Comfort measures only

I will never forget the 56-year-old woman who was admitted to our intermediate care unit with COVID-19 pneumonia.

During the early days of the pandemic, like most other places, our hospital adopted a no-visitor policy for everyone's safety. It was hard for patients who were dealing with something so unpredictable all alone in the hospital. I will never forget the 56-year-old woman who was admitted to our intermediate care unit with COVID-19 pneumonia. She had a history of advanced COPD and had opted for DNR/DNI status many years ago. On high-flow nasal cannula, she was maintaining oxygen saturation between 85% and 88%. She remained like this for many days, barely surviving.

She was humorous and pleasant. She was a single parent of a 25-year-old son. Every day she would tell me how she had lived every single day of her life seeing her son. Families were allowed to visit patients only if they were on comfort-focused care. We had multiple discussions about goals of care and potential comfort-focused care, but she was determined that she had to live to see her son.

One morning during rounds, her breathing started becoming shallow. Even though she was hypoxic, she remained alert and oriented. We called her son on video. She was barely able to speak. While looking at her son, she said to me, “I want to be CMO so that I can see my son. Will you keep me alive until he can come to the hospital?”

Her son quickly rushed to the hospital. She slowly started declining further. In a desperate attempt, we placed a nonrebreather mask with 15-L oxygen on top of her 100% high-flow nasal cannula. Right as her son stepped onto the floor and was about to don PPE to come in, she breathed her last holding my hand. They failed to see each other by less than 60 seconds. Her ability to talk sensibly despite hypoxia with her slowly downward-ticking oxygen saturation numbers on the monitor and her bright yet hopeless eyes made it such a painful experience, it took me a long time to muster up the courage to speak to her son.

This pandemic has affected us in ways that we never thought possible. Video chats are great but not the same. We never realized that being able to physically visit our loved ones during times of sickness is a blessing. It is rightly said that you need to spend some time crawling alone through shadows to truly appreciate what it is to stand in the sun.