sure you know your staff really well,” Robinson says.

People grieve differently, don’t they? And this is a grief process for all of us.”

Anoosh Chakelian is the New Statesman’s Britain editor.

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