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March 26, 2020

'Patients dying alone': The frightening reality of many COVID-19 patients' final moments

Daily Briefing

    Despite providers' own fears of the new coronavirus and significant time constraints, Daniela Lamas, a critical care physician at Brigham and Women's Hospital, in a New York Times opinion piece writes that "it's up to us, the health care workers … to balance our fear with tenderness" for patients who will likely die alone as hospitals bar visitors out of coronavirus concerns.

    How hospitals are communicating with patients and the community about COVID-19

    As hospitals restrict visitors, patients die 'in a medical version of solitary confinement'

    Like many hospitals nationwide, Brigham and Women's has barred most visitors, even for patients at the end of their lives, out of concern that visitors could help the new coronavirus spread throughout the hospital, Lamas notes. "It's a tough decision that leaves our patients to suffer through their illnesses in a medical version of solitary confinement," she writes.

    Lamas recalls her experience telling this news to patients under her care and their families. She remembers saying to the husband of one patient, "When you leave today, you both need to say goodbye." Upon delivering the news to the couple, Lamas "watched their faces shift." The patient's breath hastened so much it set off her ventilator alarm. Lamas notes, "There was no way to soften the blow."

    "The isolation is, of course, even more profound for those who are infected with, or are being evaluated for, coronavirus," Lams writes. When caring for one COVID-19 patient, Lamas watched as a patient "alone in his room," coughed blood while his daughter watched on FaceTime. Lammas writes, "[T]hat is the last image she has of her father—on a shaky computer screen, blood staining his hospital gown."

    What hospitals and providers can do to help isolated patients

    Lamas writes that she and her colleagues are "worried" for their patients, as "those of us on the front lines simply don't have a plan for this." One nurse practitioner in the hospital’s new COVID-19 ICU told Lamar she’s most worried about "[p]atients dying alone."

    Lamas writes, "If this is our new reality, then we must do better," noting, "I want to be the doctor who is always willing to spend a few extra minutes despite being stressed or rushed." 

    Lamas admits, "[T]hat is not the kind of doctor I have been for the past few weeks." She shares that she doesn't "want to spend a moment longer in a COVID-19 patient's room than" necessary out of fear of catching the disease herself. She notes that she doesn't "take the time to reassure, to explain, surely not to hold a hand." She confesses, "Truth is, I am scared."

    Lamas explains what hospitals and providers can do to best help their patients during this scary and uncertain time. To help patients in isolation with communication, Lamas writes Brigham and Women's has made efforts to give each isolated COVID-19 patient an iPad. Doctors also need to practice delivering end-of-life news over the phone, which can prove difficult "without relying on body language and touch and facial expressions to convey meaning," Lamas writes. "As critical care doctors, we now understand that our patients and their families carry with them invisible scars from their time in the intensive care unit … The words we use matter," Lamas notes.

    She concludes, "I know that we are overworked and afraid that we won't have the equipment we need to protect ourselves. But I worry that unless we find some way to mitigate the overwhelming isolation this virus has created, we will leave a fleet of wounded patients and family survivors in its wake" (Lamas, New York Times, 3/24).

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