The Unintended Consequences Of Isolating Our Dying COVID-19 Patients

Lisa’s heart pauses every time her phone rings. She’s unsure if the call she is answering is going to be the final update she will ever receive from the intensive care doctor caring for her love, John. Her 55-year-old husband of 31 years was placed on the ventilator eight days ago for a lung infection due to coronavirus. He resides in the ICU of the local academic hospital, which, like most facilities, has a “no visitors” policy during this pandemic. The twice-daily phone calls have become progressively less hopeful, the staff painting a grim picture. At least, that’s the impression she gets. Isolated at home away from her groom, Lisa is not fluent in medical jargon and does not get the benefit of seeing the facial expressions of the doctor giving her updates. She thinks there are tears, but she’s unsure. She also cannot be the recipient of a therapeutic touch on the arm by a caring nurse. Such is the fate of thousands of loved ones as they anxiously await updates from the team providing what, for some, will be end-of-life care.

“In an effort to more thoroughly eliminate risks in our hospitals, I believe we are jeopardizing the humanity of the care we are providing.”

As an ER physician, I understand the discontinuation of visitation in hospitals. We are at the foothills of the sigmoid curve of this pandemic, I believe. However, my role in the emergency department also allows me to understand that facing this crisis head-on is all about balancing risk mitigation by providing the care and comfort our patients and their families need. The only way I can take my risk to zero during this outbreak is to live in a bunker and not traverse the threshold of the hospital; that will not happen because I have been called to this place at this time to provide care for God’s people.

We still allow one visitor in our ER, but across the country, most institutions do not allow visitors for inpatients. In an effort to more thoroughly eliminate risks in our hospitals, I believe we are jeopardizing the humanity of the care we are providing. I have to wonder: What are the downstream consequences of this stance?

Patients need family

In medicine, we realize that our one patient in front of us is just the face of the small tribe of people who need our care. Spouses, children, and other relatives rely on our improving the health, or at least reducing the suffering, of their loved one as they stand vigil to that work. Now, they are deprived of being integrated into the healing process. In addition, as our hospitalized patients are struggling to breathe and fighting for their lives, they are not permitted the comfort of the familiar face of their dearests. COVID-19 is a disease that strips us of the humanity of healing in community or dying with dignity amongst people who know our stories, cherish us, and see us for everything we mean to the world beyond the label of “the patient in room 4257.” What if the lack of family at the bedside is a detriment to improved survival?

“If I become infected and am critically ill, please don’t let me die alone.”

Caring for the survivors

I learned long ago in residency that my role in caring for the dying patient did not end when the code was called or even after the “death talk” in the quiet room. I have to be willing to step into being the comforter and caretaker of my patient’s survivors. I dread informing the family that our resuscitative efforts were unsuccessful; I am the face that delivers the news that makes that day the worst day in this person’s life. Witnessing the agony that occurs in the wake of death tattoos little scars on my spirit each time. However, I now realize that our army of health care providers no longer hears those wails in-person, so we are unable to provide comfort to these families at a time when they need our attention. The survivors are denied not only the closure of being with their cherished on their last days, but they are also banned from receiving the immediate care of those of us who have developed the skill of tending to their grief. From home, families do not have the physicians, nurses, chaplains, and the social workers, helping them navigate those minutes and hours following death.

A proactive plan

My heart breaks at the isolation I see the families of our sickest patients enduring. Let’s develop mechanisms to don one visitor per day with PPE so that we lessen the toll this disease is taking on our need for connection. This is possible with proper planning. Lisa’s being able to see John would initiate a cascade of events that would unleash incalculable benefits. Her husband’s spirits would be lifted, knowing he is not alone. If his illness proves not survivable, she would know that she served him well by her presence in his final days. She would also receive the comfort of the people who have been trained to care for her in the aftermath. There would be closure.

I’m an emergency physician. You will never convince me that risk elimination is worth the cost we are paying for it. If I become infected and am critically ill, please don’t let me die alone.

Dee Bonney is an emergency physician and can be reached at his self-titled site, Dee Bonney.

Source