Under normal circumstances, I meet family members at the bedside of a patient. Meeting with and supporting family members give meaning to my days. This is especially true during times when I have little control over the patient’s trajectory; yet, what I can do is ease family members’ suffering. Due to COVID, however, there were new rules about family members visiting—no family member could visit unless the patient was within days of death.
My patient was in the cardiac critical care unit where he had been struggling with COVID-19 for over a week on a ventilator. I knew that he was going to die in this hospital based on how his labs looked progressively worse.
As the medical intern on the team, it was still my job to ease the family members’ suffering, and now I had to do so over the phone. I called them daily—there must have been eight people in the patient’s wife’s household every time I called—daughters, sons-in-law, grandkids. I pictured them sitting together every day anxiously awaiting my phone call. I sensed the patient’s wife’s fear during my calls, the tremor in her voice. The thought that my phone call could bring fear to people I wanted to help troubled me. I wanted to reach out and hold all of their hands through the phone. Instead, I had to focus on my job to update them, to somehow convey how sick he really was so they did not have to wonder or be misled. “He’s still very sick,” I would say with sorrow, and then I would describe the day’s events. I would hang up, wondering if my phone calls adequately conveyed the severity of the situation. Did they really understand what I meant when I explained his need for increased medication to maintain blood pressure? Eventually, I had to tell them—over a phone, with zero facial expression, zero hand holding, and without them seeing the tears in my eyes—that their loved one was dying.
Most people do not want to die in a hospital, and most people do not want to die alone. Determined not to let this patient die alone, the day after relaying that horrible news, I obtained permission for one person to visit the patient while he was still alive. We were not sure whether he was going to die “within days,” per the visitor policy, which is why I had to obtain permission. The fact that I had to obtain permission for someone to visit my extremely ill patient on a ventilator haunts me. But finally, I thought, I have done something to help ease this family’s suffering. Yet, when I told the family, I sensed that I had caused increased stress among them. “Only one person can say goodbye?” the patient’s wife said quietly. The decision of choosing just one person was too difficult to bear.
Instead, we decided on a Zoom call amongst family members so that everyone could say goodbye together. Within hours, our compassionate palliative care team set it up. I promised the family I would be on the call to help support them, so I anxiously put on the gown over my scrubs, then gloves, then mask, then face shield to enter the patient’s room and hold the iPad. The family I had spoken with so many times over the phone would now “see” me for the first time, looking extraterrestrial through an iPad screen.
Before I entered the room, I glanced at the patient’s “about me” page taped to the door. Someone had worked with families to create “face sheets” on patients that included photos of them dancing with loved ones, facts about their favorite artists, or funny stories regarding their 60-year marriage. These helped fill the void, in some ways, of the patients’ loved ones not being at the bedside sharing memories with us. I was not sure whether to be thankful for or upset by the face sheets. Recognizing the patients on ventilators as more human reminded me of why I was there but also made me feel angry. I was angry that these patients—these humans who surely made an impact in so many loved ones’ lives—were dying with just their nurse, a handful of other medical professionals, and me by their side.
Still, I tried extra hard to pay attention to the face sheet this time before entering the room, to try to imagine what this patient’s wife of 60 years could be feeling as she approached these final moments with her husband over Zoom. I took a deep breath and entered the room to hold the iPad. The family members with whom I had spoken daily, plus others, were on the Zoom call. I said hello through the mask and face shield, and I held the iPad to face their loved one as he lay there motionless on a ventilator. One by one, his loved ones said goodbye to him. My face became damp with tears, loosening the grip that my mask had against my face. My mind wandered to this patient’s roommate, also suffering from COVID, also on a ventilator and very sedated. Could he hear this discussion?
I held my patient’s hand the whole time through my glove. Normally when I hold a patient’s hands, I appreciate the wrinkles, thinking about the life those hands have lived, the hands those hands have touched. Holding the hand through my glove meant that I could only appreciate a pulse as he lay motionless.
After about one hour of goodbyes, we wrapped up the Zoom call. “Thank you, doctor,” the wife said, with seemingly genuine gratitude. “You’re welcome,” I replied quietly, not understanding what I was saying you’re welcome for. The Zoom call felt wildly inadequate, and I did not know what else to say. I wanted so badly to ease the family members’ suffering. I wanted so badly to hug them. I wanted to and I needed to, for my own coping. I said goodbye through the mask, face shield, and iPad. I exited the room, removed the protective equipment, tucked back into our physician workroom, and cried alone. As the next wave of COVID devastates our country and visitor policies remain strict, I wonder how we can do better both for our patients’ families and for our colleagues.