May 28, 2020

'I'm so sorry': A doctor's apology to patients and families separated amid Covid-19

Daily Briefing

    When the new coronavirus first started spreading throughout America, hospitals quickly moved to restrict visitors to prioritize the safety of patients and staff. But in the New York Times Daniela Lamas, a critical care doctor at Brigham and Women's Hospital, pens an apology to her patients and their families, noting that the restrictions had an unintended emotional toll.

    Covid-19 guidance from clinicians at the forefront

    'I'm sorry you can't be with him'

    Lamas first pens an apology to a parent she'd called to inform that doctors might need to intubate the parent's son.

    Lamas writes that the parent had been present at every one of the son's hospital admissions for almost 40 years, "[t]hrough the transplant, those long nights in the chair by his bedside, watching his chest rise and fall, his hand, puffy from fluids, in yours." However, due to visitor restrictions imposed because of America's coronavirus epidemic, the parent was at home when doctors determined the patient might need to be intubated.

    "Home … must have felt like worlds apart when I called and told you that his breathing was getting worse, and we might have to intubate," Lamas writes. "I tried to say it gently. I hope you could tell that I was trying."

    Lamas writes that although she tried to "balance kindness with clarity" and "make sure [the parent] understood how serious it all was without being able to see" their son, she "could have worked harder to prepare" the parent. "[B]ut I didn't think of that until you started to cry," she writes.

    Lamas explains that, at the hospital, providers have "seen family members collapse under the news we deliver," and she "imagined [the parent] doing that alone in [their] home." She writes, "If you were with us in the family meeting room, I would have passed you a box of tissues. If it seemed right, I might have touched your shoulder or even offered you a hug. But the meeting room is eerily empty. And it has been months since I offered a patient's family member a hug."

    Lamas said she told the parent that providers were doing everything they could to take care of their son, even "though [she] was aware of how hollow these words must have sounded coming from a faceless stranger. Ultimately, Lamas told the parent, "I'm sorry you can't be with him. … I'm so sorry."

    Saying goodbye on FaceTime

    Lamas writes another apology to a person whose father was dying. "I'm sorry to you, too, for the night I called at 2 a.m. to tell you that your father was dying. You were startled, your voice thick with sleep. I'm sorry that you could not come to see him."

    Lamas explains that, at the time, her hospital was allowing only one visitor per person, and that one person was the patient's wife. As a result, the patient's child had to say goodbye to their father via FaceTime.

    "I hope I held the iPad still enough so that it didn't shake while you were saying the things you would regret not saying," Lamas writes. "I wanted you to feel as though you were alone in that room, to forget for a moment that your surreal farewell was being facilitated by a doctor you had never met."

    Lamas also apologizes to the patient's wife, who was "left alone at the bedside in her grief as her husband died."

    Although some restrictions have eased, 'isolation continues for most'

    It's been two months since Brigham and Women's began implementing visitor restrictions, which "seemed to make sense at the start" of America's coronavirus epidemic, Lamas writes. She explains, "In the initial days … the only rational response was to prioritize safety above all else," and "[t]he safest way to minimize contact would be to keep all visitors out, with limited exceptions."

    But now, as the country passes its first peak of the epidemic, many hospitals are "in a different place," and Lamas and other clinicians are "wondering how these rules can safely begin to shift."

    At Brigham and Women's, for instance, the visitation policy has changed to allow two visitors at the end of a patient's life, Lamas writes. "[A]nd over a longer time frame, three days instead of just in the moments before dying," she notes.

    But visitors still have to be screened for symptoms of Covid-19, the disease caused by the new coronavirus, before they're allowed to enter the hospital, and those who are permitted in have to wear "appropriate personal protective equipment and make sure they stay in the [patient's] room—masked and gowned—until they are ready to leave the hospital," she writes. "It is a strange way to be with the person you love when that person is dying. But it is something—a meaningful step as we move cautiously toward a new version of normality."

    Despite the new policy, "isolation continues" for most patients, Lamas writes. "The restricted visitor policies apply not only to those who are diagnosed with coronavirus, but to everyone—people with cancer and transplants and heart failure," Lamas writes, adding, "I should say I'm sorry to them too."

    "And it doesn't end when a patient leaves the hospital," Lamas notes. She writes, "I should apologize to my patients at the long-term rehab hospital where I sometimes work, to the woman who has not seen her family for six weeks, who woke up from her intubation alone."

    Ultimately, Lamas writes that she knows patients are "unimaginably lonely," and although clinicians "have tried to balance [patients'] safety with [their] humanity, … that too has been a casualty of this pandemic."

    For that, too, she writes, "I wish I could tell you I'm sorry" (Lamas, New York Times, 5/20).

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