COVID Crisis Post 27: When Heart Trumps Brain.
Every person deserves to have their loved ones, their family, by their side during their last few breaths in this world.
And I never thought there would come a day where this was not an option.
I understand 100% why it is not. But I also want to scream uncontrollably as a result.
The events of the last few days have made me think about my dad more than I have in a long time.
First Ashish. Then Lin. Then a family yesterday early morning who would continue to fight for their husband and father till his final breath.
We had an elderly gentleman, someone who was COVID-19+, intubated, and very sick. He was no stranger to near-death experiences as he had survived numerous deadly arrhythmias in the past.
He was a fighter.
Every institution has set strict policies that family cannot be at the bedside of a family member who is COVID-19+, even in the likely event of death. Except when those policies do not apply.
Because sometimes humanity breaks through and says screw policy.
So the wife was allowed to be by her husband's bedside because the expectation was he would pass. Except he didn't.
This is a success, do not get me wrong. But typically in this disease process, a short lived-success.
And then, the wife refused to leave him.
And every request from the primary ICU team asking for the wife to leave was met with the same response:
No.
Obviously. So enter me.
I happened to wander down to the floor when I caught the eyes of those frustrated with the current situation, those individuals believing it was a mistake to have allowed the wife to be at his bedside in the first place.
So frustrated, I was asked to take the lead in this regard. The way I approach any situation with a patient or patient's family is having a clear understanding of what I believe are the only acceptable outcomes. And the only acceptable outcome in this situation was for the wife to leave. So I donned my PPE, including my Bane-like mask with pink filters, and went in.
When I entered, the wife was at her husband's bedside with her children on FaceTime. But without hesitation I went into doctor mode and said directly to the wife, I am sorry but you will have to leave your husband's bedside per hospital policy and we could not make any exceptions. She immediately retorted by saying she was not interfering and she will not leave. When I said her husband is doing fine and we would notify her should anything change, she took a long look at me and said:
"Yes, the only reason he is doing fine is because I am here."
And with that comment, I took pause.
As ICU assist, I make myself available for any needs in the ICU. Usually, this involves airway management, invasive line placement, ventilator management, and assisting in clinical decision making.
But this task was much more challenging than any of the above.
She then turned to her children and told them that the doctors were telling her she had to leave, and the daughter immediately asked to speak with me.
I repeated to her what I had told her mother. I stated he is very ill but is currently stable, but she could not stay there. We were offering a private waiting room for her mother. But she retorted by stating my dad is only alive because my mom is with him.
"As a hospital, isn't the goal to make sure your patients get better?"
This response flustered me for a moment. Yes, that is our goal. And in any normal time, her request would be totally reasonable.
But these are not normal times.
I repeated again that we cannot have her mother at the bedside any longer, and even giving her the opportunity to be there in the first place is a rarity. And I said in the case their dad did code, we would have to have your mom step out during that time anyway.
But they kept arguing and saying there should not be a reason she could not stay. Their mother was not in the way and her father knew she was there and that was keeping him alive. And if there was any pump that beeped or vital sign that looked off, she could immediately notify the nurse because she knows we are stretched thin. And everything she said made sense. In normal times.
And then her daughter said the following words:
"Don't you think it's important to have family at the bedside of an ill family member?"
And it took everything to keep myself together.
And I realized, in that moment, they did not need me to be a doctor.
They needed me to be a human.
And I passionately told her point blank the following:
"Every one of the 100+ people in this ICU do not get to have their family with them, even in their final moments. The fact your mother is even at your dad's bedside at this moment is an extreme rarity and privilege. Do you not think the thing I want the most is to have EVERYONES loved ones at their bedside?? I wish that more than anything. But I can't allow that. And it sucks.
I know what it's like to have a father in the hospital who is very sick. And I was lucky to get to be at his bedside along with the rest of my family in his final moments. But we have to keep everyone safe. And it is not safe for your mother to be in here because she could get sick, and I do not want to see her end up like your dad. So please, meet me halfway. I understand your concerns but your mom cannot stay here."
And then: breakthrough.
Immediately, the tension dispersed. And the daughter and son started to open up.
They just needed to know I gave a damn.
They expressed how they felt their father was not given the attention he deserved before he got intubated. They said they understood that resources were stretched, but they had to fight for their father and could not stand idly by when they believed their father was being ignored.
I explained to them that everyone was fully aware of their father's condition, and even amongst a floor full of sick people, he was one of the sickest. And as a result, we were keeping an extra watchful eye on him. But I also told them I heard he was a fighter, and his kids said yes he is and they were comforted by the fact he was fighting once again.
They thanked me and then asked me to promise them that he would be taken care of, and I said yes, I promise you. And with that, they were satisfied.
After I exited the room, I was lauded for being able to convince the wife to leave after so many failed attempts. But the conversation was draining.
I went and sat in the workroom after one of the residents took the wife to the private waiting room we had promised. Soon after, the room was full of residents and fellows who then asked me what I had said to convince the wife. I then explained the following:
The most important part of being a physician is to be a human first and a doctor second.
Do not be afraid to be vulnerable in these moments because these families are already in their most raw and vulnerable state. They are scared and hurting. Let them know you understand. That you care. Share personal experiences. Empathize. Connect with them. Get them to realize you do not view their family member just as a nameless body, but as a human. Ease their minds by ensuring they know you hear what THEY are saying. And that their concerns matter. That their family member matters.
And with that, the room silently nodded. The advice I gave seemed so obvious. At least to me.
So why is it so hard, for so many, to just do so? Have some become so disconnected in their job that they no longer see people but only nameless bodies? Or are we too afraid to get close because we fear the emotional ramifications if we do?
Every person may have their reasons.
But if you cannot connect human to human,
heart to heart,
soul to soul,
then please find another line of work.
Because the world needs love and compassion more than ever.