I spent many weeks as a patient in the hospital a few years ago and was encephalopathic during the entire stay. This means that I could speak and interact and, at times, especially to those who did not know me, appeared normal. I was told that I would give coherent lectures to the medical students who came to see me on rounds, only to not remember doing so an hour later. I am sure that I was assumed to have the capacity and could consent to tests and treatments. The fact was that I still do not remember anything of that time, even years since. My wife was at my bedside daily and made every decision during that horrible time, and she guided me to wellness. She was more than a visitor. COVID-19 has taken away visitors from the hospital. Throughout the country, people lie in bed, alone, for what is often the singular, most challenging time of their life. Families are forced to stay home – wondering how their parent, spouse, child, or friend is doing. The nursing staff and others at the hospital are given the added task of being family to each patient. At a time when they are already burdened by what this terrible virus is doing, they now must take on this new role. They are doing it daily and doing it with compassion. Finally, people are seeing how amazing health care workers are. In the absence of family at the bedside, all are reaching to technology as we are through social distancing every day. They are bringing family into the room through FaceTime, using phones and computer tablets – even showing patients how to Zoom, Google Meet, and so many other forums that have risen up to help us fill the social needs we all seek. What is obvious to those who treat people in the hospital now is that everyone is very ill. COVID has stopped elective surgeries. People do not even come to the emergency room now unless they are seriously ill for fear of exposure. The non-COVID patient is getting little attention in this pandemic by the media. They lie in beds in every hospital fighting to recover without visitors while fearing they will get the virus and bring it to loved ones once discharged. The COVID patient in the hospital presents yet another challenge. Not only can they not have visitors, but all those they see are stripped of humanity. It is a nightmare. Caregivers are now making badges with their faces on them to wear on their protective clothing so a patient might get some idea of what they look like. Each encounter is a vivid reminder of how serious what they have is. The many tales of how those who treat these patients are going above and beyond are both heartbreaking and enlightening. So why not open the doors and let those who want to visit come? Isn’t it their right? Shouldn’t it be up to each patient to have a willing visitor come to see them? Autonomy means that the patient has the right to choose as long as they are informed and have the capacity to understand. Autonomy has been the ruling principle in medical ethics for decades. Autonomy now has yielded to Justice – the principle that must guide us in a Pandemic. Our decisions must be focused beyond self and to society. We must look to the good of many as well as the one. Every visitor to a hospital right now must be treated as a possible vector who can carry this horrible virus to and from the hospital. We have no idea yet who is infected, how exactly it is carried, and who it will kill next. These are simple facts. Allowing visitors is likely to continue the spread of COVID-19, and in doing so, continue to fill our hospitals with patients who are alone. These are horrible times. Science fiction is now reality. What about the patient who is dying and in the hospital? What about the child? Rules are created in every hospital, and exceptions are part of all rules. People working within hospitals who know the relative risks are making these decisions every day. The reality of the patient who is in the dying stage of COVID-19 is that they are sedated, unable to talk because they are on a ventilator, and they are unaware. The visitor may want to say goodbye and know they were there. The patient will not know. The fact that someone wants to visit despite the risk shows the incredible love that they have for this dying person. No doubt that the patient would have felt the same. Part of love is protecting. The last thing I would want if dying of COVID would be to have those I love risk getting this disease or bringing it to others. The last vision I would want for them is to see me in an ICU on a ventilator. My parents are no longer alive. When I close my eyes, I see my father standing tall in his police uniform, and I smile. I see my mother baking chocolate chip cookies, and I salivate. My wife is resourceful and brilliant and would have found a way to direct my care from home if not allowed at my bedside. She would have gotten me well. We owe it to those we love, as well as to those we do not know, to do our part to control the spread of this heartless virus. Not visiting a hospital right now is an act of love for all. John F. McGeehan is an internal medicine physician. Source
