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In 2007, psychiatric nurse Linda Lombardi started treating a small, thin, gray-haired woman of nearly 70 who mixed sweetness with stubbornness.
"She was spunky," Lombardi says. "If she didn’t like something — she let you know." Like a medication — if she didn’t like its effects, she’d stop taking it, and say so. But she'd soften her refusal with a giggle.
"And she loved the Red Sox," Lombardi says. "She loved sports in general. And she loved doing word books where you pick out words on a page full of letters. And she liked to cook in her apartment."
The patient had no family or close friends, no one who could give WBUR permission to use her name, so we’re using her middle name — Ann — instead.
Ann had a difficult life. She had no memory of parents or other relatives. When she was just five years old, Lombardi says, she was left at an institution in western Massachusetts that sounds straight out of Charles Dickens: It was called the Belchertown State School for the Feeble-Minded, and eventually closed after its mistreatment of residents came to light.
Ann lived at the school until she was 17; then at the state hospital in Waltham, and later in state-run apartments. She had chronic mental illness and could never work.
"She had a diagnosis of schizoaffective disorder, and at times could be mildly paranoid," Lombardi says, "and at times she could be depressed. But otherwise she pretty much lived her life, in the years that I knew her."
Three years ago, Ann broke a hip. She recovered, and broke the other. Then this April, she got very sick with COVID-19. Lombardi called her at Cambridge Hospital, and found her confused and distressed, "very scared and wanted to go home, and wasn’t even sure where she was or why she was there," she says.
Ann calmed down, but she kept getting sicker. Lombardi didn’t know if Ann was prepared to die and didn’t want to frighten her by mentioning death, so the next time they spoke, she just asked what Ann hoped her “outcome” from being in the hospital would be.
"And she looked at me with her eyes wide open, and she said, ‘I want to go home! I want to see the Red Sox.’ " Lombardi says. "And I couldn't bear to tell her they weren't playing."
Ann’s condition got so dire that she was moved to the Comfort Care Center, a special palliative care ward set up for patients dying of COVID-19.
Dying COVID patients in many hospitals have been communicating with loved ones using tablets and smartphones. Dr. Robert Janett, medical director of the temporary Cambridge Health Alliance Comfort Care Centers in Cambridge and Everett, says the the staff used mobile iPads to support patients.
"No one wants to die alone," he says. "People really deserve, in those final precious days of life, as much comfort, as much caring, as much affection as they can possibly get. And if someone is alert enough, aware enough to receive that, then it's so important that you provide it in any way possible."
Of all the centers' patients, Janett says, Ann seemed the most alone.
"Of the 22 other patients we cared for in our comfort care units, the rest of them all had identifiable families who remained really very involved in their care," even if only virtually, he says.
It can help just to hear a loved one’s voice at the end, he says, because as life ebbs, "it’s the hearing that is the last sense that people lose. And so being able to talk to your loved one, and be pretty well assured that they can hear what you’re saying, can be a very good thing."
The Last Voice
The last voice that Ann heard was Linda Lombardi’s. The final time Lombardi checked in — via FaceTime on a tablet set up by Ann’s bed — Ann was breathing fast and unable to respond.
"But she made eye contact with me, and I told her I would just stay with her," Lombardi says, "and started talking to her about the things that she enjoyed."
She has worked in intensive care units and could see that Ann was near the end. "And I just couldn't let her die alone," she says. "I just couldn't do it."
After a while, Lombardi thought it might not make sense to keep talking non-stop, "so I just told her I was going to be with her. And that I would be silent, but that she could see me, and I would just be with her."
Over nearly an hour and a half on FaceTime, Lombardi could see Ann’s breathing gradually slow from about 40 breaths a minute to just two.
"She just looked peaceful," Lombardi says. "And I kept telling her to just be calm and to be at peace. And she was going to a place where she wouldn't be suffering anymore. And it was okay to go whenever she was ready. And…and she just slowly slipped away."
Lombardi couldn’t sleep that night, and she needed to talk through the experience with family and friends, but she says she doesn’t think she did anything special. She just couldn’t abandon a patient, especially one who’d been abandoned by everyone else in life.
Dr. Jason Strauss, the director of geriatric psychiatry at Cambridge Health Alliance, begs to differ on whether what Lombardi did was special, and encouraged her to share her story despite her reluctance.
"What she doesn't understand, what I'm trying to help her to understand, is that what's normal, what's routine for her is, just really, truly extraordinary."
Lombardi does hope to do one last special thing for Ann, though: spread her ashes somewhere meaningful.
"It’d be lovely to do it at Fenway Park," she says, "but I don’t think that’s possible."
And she says despite all Ann's travails, she didn't feel shortchanged by life.
"You know," she says, "it was the only life she knew. And she lived it the best she could."
This segment aired on May 28, 2020.
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