‘A lot of suffering’: Frontline health-care workers describe the moments before death by COVID-19

It is a bright, crisp early March morning and the sun is shining outside of Downsview Long Term Care Home in the north end of Toronto.

Spring is coming, a season of hope.

The team working inside the long-term care facility was recently vaccinated against COVID-19 and is feeling optimistic since the residents have now received their shots as well.

But it was not that long ago, that an outbreak of COVID-19 led to a total of 64 deaths, including a personal support worker, at the North York facility.

Read more: Coronavirus vaccinations in Ontario long term care homes saved hundreds of lives: report

“It was rough, it was sad. It’s a place I don’t want to go back. It would bring tears … to see the residents so sick. You see them today, tomorrow you come, they’re gone,” recalled Belvon Thomas, personal support worker.

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Thomas called it “the dark time.”

“No family could come visit. We were the family. We showed them compassion, showed them love. We cared for them even though it was rough. We cared for them in the best way we could,” she said, tears in her eyes.

Thomas described some residents with a mild cough, others with no symptoms at all.

I walked to the residents and I didn’t know that they had COVID until they got the tests. They had no symptoms. Some, you will see have a lot of runny noses and a cough, and then you just see the change … complete change,” she said pointing to her face. “When you see that, you know, something’s not right. Without a test, you know, something is not right.”

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Last May, during the peak of the outbreak, 153 residents and 110 employees tested positive for COVID-19.

Staff were stretched thin, working extra-long shifts to care for the residents.

Thomas said, at times, there was nothing more she could do than be there, at the bedside of the dying.

You talk to them, you pray with them. You sing with them,” said Thomas, crying.

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“I remember one resident — I sang, ‘Amazing Grace how sweet thou art’ and I said, ‘I know your family. … Your family loves you but just cannot be here.’ And you have your gloves on just to hold their frail hands.”

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“They’ll always be in our memory. The memory will always live on, always,” Thomas added.

Working overnight, sometimes up to 18 hours at a time, during the outbreak was Registered Practical Nurse (RPN) Andrea Cuff.

A lot of people feel like we must be used to seeing people sick and seeing people dying, and so that’s just our job. So that has been challenging because before I’m a nurse, I’m a human being,” she said.

Cuff has spent the last seven years of her 14-year career as an RPN at Downsview LTC and said many of the residents are like family.

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“It was challenging because someone passed and there’s all these other people to still take care of,” she said.

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Cuff said one of the things she would do for her residents in their dying moments is wash their bodies.

“I decided that if we could tell that death was coming soon that we would make sure, me and my team that I had, that we would be giving that aftercare before that person passed,” she said.

Cuff explained, usually after a death, the nurse or PSW would clean the body from top to bottom but because of infection control rules and regulations, they were prohibited from touching the body.

There were times when I took my own cell phone and facetimed families,” she recalled.

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“People think like, ‘Oh, you’re used to death.’ No, I’m not, but when you have 120 other people that need you, you have to keep working and you have to suck it up. You can’t be in front of patients losing it,” she said, adding, “It was like a war zone.

The only downtime, the only time she took to grieve, was when she left to go home.

“You wake up from your sleep crying. You can barely drive home because you’re crying. You can’t get on the highway —ugly crying,” she recalled.

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Down the street from Downsview Long Term Care Centre at Humber River Hospital, each patient lost to COVID-19 is etched in the minds of those who cared for them.

“We had a young woman with three kids,” recalled Paula Abramczyk, a social worker in the Intensive Care Unit.

“Before she was intubated, we called the family so she can say goodbye to her kids. She was 30-something years old with three little kids.”

For Abramczyk, it is important that the families of those who died from COVID-19 know they were not alone in their final moments.

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“We were there for them. Certainly, we don’t replace family … but they just did not die alone because we were with them,” she said.

Abramczyk is finding the second wave especially difficult because some of the dying are family members.

“Three family members on different units and one day after the other, they all died. And the families who weren’t affected by COVID had to live with that, although they could come in and see them, it was overwhelming for them,” Abramczyk said.

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“At times it was overwhelming for us.”

Abramczyk often facilitates video chats with family members so they could say goodbye to a dying loved one.

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Registered Nurse Manpreet Kainth, who also works in the ICU at Humber River Hospital, said it is not only about consoling the patient in their final moments, it is about comforting their family.

We just try to be there for them. We are just trying to be the shoulder for them to cry on. That’s the only thing we can do,” she said.

Kainth described dying by COVID-19 as “painful, stressful” for the patient.

“Sometimes it’s quick or sometimes it’s not quick. … It’s a lot of suffering,” she said.

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For Critical Care Registered Nurse Festus Ehiozonwangie, it is unlike anything he has seen in his nearly 17 years working on the frontlines.

“If you have seen a picture of somebody who is drowning in water, imagine this lack of oxygen, you’re looking for oxygen, you see how distressed that person is. … It’s not like, ‘I have a headache,’ you take Tylenol. It is different,” he said.

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In addition, Ehiozonwangie pointed out, the patient is usually dying without close loved ones around.

“Dying without somebody close to you is a terrible way on its own and, you know, knowing that you’re dying now and you’re gasping for air is another terrible way to die” he said. “It is a terrible way.”

Back at Downsview Long Term Care Home, no one goes inside with first receiving a rapid COVID-19 test.

There are precautions in place and no chances are being taken, given what happened last spring.

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“Since the second wave, we’ve stayed out of outbreak, and so that’s been the biggest success story so far,” Cuff said.

She is in a happy mood, chatting with her colleague at the rapid test centre.

Not far from her mind though, are the many residents who died there.

You just push everything down and you keep working. But it does, you know, usually on your way home or in the shower — that’s where all the emotions come out, in private,” Cuff said.

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“We grieve with families. .. We’re grieving with our community. We’re grieving with each other.”

Thomas said the vaccine has brought back hope to the staff and the residents.

“They’re very happy. And the light you see in their eyes,” Thomas said.

“It is hard for them to be without family. … But once you have the staff who goes to you, smiles with you, talks to you, they feel good.”

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