He was one of the few ICU patients I saw in the early 2021 when Covid was furious through Los Angeles. As a palliative care physician, my job was to meet the family of intubated patients through ZOOM, making sure they have a full medical renewal, especially when the person faces death, and helping them make difficult medical decisions on behalf of their loved ones. However, with a surreal departure from my usual practice, I never saw these patients myself. At the time, it was members of the ICU team who were allowed to regularly enter the ICU to minimize exposure to Covid.
This particular patient survived several dangerous surgeries the previous year. He began to breathe in the winter and get out of breath for the air before returning to the hospital that winter. He promptly requested intubation and medication to raise dangerously low blood pressure. His wife confirmed that during his many previous illnesses, she had been sleeping in his hospital room every night, asking him to spend time watching a movie with him, asking for painkillers. “When I was there he fought so hard to survive,” she told me.
I explained to her and all my patients’ families that our hospital only allow visits if the patient gets irreparably ill. Still, only one family member who was so unrecognised by a layer of PPE could spend 10 minutes in the room before the doctor removed life support. I had a hard time telling those families that many of my patients still died alone. Their condition sometimes deteriorates suddenly and unpredictably for a loved one to arrive in time.
The tragedy of those suffering, dying alone is one of the lasting and unred traumas of the pandemic. During the early surge, we restricted visits and stopped the Covid spread. However, even as the number of infections decreased and transmission rates decreased, many of these strict policies remained despite the major damage to patients, families and hospital staff.
Hundreds of thousands of people in the United States died of illness in the first few years, many of whom died in isolation from friends and family. Intubated and unconscious, they may not have known that they were alone, but their family did, and Many developed PTSD. all over the worldThe same was true for the ICU staff. I was distraught and lost morale By caring for the onslaught of people who die in isolation.
Some states have since The law passed It codifies the rights of families to visit loved ones in hospitals, but in most cases this phenomenon is treated as a painful memory rather than worthy of public conversation. However, only by facing the way that separation between patients and families has shaped human experiences of grief and loss can we understand why we have to do better next time.
From late 2020 to early 2021, Los Angeles experienced a version of what New York faced at the beginning of the pandemic. It’s a horrifying and quick onslaught of the Covid incident. An ambulance line wrapped around a crammed hospital. Important oxygen and ventilators were reduced in the most intense hit areas. Within the hospital, my team and I could no longer share the office due to socially endurable orders. I left a job where I interacted with a few patients outside the ICU and a few coworkers in person. When I left, I drove down the street lined with dark storefronts that emptyed cars and people. Governor Gavin Newsom had I’ve recovered Home orders in all regions where less than 15% of ICU beds are open.
At the time, and at the worst of the pandemic, numbers became our singular focus in hospitals. The vaccinated people, the rest of the ventilators, and local covid cases all shape the way we cared for sick and protected staff. The family suddenly became visitors, and the visitors were vectors. And despite witnessing the tragedy of isolated people dying or experiencing the illness alone, I resigned to the fact that there was no other way to contain the spread of the virus, especially when community infections between hospital staff rose.
However, as months went by, the benefits of visiting restrictions became bleak as the human costs of preventing families from visiting sick relatives became more clear. In recent years, practitioners have recognized that families are not merely comforting, but also an integral part of care teams that help people with dementia understand how people with dementia express their pain or persuade stubborn people to participate in physical therapy. I felt it was disrespectful to them and my patients to entrust them with a visit to the end of life.
Even when I tried to distract myself after work, the scenes from my day that began to bother me were those who endured the consequences of facing illness forcedly separated from my loved ones. In the hospital courtyard, I comforted the father’s daughters of one of my terrifying teenage daughters and brought in a photo of the family that had been framed for him when I received chemotherapy. Elderly patients with dementia needed strong medication and restraint to treat delirium. A gentleman with emphysema cried. Without my wife I was afraid that I wouldn’t be able to warn the nurse if I couldn’t breathe. The pandemic has destroyed funerals and monument rituals, but it also destroyed rituals that help loved ones through illness.
And as the end of my life approached, I have seen it over and over again. Experience the care of your loved one together, paying attention to needs only known to relatives, and understanding that they were with them when they were facing the ultimate unknown allows a sense of agency in the midst of helplessness and uncertainty in the situation. Before the pandemic, I observed that by witnessing details of a person’s illness, it was extremely helpful for my family to talk about the final day or time.
Instead, the family I worked with during the pandemic only understood the illness of my loved one through the words of a masked care team that I had never seen before. On the iPad, we can only get a momentary glimpse of their beloved and point out the purpose of each machine around us. Deprived of the sensory experience of seeing the disease unfold or treatment fail, families struggled to make urgent decisions and accept the limited ability of medicine to reverse much of Covid’s destruction.
The hospital certainly had an obligation to protect staff from COVID infection. Visitors had to be restricted, especially in the early stages of the pandemic, when PPE was limited and no one knew much about the behavior of this new virus. During the early 2021 spike, most hospitals generally had enough PPE and doctors understood the virus better, but many of my colleagues were still exposed and infected. It was not entirely clear whether they had signed the virus both inside and outside the hospital. If the family agreed to wear PPE at all times and presenting negative covid test results, they could have been allowed to visit with minimal risk of infecting staff. (Some Research suggests that appropriate PPE reduced the risk of transmission; There is not enough research To determine whether visitors have protected staff from infection. )
All hospitals had their own policies, but the visit rules remained unchanged even if visitors were vaccinated or tested negative against Covid. I often wonder if this was different because minimizing death is not the same as minimizing suffering, and the emotional aftermath of these decisions was more powerful insisted that it was not always fixed, whether it was schools and businesses reopening, or whenever it changed their lives and the lives of patients and families.
Visitor alternatives need not be ruled. If lawmakers attempt to codify visitation rights, they often allow at least one hour of visitors for at least one hour, then they respect the hospital’s policy to implement safety measures to ensure infection prevention. However, as accounts of human casualties of strict visiting policies began to emerge, hospital managers would have been able to ask themselves, and their staff would have asked about how to respond to visits, and how to respond to visits more frequently. An extreme version of traumatic loss, in which without that bounty, patients’ families and medical teams were forced to experience sustained without waning.
If a person can only imagine scenes and invent the details of death, they may face the vague loss that was first used to describe the family experiences of a loved one in Vietnam where they went missing. Living both with the fact of death and the lack of details or evidence of what led to it can make the loss look truly realistic. Ambiguity plagues all losses to some extent, but these isolated deaths were denied by families, even by families. try Witness the development of the illness and the final moments of their loved ones.
Just look at just an image of a ventilator, a bag of antibiotics, and a mere image of a blood pressure medication hanging over the person she loved, as my patient’s wife did. In the incantation of confusion, you’re just hearing how he was heated up, shaking and rashed. ICU residents and I pointed out how his skin became salou. Even with maximum support from the ventilator, his lungs struggled to maintain normal oxygen levels, his heart was unable to pump blood efficiently, his legs were swollen and some of his toes turned blue. But he could not explain all this or tell her that blood had begun to pierce his mouth, and confront her herself experiencing degradation.
I remember him very well because I had to easily enter the ICU to talk to my colleagues. He was the first room on my right. I’ve seen him like his family had. I gasped at the shock of seeing myself the sharp angles of his face, his dim toes, and the blood that stripped his breathing tube. Almost two weeks after he first arrived at our ICU, his heart, lungs and kidneys all failed. He was almost dying. And although his wife agreed that she didn’t want to live this way for life support, she finally got to visit.
When she arrived at the ICU, I later learned that I had just left the hospital. She wanted to remove the gloves and push his hand into hers. Unfortunately, this was not permitted, his nurse said. She left the room for a few minutes to give my patient and his wife privacy. When she returned, my patient’s wife disappeared. He passed away 30 minutes later.
Over the next few days I called his wife several times and she didn’t return my phone. I tried to imagine what had happened in the minutes she last saw her husband. Perhaps she followed the rules. I like to imagine another scene. Perhaps in a final and rebellious act of love, she removed her gloves, kissed her husband’s hand, smoothed her hair before slipping out, unnoticed, ready to live in the world without him.
