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'COVID Hit Us All So Hard': Vt. Hospice Workers Say PTSD Will Last Years

A tree outside a single-story building.
Elodie Reed
VPR File
During the pandemic, many hospice workers cared for patients who were dying without their families around them, often in long-term care facilities like Birchwood Terrace in Burlington, shown here. Some say this has had a lasting impact on them.

The trauma of the pandemic has affected many: health care workers, first responders, even grocery store clerks. Hospice workers - who deal with death every day - were heavily affected.The isolation of the coronavirus pandemic turned hospice care on its head. While the death rate from COVID-19 has dropped, some hospice workers worry about the next surge and the personal toll the past year has taken.

Hospice care focuses on the quality of life, comfort and emotional well-being of people near the end of their lives. The work is typically slow and calm.

CarrieRae Shamel is a medical social worker for BAYADA, a not-for-profit home health care company. “I absolutely love my job,” she said of hospice work.  

A woman stands in a room in hospital scrubs and a face mask and face shield.
Credit CarrieRae Shamel, Courtesy
CarrieRae Shamel is a medical social worker for BAYADA, a home health care company that employs about 400 hospice workers in Vermont.

Heather McAllister agrees.

“It fills my cup and gives me gratitude,” she said.

McAllister works for BAYADA as a hospice nurse. Both women work in and around Chittenden County.

“Pre-pandemic, people would say to me, 'Your work must be so depressing,'” Shamel said.

“And that is, like, the opposite [of what it is],” she went on. “A lot of the time, I’m in disbelief that I’m paid to listen to people’s stories and have these intimate moments with individuals and their families.”

Death is social and spiritual, both women say. It’s raw and powerful and ideally, families go through it together with lots of tears, laughter and touching.

But this past year, because of COVID-19, Shamel says she was often the only person in the room with patients. And there were times when it was hard to keep up.

“[I was] going from room to room, trying to hold these hands of people who were dying, trying to schedule these Zooms and it was so chaotic and so sad,” she said. 

Shamel provided hospice care at Birchwood Terrace, the Burlington nursing home that had the deadliest coronavirus outbreak in the state. Twenty-one residents died there. 

A selfie of a woman wearing a mask, gloves, face shield in a health care setting.
Credit Healther McAllister, Courtesy
Heather McAllister, on the job, working in hospice care.

McAllister, meanwhile, was caring for COVID-19 patients at Burlington Health and Rehab.

“I remember at 4 a.m., I got a call from the facility saying we had seven patients crashing at the same time ... [There were] nurses running around, crazy. We’re in full gear, head to toe, and [with] N95 masks and the shield.”

In November and December, Shamel worked at Elderwood, a Burlington long-term care facility ravaged by COVID-19.

“I never understood the term 'dropping like flies' until I went to these facilities,” she said.

People would test positive and have no symptoms, she went on, “And I’d think, 'Shouldn’t we re-test these people? They’re not coughing, they don’t have a loss of smell and [they] seem to be doing OK.' And the next day I’d go in and they were actively dying.  They would turn in a second.”

Heather McAllister worked at St. Albans Health and Rehab around the same time and says it still haunts her.

“That was probably the worst that I had,” McAllister said. “I became basically a triage nurse and started having to [do] what we call 'black tagging' people. In nursing, if you’re going to die in a couple hours, that’s a black tag. It was absolutely a war zone.”

McAllister said she’s lost track of how many people she had to pronounce dead.

“I can’t tell you how many bags of belongings sat outside doors because families weren’t able to pick [them] up. I can’t tell you the sheer amount of exhaustion and stress and frustration of having to call a family member and say, ‘I know you haven’t seen them, but here’s what’s going on. They’re dying and you still can’t see them.’”

McAllister pauses then continues, “Hospice work has always filled my cup, but COVID just hit us all so hard. The PTSD (post traumatic stress disorder) from COVID, you’re doing to see for years and years to come.”

Credit provided photo
Heather McAllister says working as a hospice nurse has always filled her cup and been uplifting. But the pandemic has been physically and emotionall exhausting and she says the PTSD she and her colleagues have experienced will last years.

The women talk about balancing iPhones over patients, their arms aching at the end of a long day. 

CarrieRae Shamel remembers a Facetime goodbye she set up between a dying husband and his wife of 55 years.

“I mean, I know I have PTSD,” she said. “As one nurse at a facility said, ‘Every time I put on an N95 mask, I have a trauma response.’” 

Shamel and McAlllister both describe the red marks etched into their faces from those N95 masks -- masks McAllister admits she sometimes forgets to take off. “I will walk into my house wearing a mask and my kids will just laugh at me,” she said.

CarrieRae Shamel said working with the elderly, she’s always hated the ageism she sees in society. But during the pandemic, in the midst of all this trauma, she said it felt especially cruel.

“For example, just in my neighborhood, I ran into my mother-in-law, who was talking to another neighbor I didn’t know. And I overheard this neighbor saying, ‘Oh, it’s just people in long-term care facilities that are dying. You know, it’s already people who are sick.'”

She says she was too exhausted to confront the woman, but said comments like that infuriate her.

The good news is that she hasn’t had a COVID-19 patient die in her care since January. 

But both she and Heather McAllister say that in their minds, they know the pandemic is not over.

Amy Gray is director of area growth and experience for BAYADA Hospice. She says the company employs approximately 400 people in Vermont; from nurses and social workers to physicians, chaplains and home health aids.

During the height of the pandemic, she says BAYADA facilitated a daily prayer line for staff of all disciplines. They also held daily calls with leadership and field staff, expanded medical director office hours, created a COVID-19 response line and weekly Friday afternoon check-ins for any staff in Vermont and New Hampshire.

While many feel encouraged by the vaccination efforts underway, Gray admits there’s still a lot of unease about the coming months.

Even before COVID-19, a study published by the National Library of Medicine found nearly 40% of hospice workers experience burnout. 

“The pandemic created staffing shortfalls and it’s gone on so long,” Gray said. 

“So when I start to hear about new strains of COVID, I’m like, 'Let’s get ready.' There’s just so much we don’t know and that’s what’s hard. And I’ve got to be honest, as a clinician, that’s what’s exhausting.”

A woman holds a sign that reads Sweet 16 on the summit of Camels Hump
Credit CarrieRae Shamel, Courtesy
CarrieRae Shamel says to deal with the emotional toll of her job she gets outside as much as possible. An avid hiker, she climbed Camels Hump 16 times during the month of July last year.

Carrie Rae Shamel and Heather McAllister say they’re trying to take care of themselves. Both are in therapy, which they say is helpful. And both say they spend as much time as possible outside. 

Last July, Shamel climbed Camel's Hump 16 times.

The women each consider hospice work their calling and they have no plans to find different jobs.  

But Shamel said she was struck last month by the warmer weather and longer days. Normally she celebrates the change of season. But this year, she said it triggered memories of last March, when all the dying started.

“[It was] to the degree that when I went to let my dog out the back door, I smelled the spring air and I thought 'Hmm, it smells like COVID to me,'” Shamel said.

“It’s making me think of all the lives I’ve seen lost to the disease.”

Correction 4:55 p.m. 04/20/2021 An earlier version of this story did not list BAYADA as a not-for-profit company.

Have questions, comments or tips? Send us a message or get in touch with reporter Nina Keck @NinaPKeck.

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