She started crying. This tough, capable, juggernaut of an ICU nurse looked just a little broken for a second while she cried. “It’s not fair. It’s immoral—or unethical. I don’t know—I know it’s the right thing. We have to protect the patients and staff but … if it were my dad! I just … I can’t go tell them that she can’t come see him when we know he’s going to die. She wants to be there for him. I just can’t do it.” I told her I could talk to the family. It would be okay. She looked at me, a general surgery resident on my sixth straight night of ICU call, shook off her tears, and told me she could do it. She left to go tell the family that the hospital isn’t allowing visitors under any circumstances right now because of the coronavirus pandemic. As health care providers, we learn to be—to some degree—emotionally distant from the pain of our patients. Feeling the full weight of the grief we see every day is crushing. So, we all learn to compartmentalize those emotions at the moment; work through them later—when we have the time. At work, we must do our jobs. We must take care of the next patient. But we are human beings. When I look at my patients, I see my mother, my brother, my children, myself. I put myself in their shoes to help them make decisions. That empathy helps me to be a better physician. But it also takes a toll. In this global pandemic, that toll has exponentially increased. In the last several months, as the hospital has put in social distancing restrictions to protect staff and patients during the COVID-19 epidemic, I have found myself spending more and more time doing emotional work with my patients. Because family members cannot be there, health care providers act as surrogates, intermediaries, advocates—important roles that significantly contribute to patient care. The patient with terminal cancer diagnosed on this hospital admission—after placing an arterial line, I held his hand. I listened to his fears about dying; about the pain he would feel. I didn’t know what to say, but I could listen to him; I could witness and sit with him. Another patient came to our ICU after an accidental overdose of medication. Her daughter called me five times that day—she was terrified that she couldn’t be there for her mom. I did my best to describe her condition and show what I could through the phone camera, but nothing could replace the reassurance loved ones feel just being there. My wife (also a physician) and I know the difference it makes to have a family member at the bedside in the hospital. A few years ago, her father developed Guillain-Barre syndrome that left him completely paralyzed for several weeks. Along with the rest of the family, we took turns staying with him in the hospital so that there was always someone with him. When I stayed with him at night, sometimes he would just call out to make sure I was there. That he wasn’t alone. That someone was there for him. I can’t quantify it; I can’t measure it; but I know that it made a difference for him, for my wife, for his entire family. The act of being there was an act of love. It was the thing that we could do. It was all that we could do. During this epidemic, we have to deny families that last, only act of love left that they can give—the act of being there. Getting sick enough to be in the hospital right now—for any reason—means being alone. Being sick and alone. Dying alone. Alone except for us; we are the ones that can be there. Kathleen M. O’Neill is a surgeon Source
