spin_dry Posted March 24, 2020 Share Posted March 24, 2020 BOSTON — As an I.C.U. doctor I’m used to giving bad news, but I was not prepared for this. I paused outside my patient’s room to watch her for a moment. She lay on the bed, tethered to a ventilator by the tracheostomy tube in her neck. Her husband sat in a small plastic chair beside her with his hand on her leg, smiling at some silly sitcom playing on the TV. I hesitated a beat. And then I entered. I had to tell him. There was no way to soften the blow. The hospital is changing its rules, I said. No more visitors. When you leave today, you both need to say goodbye. I watched their faces shift. My patient’s breathing quickened, and her ventilator alarm sounded. Her husband quickly moved his hand to her shoulder and her breaths slowed; the alarms silenced. He knew how to calm her. He had been there through all of it — hospitalizations for cystic fibrosis, the transplant, the bouts of rejection. When we took away her voice with the tracheostomy tube, he spoke for her. But now, as we tighten our protocols to protect our patients from the threat of Covid-19, she’s alone. Here in my hospital, as in so many others throughout the country, we’ve banished most visitors. It’s a tough decision that leaves our patients to suffer through their illnesses in a medical version of solitary confinement. And I’m worried for them. Because those of us on the front lines simply don’t have a plan for this. The isolation is, of course, even more profound for those who are infected with, or are being evaluated for, coronavirus. I took care of one such patient who was intubated when he started coughing up blood on the general medical floor. He was alone in his room, on FaceTime with his daughter, when it started. So that is the last image she has of her father — on a shaky computer screen, blood staining his hospital gown. I offer her updates over the phone, but the truth is that I am not sure when she will be able to see him again. Or even if she will be able to see him. The devastating image of the lonely deaths of coronavirus patients in Italy hangs over us all. Talking with one of the nurse practitioners in our hospital’s new Covid-19 I.C.U. one recent night, I asked what worried her most. “Patients dying alone,” she replied quickly. A doctor next to her nodded in sad agreement. On a recent shift, he had intubated an elderly husband and wife, both of whom had severe respiratory failure from coronavirus. Their daughter asked if she could come in to see them. Though we will make exceptions for many end-of-life visits, in this case, he had to say no — they all lived together, the daughter had a fever herself, and as a result could risk infecting other hospitalized patients. Which means that if her parents die of this, they will do so in separate sterile hospital rooms, far from anyone who loves them. So it’s up to us, the health care workers who are seeing these patients at the front lines, to find ways to maintain connection, to balance our fear with tenderness. This won’t be easy. I think of myself as the kind of doctor who sits at a bedside, who holds a hand, who explains what is going on slowly and gently even to my intubated patients because I can’t know what they will remember. I want to be the doctor who is always willing to spend a few extra minutes despite being stressed or rushed. But that is not the kind of doctor I have been for the past few weeks. Because I don’t want to spend a moment longer in a Covid-19 patient’s room than I have to. Even with a mask firmly in place, even with a gown and eye protection, I do not want to share the same air. So I do what I need to do and then I leave. I don’t take the time to reassure, to explain, surely not to hold a hand. Truth is, I am scared. As for keeping families involved from afar, this is not easy either. The number of phone calls we need to make has soared — just as our volume of patients threatens to as well. I can feel how much these conversations matter, in the breathless way a daughter answers the phone when I call, the way a husband asks me to speak slowly, please, so that he can take notes. But time is short. The incessant beeping of our pagers urges us off the phone. We will talk again tomorrow, I say, and I hope it is true. This is not enough. If this is our new reality, then we must do better. At my hospital, efforts are underway to bring an iPad to the bedside of every patient in isolation for coronavirus. We will also need to practice difficult conversations like delivering end of life news over the phone, without relying on body language and touch and facial expressions to convey meaning. As critical care doctors, we now understand that our patients and their families carry with them invisible scars from their time in the intensive care unit — anxiety, depression, post-traumatic stress. The words we use matter. And I know that we are overworked and afraid that we won’t have the equipment we need to protect ourselves. But I worry that unless we find some way to mitigate the overwhelming isolation this virus has created, we will leave a fleet of wounded patients and family survivors in its wake. I was thinking about all of this as I walked through the hospital on my way to the unit the morning after my patient and her husband said goodbye. The family waiting room, often so full that people have to sit on the floor, was empty. I had never seen it like that. A lone coffee cup on the table was the only sign of how things had been just the day before. I entered the unit, headed to my patient’s room. She was awake already, breathing quickly on the ventilator, eyes wide. When she saw me, she started to mouth words. Her husband would have been able to understand, but her lips moved quickly and I had no idea what she was trying to say. She soon grew frustrated. “I’m sorry,” I told her. But she was done. She closed her eyes and turned away, toward the empty chair next to her bed. I apologized once more and then, as my pager summoned me down the hall, I stepped from the room, leaving her alone. Daniela J. Lamas is a critical care doctor at Brigham and Women’s Hospital in Boston. Quote Link to comment Share on other sites More sharing options...
AKIQPilot Posted March 24, 2020 Share Posted March 24, 2020 (edited) This is a very tough enemy to fight. Many old couples are going through this exact scenario. May families as well. Hopefully the social distancing can take bold and we see the numbers start to level off. Things seem to be slowing down just a little bit on the west coast. The numbers of new cases in New York and New Jersey continue to explode. Our world has been changed forever Edited March 24, 2020 by AKIQPilot Quote Link to comment Share on other sites More sharing options...
f7ben Posted March 24, 2020 Share Posted March 24, 2020 10 minutes ago, AKIQPilot said: This is a very tough enemy to fight. Many old couples are going this exact scenario. May families as well. Hopefully the social distancing can take bold and we see the numbers start to level off. Things seem to be slowing down just a little bit on the west coast. The numbers of new cases in New York and New Jersey continue to explode. Our world has been changed forever It’s just a cold dude Quote Link to comment Share on other sites More sharing options...
Platinum Contributing Member Highmark Posted March 24, 2020 Platinum Contributing Member Share Posted March 24, 2020 Honestly considering how long they've been in there I think not allowing him to stay with his wife is going too far. Quote Link to comment Share on other sites More sharing options...
AKIQPilot Posted March 24, 2020 Share Posted March 24, 2020 3 minutes ago, f7ben said: It’s just a cold dude For some. For others it’s a death sentence. Quote Link to comment Share on other sites More sharing options...
Platinum Contributing Member steve from amherst Posted March 24, 2020 Platinum Contributing Member Share Posted March 24, 2020 Just now, Highmark said: Honestly considering how long they've been in there I think not allowing him to stay with his wife is going too far. x2 Quote Link to comment Share on other sites More sharing options...
Platinum Contributing Member Highmark Posted March 24, 2020 Platinum Contributing Member Share Posted March 24, 2020 Just now, steve from amherst said: x2 Is this serious......yes. Do precautions need to be taken....yes. Is this like the virus shown in the movie Contagion or Outbreak.....NO. Vulnerable people are going to die but I don't think its death rate is to the point where we stop our humanity....its a part of this. Quote Link to comment Share on other sites More sharing options...
frenchy Posted March 24, 2020 Share Posted March 24, 2020 sobering read Quote Link to comment Share on other sites More sharing options...
Redheaded Stepchild Posted March 24, 2020 Share Posted March 24, 2020 23 minutes ago, frenchy said: sobering read Very And it happens all the time sadly. Not just because of covid 19. Quote Link to comment Share on other sites More sharing options...
spin_dry Posted March 24, 2020 Author Share Posted March 24, 2020 1 minute ago, Redheaded Stepchild said: Very And it happens all the time sadly. Not just because of covid 19. Yeah, leprosy and the common cold 3 Quote Link to comment Share on other sites More sharing options...
Redheaded Stepchild Posted March 24, 2020 Share Posted March 24, 2020 Just now, spin_dry said: Yeah, leprosy and the common cold Cancer. Etc etc etc. Quote Link to comment Share on other sites More sharing options...
Zambroski Posted March 24, 2020 Share Posted March 24, 2020 You die alone anyway. Nobody is really “in it” with you. FFS, go home and die if you want an audience. 1 Quote Link to comment Share on other sites More sharing options...
spin_dry Posted March 24, 2020 Author Share Posted March 24, 2020 2 minutes ago, Redheaded Stepchild said: Cancer. Etc etc etc. That hasn’t been my experience with family members. The family was allowed in the room. Quote Link to comment Share on other sites More sharing options...
Platinum Contributing Member Highmark Posted March 24, 2020 Platinum Contributing Member Share Posted March 24, 2020 (edited) 1 minute ago, spin_dry said: That hasn’t been my experience with family members. The family was allowed in the room. As should a spouse here. FFS's we are leaving liquor stores open. Lets use a little common sense here. 1000 people a day can risk infection to buy booze but lets not let a spouse with their loved one while they die. Its fucking ridiculous. Edited March 24, 2020 by Highmark Quote Link to comment Share on other sites More sharing options...
Redheaded Stepchild Posted March 24, 2020 Share Posted March 24, 2020 Just now, spin_dry said: That hasn’t been my experience with family members. The family was allowed in the room. Sure. But many die in old age homes and hospitals alone all the time. Dying sucks. Quote Link to comment Share on other sites More sharing options...
Cold War Posted March 24, 2020 Share Posted March 24, 2020 we come in this world alone and go out alone .........we spend the time in between trying to convince ourselves that isn't so. 3 Quote Link to comment Share on other sites More sharing options...
Zambroski Posted March 24, 2020 Share Posted March 24, 2020 5 minutes ago, Cold War said: we come in this world alone and go out alone .........we spend the time in between trying to convince ourselves that isn't so. Sig worthy. Quote Link to comment Share on other sites More sharing options...
spin_dry Posted March 24, 2020 Author Share Posted March 24, 2020 46 minutes ago, Redheaded Stepchild said: Sure. But many die in old age homes and hospitals alone all the time. Dying sucks. Keep trying Quote Link to comment Share on other sites More sharing options...
Redheaded Stepchild Posted March 24, 2020 Share Posted March 24, 2020 Just now, spin_dry said: Keep trying I don't need to. You are blaming covid 19 for something that happens all the time unfortunately. Quote Link to comment Share on other sites More sharing options...
spin_dry Posted March 24, 2020 Author Share Posted March 24, 2020 Just now, Redheaded Stepchild said: I don't need to. You are blaming covid 19 for something that happens all the time unfortunately. Oh? Quote Link to comment Share on other sites More sharing options...
Redheaded Stepchild Posted March 24, 2020 Share Posted March 24, 2020 1 minute ago, spin_dry said: Oh? So you don't care about people who die alone. Just the ones who are forced to die alone. Gotcha. Quote Link to comment Share on other sites More sharing options...
F3600 Posted March 24, 2020 Share Posted March 24, 2020 Its a tough deal for sure and a reason why you should never let a moment pass without your loved ones knowing your heart. Some may be lucky and have a conscious person to say goodbye to. Most times its not during vising hours or you are rushed out of the room when they code and you are left with an unconscious person and remains that way until they pass. Its not the movies where they hold your hand saying last goodbyes and close their eyes. 1 Quote Link to comment Share on other sites More sharing options...
spin_dry Posted March 24, 2020 Author Share Posted March 24, 2020 1 minute ago, Redheaded Stepchild said: So you don't care about people who die alone. Just the ones who are forced to die alone. Gotcha. What are you talking about? Quote Link to comment Share on other sites More sharing options...
racer254 Posted March 24, 2020 Share Posted March 24, 2020 Guys, you are ruining the fear factor for spin. Fearmongering is what it's about. Quote Link to comment Share on other sites More sharing options...
Redheaded Stepchild Posted March 24, 2020 Share Posted March 24, 2020 Just now, racer254 said: Guys, you are ruining the fear factor for spin. Fearmongering is what it's about. Yes. He's trying to make dying alone all about covid 19 and failing miserably. Quote Link to comment Share on other sites More sharing options...
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