In the break room of the small Maryland community hospital where nurse Chaya Milikowsky works, a large painting depicts a tree standing in grass against a deep blue sky.
Every time a patient hospitalized with the coronavirus dies, their nurse paints a star in the sky; for every patient that recovers from the virus and is discharged, they add a flower in the grass.
“We’re all so invested in these patients and know we’re never going to forget them – both those who die and those who make it out of the hospital,” Milikowsky, who works in the intensive care unit exclusively with COVID-19 patients, tells Haaretz.
After having children, Milikowsky, an Orthodox Jew, became a nurse as a career change. Early on, she was assigned to critical care patients and now works in her hospital’s ICU. “It’s a constantly changing environment, you have to be on your toes,” she says. “That’s what I love about it. And yes, it can be hard seeing a lot of sickness and a lot of death. But on the other hand, I can be witness to people who we didn’t think would recover and then end up recovering.”
Milikowsky, 36, is a member of the Orthodox Jewish Nurses Association, an organization established in 2008 by Rivka Pomerantz, a nurse who felt the need for a forum to discuss issues specific to those in her field from her own community. She began an online support group at the time, which is now a proper organization with 300 paying members and close to 2,500 people interacting on its Facebook group.
The association’s president, Shevi Rosner, also 36, says that at first the group was intended to help navigate concerns such as not working on Shabbat, wearing a skirt or covering one’s hair during shifts.
“Anti-Semitism is always an issue, too. Co-workers are making remarks about different patients and stereotyping, so it was a safe place to discuss the issues that came up at work, what people’s view are on how you handle [them],” Rosner says.
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But the group also discusses medical experiences and shares best practices. In recent months, as the coronavirus has overtaken hospitals across the United States, the association acts much like a support group for Orthodox nurses, men and women alike, who are dealing with the pandemic.
They now hold weekly Zoom conference calls to talk about issues relating from stress management and emerging treatments to halakha (Jewish law).
“Some of the nurses were forced to work on [Passover], on Shabbat, because it’s a critical situation now,” Rosner says. “It’s a lot of new situations, so you have to be very flexible and quick to learn, and just be a team player.”
In addition to working their daily shifts, nurses involved with the Orthodox Jewish Nurses Association have also been trying to help their own local communities. People come to them with their health questions, and see them as point people – especially for those afraid to go to the hospital.
A pandemic of separation
Because of the high rate of infection associated with the coronavirus, hospitals have banned family members or any visitors from COVID-19 patients’ bedsides. Nurses like Milikowsky and Rosner have taken on the responsibility of connecting patients to their loved ones.
“The family ends up being almost our second patient,” Milikowsky explains, adding that in general, families are highly involved in caring for those in the ICU. “[Now] we need to change our role both with the patients and with the daily interaction with family.”
Rosner has worked as a nurse for 15 years. The past 13 of those years have been at the New York Presbyterian Hospital, where she is assigned to the Neonatal Intensive Care Unit. Many of the mothers giving birth are carrying the coronavirus, she says, so if a baby needs to come to the NICU, they must be treated as if they themselves are sick. Only one parent can visit at a time, and mothers and fathers feel left out of the process.
“We do have a patient in our unit now: The mom was positive so she couldn’t visit, dad also was just getting off it so he couldn’t visit and the baby ... needed surgery after birth,” Rosner says. “So the baby is going through it alone, without the parents.”
Making sense of tragedy
Although Milikowsky had received some training in epidemics during the 2014 Ebola crisis, the coronavirus outbreak is not something she ever thought she’d experience. “I knew I would see sick people, but I didn't ever imagine seeing this quantity of sick people,” she admits. “I would say about half of our COVID-19 patients in ICU are dying.”
Another member of the Orthodox Jewish Nurses Association, Mara McCrossin, works at Stony Brook Hospital on Long Island as an ICU nurse specializing in neurological issues. Although she has recently seen a reduction in COVID-19 patients at her ICU, McCrossin says the numbers change daily and the sense of urgency is still dominant.
Rosner, Milikowsky and McCrossin all say they have found some solace from the tumult and uncertainty in their Jewish faith.
“There is of course the value we ascribe to every life,” Milikowsky says. “I do find myself saying a brief prayer for my patients, usually before I am about to do a procedure. Having belief in a higher being gives me strength in knowing there is purpose and meaning behind this all, even if we don’t see it now,” she explains.
Rosner says that navigating the crisis has actually strengthened her faith. “So much is unknown and seems so random. I truly believe that this is Hashem, God running the world, sending strong messages to us,” she says. “I’ve been strengthened that there is a master plan, because if you don’t believe in that, you just can’t make sense of this tragedy.”
“I think my faith has a lot to do with how I practice most of my life,” McCrossin says. When it became apparent that the outbreak meant she would have to work on Passover or Shabbat, McCrossin says she consulted a rabbi to make sure she was “on the right track in terms of what I should and should not be doing.”
She adds that some of the videoconferences organized by the association are led by rabbis with medical backgrounds, who have helped her deal with the crisis by putting its issues in a Jewish context.
A community in the spotlight
As the crisis has unfolded in the United States, the Orthodox community has received an outsize amount of attention. Although Orthodox leaders, rabbis and organizations have called on their public to heed government instructions, and community members overwhelmingly comply with the guidelines, some incidents have attracted media attention.
Last week, a crowded funeral in Brooklyn led Mayor Bill de Blasio to post a controversial tweet addressing “the Jewish community” as a whole, which some warned could exacerbate the anti-Semitism already present on social media.
“As someone working with COVID-19 patients, and who sees the horrific manifestations of this virus on a daily basis, I get very frustrated and upset whenever I hear about anyone – whether in the Orthodox community or in the world at large – breaking social distancing guidelines or behaving in a manner that can put others at risk,” Milikowsky says.
“That small percentage of Orthodox Jews who do flout restrictions and place others at risk will have to answer for their actions to a heavenly court one day. It is inexcusable,” she adds.
“That being said, I personally have not seen much of that behavior in my Orthodox community. And, from what I hear, most other communities in my area are adhering strictly to social distancing guidelines.”
Orthodox Jews, she says, are not disproportionately represented in her area’s hospitals, but some fellow members of the association from other states had reached out to ask Milikowsky to “inject some fear” into their community members, who were not grasping the importance of social distancing.
“This is another example of community leaders being proactive and making sure those in the Orthodox community take all necessary precautions,” she says.
“As with any group, there will always be a few bad apples. That being said, I and my Orthodox colleagues are also struck by the way the media focuses on the breaches in our community, while often overlooking those in other communities.”
The high population density of the New York area’s Orthodox community, along with its intimate social structures, Milikowsky says, make it more likely that the disease will spread more quickly among its members. “So the takeaway for our communities is that we need to be even more strict on some things than the general public.”
For McCrossin, the severity of the outbreak within the Orthodox community has influenced her view on the crisis. “I know that just by nature Jews are creatures of congregation, that’s how our religion is ... and by nature that puts us at higher risk and greater risk of developing the disease.” But she notes that this effect is not restricted to any one population group or religion, or even behavioral patterns. “It’s not selective to those who congregate; it affects everyone.”
Rosner concurs. “I think for people who don’t have sick family members or friends, it’s hard to believe what we’re all dealing with,” she says. “But unfortunately, once we started having people pass away, it became more real and people took it more seriously. Obviously, we don’t want to scare anyone off and share horror stories – but the truth is, there are horror stories to share, there really are.”
“It’s like nothing I’ve ever seen before in my career,” adds McCrossin, who has been a nurse for 11 years. “There is no other way to put it.”
But amid the chaos, the ultimate message is still hope. At Milikowsky’s Maryland hospital, the current motto refers to that canvas in the nurses’ break room that shows the tree and deep blue sky. “We’ve been telling patients, ‘Be a flower, not a star,’” she says.