April 2, 2020
Photo courtesy of Brigham and Women’s Hospital
This episode is part of a limited series of conversations with people who are being forced to make difficult decisions in a rapidly evolving situation with many unknowns.
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Listen to the conversation below or scroll down for the transcript and more information.
Daniela Lamas: The truth is, everybody is terrified of coronavirus and so nobody said, “No, I refuse. I’m coming the next day.” Everybody is like respectful and infinitely gracious and they leave quietly at the end of the day.
Dan Gorenstein: It’s Thursday, April 2nd.
I’m Dan Gorenstein, this is Tradeoffs. Like many hospitals around the country, Brigham & Women’s Hospital in Boston recently announced that, for the safety of patients and staff, most visitors are no longer welcome.
Today, from the Annenberg Studio at the University of Pennsylvania, Daniela Lamas, a critical care doctor in the Brigham’s ICU talks about how she and her patients are adjusting to this new normal.
News clip #1: Area hospitals are limiting the number of visitors
News clip #2: The Mt. Sinai Health System is restricting access.
News clip #3: Making it extra hard on families who are anxiously waiting.
DG: Daniela gets that this new policy is necessary, but that doesn’t mean it’s benign.
DL: I have a patient who got really sick before coronavirus and was on a vent and had really profound delirium and slowly has kind of come to. I was talking her this weekend and she was saying that she feels like she just woke up in this alternate universe, that she keeps thinking, “Alright, there is no way that I have somehow come to in a world where there is a pandemic. And my family can’t visit.” And she asks the nurses, “Is this true?” And they say, “Yeah, that’s true.” And she says that she wishes she were delirious because it is just inconceivable.
One of the things that makes her feel so sort of disjointed from the rest of the world is that is that she is lonely, and it could be weeks to possibly even months before she can see her family again. And not only does she have a husband, she has a couple of little children. To her, it just feels like an insane turn of events.
DG: Patient care has been turned upside down.
These days, Daniela keeps her distance from patients she’d normally see many times a day.
When she does go in the room, it’s with a mask that makes it harder to connect. And when she leaves the room, she worries about her patients being alone.
Like one fairly young patient who, just a few days ago, wound up getting stuck in the hospital after a COVID scare.
DL: He ended up spiking a fever and needing some oxygen, so then the question was raised: does he have coronavirus? He has a fever. He has trouble breathing. And he gets taken, rushed to the coronavirus ICU over a bridge through the the hospital hallways. So they rush him there and he’s scared. You know, “I came in for this outpatient procedure. Do I have coronavirus?”
DG: By the time Daniela visits his room for the first time, her patient has had two tests come back negative for COVID. But he has an altogether different type of concern.
DL: His first question to me is if I have an iPhone charger. He hasn’t talked to his family and nobody can come see him and he needs to update people.
DG: Daniela’s patient wasn’t prepared for his minor outpatient procedure to morph into a major inpatient stay. He tells her he’s been nursing his phone’s battery life on airplane mode for hours wanting to maintain some kind of connection.
Feeling relieved about his condition, Daniela focuses on finding him a phone charger before leaving for the night.
DL: Overnight, his oxygen needs have increased more. He was breathing quickly. And it was clear, he was very sick. And so we made some changes to our antibiotics, And I kept, you know, walking by his room and watching his chest rising and falling from outside the door and watching his belly moving as he worked to breathe. And then he gave me a thumbs up, like, I’m OK. And so I would feel a little bit reassured by that, until a couple hours later, he stopped giving me the thumbs up and in fact, started asking me, “What is intubation? I’m really tired. I’ve been working really hard to breathe. And it wouldn’t be the worst thing to have a break.”
And I explained to him that if we needed to put him on a ventilator, we would. But intubation comes with risks. The hope is the tube goes in and things get better. Tube comes out. That’s our hope. That’s what we do that for. But there are cases where the tube comes in and doesn’t come out again.
And I find myself thinking that if he ends up getting intubated, this could be the last time that he talks to his family, at least for a while, hopefully not forever, but at least for a while.
I’ve messed up many times. There are many people who, over the course of being a doctor that I’ve decided to intubate and I have not taken that moment to give them time with their family. But on this day, for whatever reason, perhaps because he had asked me for the phone charger the day before, you know, we did pause. I asked him if he wanted if he felt up to talking to his family or did he want us to talk to them.
And so I dialed the mother, and she answers the phone, and I start giving her some updates and she panics. She starts to cry and she tells me she doesn’t have anybody that she can turn to for comfort because she’s scared of everybody. She doesn’t want to get coronavirus.
So I find myself you know, I’m reassuring her that, yes we’re doing the best for him. It’ll be okay. And she tells me that with every prior hospital admission, she had been there, that she was always there. And now that she can’t be there, it is just so hard.
DG: Daniela thinks ahead to all the other family members who, because of new COVID visiting policies, she’ll be meeting for the first time by phone and under the worst circumstances.
DL: I do think these policies are necessary. And for the families who are waiting at home, you know, by a phone, waiting for an update, desperate and scared. And then when that update comes, it’s from somebody whose face they have never seen, who they can only just have blind trust that we’re doing what we can for the person that they love. That’s an awful place to be in. And it’s not that the whole family’s together, you know, generally clustered around a phone comforting each other. It’s that people are spread out and nobody can travel to see each other. And so there’s there’s just so much loneliness and fear.
So I brought the phone in, put him on speaker phone with his family and and left that phone with him and left the room and gave him that time to talk to them. The oxygen he was on was high flow oxygen. It was like wooshing in the background. And they couldn’t hear him all that well and he couldn’t hear them all that well. But there was that moment and that mattered.
And I spent some time outside the door watching him thinking about, the cases where I thought of making a call and didn’t. I can remember the cases where I deprived a patient of that last moment thinking, well, this is just a quick intubation for a procedure. It’ll be fine. And then there was a catastrophic sequence of events where the person never woke up or the person died. It’s easy to lose that moment.
After that, maybe the antibiotics started kicking in. Maybe the little bit of fluid that we got off helped. By the end of the day, he was actually breathing a little bit more comfortably. Ultimately, he never got intubated after all.
But he’ll be in the hospital for a while longer. He got to talk to people on the phone, but they wanted to be there at his bedside. And these are the sort of people who would have been there at his bedside. And they weren’t. And that’s sad. He’s going to have another lonely night and it will be one of many lonely nights to come.
DG: I’m Dan Gorenstein, this is Tradeoffs.
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Additional Resources & Credits
COVID-19 Information and Updates
Hospital Visitor Policies and COVID-19
I’m on the Front Lines. I Have No Plan for This. (Daniela Lamas; New York Times, 2020)
‘A Heart-Wrenching Thing’: Hospital Bans on Visits Devastate Families (Katie Hafner; New York Times, 2020)
Visitation Policies and Practices in U.S. ICUs (Vincent Liu, Julia Lindeman Read, Elizabeth Scruth, and Eugene Cheng; Critical Care, 2013)
Music in this episode by Miscellaneous, courtesy of Badman Recording.
This episode produced by Leslie Walker and mixed by Andrew Parrella.
Thanks also to Ishani Ganguli, WTVC-TV Chattanooga, WJW-TV Cleveland, and CBS New York.