Last responders: COVID pushes end-of-life workers to the brink

Warning: Descriptions may disturb or offend some readers.

Los Angeles County, California, United States — As Jason Roa opened the furnace door, a blast of hot air filled the small crematory at White Emerson Mortuary in Whittier. At times, he said, the furnace can reach over 1,093C (2,000F). It emitted a deep orange glow, and white-hot sparks danced across its bottom. Beads of sweat trickled down the 39-year-old’s forehead.

“When I first started, the heat was really intense,” Roa told Al Jazeera. “Now, I barely notice it. It’s amazing what you can adapt to.”

On a platform adjacent to the mouth of the furnace sat a brown cardboard casket. With a decisive push from Roa, it rolled into the fire and the furnace door closed shut. It takes nearly two hours for a body to make its final transformation from flesh to ash. Then Roa will repeat the process again. And again. And again.

As the United States registers more than 536,000 COVID-19 deaths, last responders — the workers responsible for laying the victims to rest and helping families navigate the grief and confusion of death — are being stretched beyond their limits by an unprecedented demand that has exacted a heavy physical and emotional toll.

“I’ve been in this business for 11 years; I’ve seen a lot,” Roa said. “But this winter was unlike anything I’ve ever experienced. When I started here in January, the storage unit was so full of bodies, you had to move six or seven to get to the one you needed. At the mortuary I was at before I came here, the lot was full of extra refrigeration units for all of the bodies.”

Heartbreakingly high demand

In California, the most populous state in the country, more than 55,000 people have died from COVID-19, according to state figures.

Between January and March, the state’s death count more than doubled, with a large percentage of those deaths coming from the beleaguered city of Los Angeles, where more than 22,000 people, disproportionately people of colour, have died from COVID-19.

Alex Matthews is the owner of All Caring Solutions, which operates four crematoriums in Southern California. In the worst days of January, he said even his relatively large operation simply couldn’t keep up with demand.

“I had a crematory worker call me one day and say ‘I just can’t do this anymore. I’m exhausted,” Matthews told Al Jazeera. “At some points, we were bringing in twice as many bodies per day as we could cremate.”

The incredible demand, as well as the confines of the coronavirus pandemic, have forced crematory owners to do something that would have been unthinkable in their line of work just a year ago: tell families who are grappling with the death of a loved one that they can’t help lay them to rest.

Bob Achermann, executive director of the California Funeral Directors Association, said that mortuaries are having to say ‘no’ at a time when ceremonies that can offer families a sense of closure are more important than ever.

“Many people aren’t able to be by the side of their loved one in the hospital for their final moments because of the pandemic,” Achermann told Al Jazeera. “So people are craving the intimacy of these ceremonies now more than ever. Having to turn those people down is heartbreaking. But it’s not for lack of desire. We’re all just struggling to stay above water.”

Workers say the emotional toll of denying services, such as gathering for a burial or cremation ceremony — or having to turn families down entirely — can be steep.

“In January, my friend’s stepdad died, and I put down the phone and cried because I didn’t know if we would be able to help,” Paul White, the managing director of White Emerson Mortuary, told Al Jazeera. “But we had exactly one more spot. It was a small miracle.”

Socially distant grief

Many in the industry say they got into their line of work to help others navigate what is, for many, one of the worst moments of their life. But now, their ability to offer comfort and closure is limited.

“You can’t hug people, you can’t put your hand on someone’s shoulder in this time of terrible anguish,” Maggie Mcmillan, who works in funeral services at All Caring Solutions, told Al Jazeera.

“It feels very cold and distant. But the most heartbreaking thing is having to turn families away, to tell someone we can’t help them. This is the first time we’ve had to do that in our 113-year history. It’s an emotionally taxing job in normal times. Now it’s multiplied by ten,” she added.

The precautions have also meant an increase in online ceremonies, and some wonder if those changes will linger after the pandemic.

“A lot of ceremonies have been moved online,” Dan Flynn, who operates Simply Remembered Cremation Care in Santa Barbara, told Al Jazeera. “The way we approach funerals might never be the same again. With the 1918 Spanish influenza, death occurred on such a large scale that there were changes to end-of-life ceremonies, like making sermons much shorter, because people had to adapt. In some ways, we’re seeing that now.”

Forgotten last responders

The level of demand has resulted in other unprecedented measures. In January, for the first time in its history, the South Coast Air Quality Management District temporarily suspended limits (PDF) on the number of cremations that can occur each month in Southern California to assist with the backlog of bodies, a decision that one mortuary owner called an act of divine intervention.

The order has since been extended several times.

“They saw us struggling, and they acted to help,” White said. “We’re all kind of shell-shocked right now, and the one thing we need more than anything else is to know we aren’t alone, that we haven’t been forgotten.”

It’s a concern shared by Matthews.

“Front-line workers deserve all the praise they’re getting, 100 percent,” he said. “But every day last responders are moving mountains, and they’ve received very little attention. It’s been lonely.”

“In a way, I think we’re seen as a sinful reminder of the larger failures of decisions that should, or shouldn’t, have been made. At the end of the day, our work is the ultimate manifestation of larger failures to contain the virus,” Matthews added.

But within the industry, and even among competitors, the collective experience of tackling the enormous demands of the pandemic has brought the profession’s exhausted workers together in a feeling of solidarity and mutual compassion.

“A lot of my friends work in the industry, too,” Roa said. “It’s been hard on all of us. We’ve had to lean on each other. But at the end of the day, there’s nowhere else I’d rather be. I believe this is important work. It feels satisfying to know I’m using my skills to serve others.”

White concurs.

“There’s a quote by William Gladstone: ‘Show me the manner in which a nation cares for its dead, and I will measure with mathematical exactness the tender mercies of its people,’” White said. “It’s been incredibly difficult. But I truly believe the work we’re doing here is sacred.”