by Sal Kamal, MD (PGY-3)
“Please, can I see her? I just want to hold her hand.”
“I’m so sorry.”
It was my last shift working the COVID ICU, and I was caring for Ms. Robins, a middle-aged woman who was critically ill from an unidentifiable respiratory infection. These days, that meant she was classified as a PUI, or a “person under investigation” for coronavirus.
Our hospital had just enacted a policy to limit family visitation unless a patient was likely to die within 24 hours. Epidemiologically, the practice was necessary to avoid further viral transmission, but psychologically, it was devastating for families. In this case, even though Ms. Robins had virtually no hope of meaningful recovery, she did not meet that criteria just yet.
After a month’s service in the COVID unit, it had only gotten harder to deny visits to family members who had not seen their loved ones in weeks. Even when we arranged for the family to video conference into rooms, seeing a loved one sedated and on a breathing machine without being able to touch them felt cruel in a different way.
I thought about my co-residents who had gotten sick, about what I would do if one of my loved ones was intubated in the ICU. Would I try to break the rules and visit them? Probably, but I tried not to let myself dwell on hypotheticals.
In the course of a week, we had gone from a handful of COVID cases to entire floors full of patients afflicted by the virus. Since our ICU doubled staff and beds, the work had been manageable. In that, we were lucky, but the virus was affecting morale in different ways. Everyone was wearing a mask, so it became harder to smile back when greeting nurses in the morning. We were physically distancing, so I withheld my hand in situations when I’d normally fist bump other members of the care team. And, when family members visited dying patients, we stood awkwardly by the door instead of offering a hand or hug in support.
As the day wound to a close, I heard a familiar beeping noise from the ventilator in Ms. Robins’ room. Her lungs were failing despite maximum support on the ventilator. After talking with the charge nurse, I called Ms. Robins’ sister back.
“Beth, your sister is getting sicker. I’m worried that she’s dying. Can you come to the hospital?”
“Oh, God. I’ll be there in 10 minutes.”
When she arrived, she was met by the chaplain and promptly given a mask like the rest of us. As she approached the room, I thought about how disorienting it must have been to be escorted to her dying sister by masked health care workers she had never met before.
I introduced myself, and she immediately recognized my voice. “Thank you so much for calling me, for everything.” I felt my eyes watering, and she put her hand on my shoulder. “I know you did everything you could for her.” Somehow, in that moment, I was the one who needed consoling.
As I walked out of the COVID ICU that evening, I passed by an empty room being diligently cleaned by custodial staff, a group of nurses reviewing new COVID protocols, and the oncoming resident retrieving a fresh N95 mask. I passed by Ms. Robins’ room and saw Beth at the bedside, holding her hand and saying a prayer. I felt the weight of our responsibility as medical providers, but I was also incredibly proud of our staff, our patients, and their families for the camaraderie and compassion I had witnessed in the prior month. And for the first time in several weeks, I left the unit with a little bit of hope.
Patient names and clinical details changed to preserve privacy.