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No time to say goodbye

Those who have lost loved ones to covid-19 are finding it hard to process feelings of guilt and grief

One of the biggest tragedies of this pandemic is that people have died in isolation, with almost no communication with their loved ones during the final moments

“My guilt is eating me,” Shaam Sareen says, holding back tears. It has been more than six months since he received a text message from his wife, Sunaina, that turned his world upside down.

On 14 April, Sareen was on an outstation assignment for his IT firm in Bengaluru when his phone pinged: “Baby Ive tested positive. Im scared. Come home.” He couldn’t. The nationwide lockdown had nixed any chance of returning to Delhi even in an emergency. A day later, a friend who had helped his wife reach hospital called Sareen to tell him she had died of covid-19. “My first reaction was, ‘How was it even possible?’ We spoke two days ago. We were so happy. It felt as if someone had pushed me off a cliff,” says Sareen. Just a month earlier, the childhood sweethearts had celebrated their second wedding anniversary over a Zoom call.

Such was the pain of loss that he took a six-month sabbatical from work, sold everything they owned in the Capital and moved back to his parents’ house in Rishikesh. “Nights are the worst. I keep going back to thinking how I left her all alone. I didn’t even get to see her one last time. Did they even comb her hair properly before burning? She was so particular about her hair,” he says. “All this wouldn’t have happened if I was there. How am I supposed to grieve; we didn’t even get to say goodbye?”

One of the biggest tragedies of this pandemic is that people have died in isolation, with almost no communication with their loved ones during the final moments.

“Grief tends to ease with time as people learn to adjust to life without the person who has died. But in covid-19, there are no final hugs, no kisses, no viewing of the dead body closely, which makes letting go so difficult,” says K.U. Manjula, chief counsellor at the Karnataka government’s Jeevasarthakathe organ donation agency.

Losing someone is never easy but hearing their last words helps the living to let go and grieve. The infectious coronavirus, much like an accident, stroke or heart attack, doesn’t allow even that comfort. Patients are often transported alone in ambulances and then restricted to isolated wards. Others are admitted to hospital by family and friends, who are then turned away. Sometimes, a nurse or a doctor is kind enough to connect a patient with their loved one via a video or an audio call so that they can say goodbye, but in times of a medical emergency, like dyspnea, or the acute shortness of breath known as “air hunger” that Sareen’s wife suffered during her final hours, there’s simply no time for that last call.

Worse, the virus has robbed people of the chance to perform the last rites or, in the case of Hindus, even get the ashes. When the number of deaths was peaking, from July to September, hundreds of bodies were being burnt together at designated electric crematoriums.

The Union health ministry has eased rules since so that families can get a last glimpse of the person from a distance—but it is not enough.

Manjula says people have approached her with feelings of guilt. “They feel like they didn’t do enough to save their loved one but there was nothing they could do.” What’s worse, she adds: “We Indians don’t talk about grief openly. The absence of final words can result in unusually severe and long-lasting grief.”

The healing word

The power of final words, both for the dying and those left behind, has long been celebrated in literature and across cultures. In one of Plato’s greatest dialogues, Phaedo, for instance, Socrates notes how swans sing beautifully as they are about to die. Devout Hindus, meanwhile, begin chanting Om when they sense death approaching, hoping it may clear the path to moksha.

Last words offer closure, believes Annie Fernandes—something she hasn’t found yet. On the afternoon of 12 June, while performing the burial rites of her maternal uncle at Mumbai’s Mahalaxmi cemetery, which allowed the burial of covid-19 patients, a thought kept distressing her: Was the body in that black bag really her uncle’s?

Six days earlier, Fernandes had driven around the city, looking to admit her 67-year-old uncle, a Parkinson’s patient who had suffered a stroke, to hospital. “I spent hours on the road but no hospital was ready to take us in. Finally, we found a place in a government hospital,” she recalls. As part of the protocol, he was tested for covid-19, and the result was positive. The six days that followed were a period of despair and helplessness.

“We could only communicate with him with actions (because of his Parkinson’s) and there was no way to reach him. So I bribed a hospital boy and sent my phone in so that at least my mother could see him (via video call). We only saw him twice,” says Fernandes, who was sure the “spoilt brat of the family” would get well soon. The third time she saw him, he was lying motionless on a stretcher, with only his pelvic area covered with a cloth in the hospital lobby. “He was so far that I am still not sure it was him.”

There are days when she feels he will knock on the door and tell her she buried the wrong person. “I know he’s dead; it’s on paper. But what if he’s alive? We never saw the face. I am glad, though, that we were able to perform the rites in a proper manner, even if there was no priest.”

It is acknowledged that funeral rites do help to process grief and offer a sense of closure. Ketika Garg, for instance, says she wouldn’t have “let go of her mother” if she had not seen her father perform the Hindu rituals that are believed to help release the soul. “It was a cathartic experience,” she says. Though her mother died of cancer last year, Garg says her situation was similar to that of a covid-19 patient. Her mother’s condition deteriorated rapidly and she was kept in complete isolation, on a ventilator. “We couldn’t see her at all in the final moments,” says Garg, a PhD student in cognitive science at the University of California, Merced, who had returned to Delhi at the time. “I could only believe she was gone because I saw her turn into ash in front of me and then scattered in the Ganga,” she says. “Cremation is not just about liberating the soul of the dead. It’s also a way to liberate the ones left behind.”

It’s complicated

The social support system, a crucial element in the grieving process, is missing too in these times of covid-19. Physical distancing norms and restrictions on gatherings have kept away family and friends—and made even that comforting hug elusive.

“There’s still so much stigma around covid-19 that people are refusing to come forward to support people who are struggling with grief. People can just pick up the phone and offer to listen,” says Deepa Bapat, adjunct faculty (psychology) at the FLAME University in Pune. She says there’s a possibility that many people may be suffering silently from persistent complex bereavement disorder or “complicated grief”—a condition in which people continue to grieve for six months or more and feel lifeless, unable to care about anything else. Like Manjula, she points out that there’s no way to ascertain the extent of the problem since people “don’t talk much about their grief openly in our country”.

The feeling of guilt, she adds, might also be widespread since we are culturally conditioned to take care of people. “Covid-19 has stripped us of that opportunity to care for someone closely and what makes this worse is that currently our social interaction has reduced,” says Bapat. “We have to physically distance ourselves from each other, not socially. We need each other more now.”

If even talking doesn’t work, seek therapy, she adds. “Grief is intrinsically a difficult process. The more we talk about it, the better. Yes, time has its own healing power but you can’t also always leave it to time.”

It has been over a week since Sareen returned to work. He has been seeing a mental health counsellor since his nightmares became more frequent, emotional breakdowns more prolonged and lack of concentration and interest in work prominent. “To be honest, it’s getting frustrating. I don’t know how will I ever come to terms with Sunaina’s death. Maybe I don’t want to?”

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