Shatzi Weisberger recognized the symptoms of a heart attack. Her chest seized up and pain shot down her left arm. Ms. Weisberger, 89, a retired nurse, did not want to die alone in her apartment. But if she went to the hospital, she was afraid that she would get the coronavirus there and die among strangers, cut off from the people she cared about.
“I know I’m vulnerable because I’m almost 90,” she said. “I would not go to the hospital under any circumstances.”
Ms. Weisberger had long ago planned for her end of life: a friend had promised to sit with her in her last days; an acupuncturist would ease any pain; when it was over, an undertaker would ice her body until burial. Alone in her apartment that night, with the city mostly locked down, she realized that whatever happened to her in the next days or months, she would likely face it alone.
“It’s going to be horrible not being able to get out of bed to go to the toilet or get food,” she said.
Death had other plans for Ms. Weisberger. She willed herself to relax and finally fell asleep. By morning in her apartment she felt better. “Another day, hallelujah,” she said. “No fever, another day.”
For New York City’s 1.7 million older adults, this has become a second epidemic: the fear of dying alone. For many, it will do more harm than the virus itself.
Many have not seen their relatives or friends since early March, when the restrictions on travel began. Then the public libraries closed, restaurants, senior centers, YMCA and YWCA’s, houses of worship. Hospital emergency rooms, where older adults might salve the bumps of aging, are now the most dangerous spots in New York.
Though young people get sick from the disease or transmit it, the overwhelming majority of people who die — 80 percent, according to an analysis of early data by the federal Centers for Disease Control and Prevention — are age 65 or older.
And many fear that if they do get sick, even hospice will be lonely, because of the health risks in gathering people around. .
“You count on people for support and to be your advocate,” said Dr. Robert Roca, chairman of the council on geriatric psychiatry at the American Psychiatric Association. “The notion that they won’t be there can be extremely distressing.”
As the quarantine wears on, Dr. Roca said, isolated elders are especially prone to brood on their fears, and to magnify them. This brooding, in turn, intensifies loneliness and anxiety, which both have severe health consequences. The virus does not create these fears, but it enlarges them in people who are most vulnerable.
It is one thing to imagine dying on a ventilator, or not being able to get one; it is another to imagine doing so alone.
“We’ve been bombarded with messages about how bad it is to isolate ourselves,” said Wendl Kornfeld, 71. Now isolation is an official goal.
Ms. Kornfeld lives on Manhattan’s Upper West Side with her husband, Barry, who is 11 years older. “We never leave the house without that last hug and saying I love you,” she said. “In the past it was always theoretical. But now, if one of us should get really sick and go to the hospital, that might be the last time we see each other.”
For Ilin Lo, 87, the anxieties began back in January, with reports of a new virus spreading in Wuhan, China. Ms. Lo, who speaks little English, lives alone in Fresh Meadows, Queens, and until recently relied on the Nan Shan Senior Center in Flushing for both food and social connection. Her children live in California.
“I’m very afraid of dying alone,” she said, speaking through an interpreter. “If I had a normal illness I could ask my children to come to New York. But with the coronavirus, I cannot ask them.”
She also cannot ease her fears by sharing them at the senior center. Instead, she said, she watches television all day, which only amplifies them.
Adding to these fears is the nature of the novel virus, said Karl Pillemer, a gerontologist at Cornell University. Most causes of death for older people are fairly slow and predictable, with time to gather relatives and say goodbye. Covid-19, by contrast, is fast and unknown. “It’s a different narrative than the one we’re used to,” he said.
Dr. Pillemer said the fear of dying alone was a fear of losing control of the dying process. “People want a feeling of agency,” he said. “The frightening reality is that coronavirus patients are not going to be at home. It’s going to be an abrasive hospital experience where they don’t have the people they want around them. To be conscious and aware and be entirely deprived of visitors, it’s upsetting even to think about.”
As disturbing as the prospect is for elders, it is often scarier for their children. Pam Loshak has had almost no contact with her father since the state banned visitors from nursing homes on March 13. Her father, Eliot, 87, is in the Mary Manning Walsh nursing home in Manhattan, part of a small chain that has had more than 200 coronavirus cases. Because of a traumatic brain injury, he cannot manipulate a telephone, so Ms. Loshak has had to rely on aides in the home any time she wants to talk with him. But this requires the aide to touch both him and the telephone, and the staff at the home, as at many, do not always have the protective equipment to make that safe.
“If he were to get sick I would not be able to go see him,” Ms. Loshak said. “It’s just a nightmare. You work so hard.” Five years ago, when he was hit by a car, she was with him every day during his rehabilitation from the brain injury. “It was just an incredible amount of time and energy spent out of love to care for him,” she said.
Now she can do none of that. “You feel helpless not just because the virus is out there,” she said, “but because the people taking care of him don’t have the equipment that they need to take care of him.”
“I don’t want him to be lying in his bed, terrified,” she added. “On my last call I assured him that I was OK and he was OK.”
The isolation at the end is intensified by the shortages of masks and gloves, said Diane E. Meier, director of the Center to Advance Palliative Care. Many hospice workers cannot go into homes where there is coronavirus because they lack protective equipment. In hospitals like Mount Sinai, where Dr. Meier works, chaplains often minister by telephone for the same reason. Instead of family around them, the dying patients get a video conversation or a telephone placed by their ear, she said.
Dr. Meier suggests families use these to communicate five thoughts, even if they cannot be present.
I forgive you.
Please forgive me.
I love you.
“Very few families aren’t in tears by the end of that list,” she said.
She also advised against catastrophizing the virus: most elders will not get it, and among those who do, even the very old, most will survive. “That’s the problem with mortality statistics,” she said. “They don’t tell you about all the people who made it through.”
And many elders thrive even now. Betty Mosedale, 87, whose son used to call once a month, said he now calls almost every day.
“It would be sad being alone, but I’m not afraid of that,” she said. “When you die, you do die alone, even if you have family around. It’s a solitary experience.”
But for others, dying alone feels like missing a last chapter on a life, said Rabbi Simon Hirschhorn, who counsels residents at the Hebrew Home in Riverdale, where death is a regular event. The people present at the end, he said, give focus to the death. “Now, if that is limited or impossible, it’s as if you might die in vain,” he said. “You become part of a statistic rather than a person whose life is at the end.”
For many older people, that is the true signature of the virus: not the fear of dying, but the fear of dying alone.
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