Heart of a hospitalist

His last words from his daughter will be a voice recording played by me, a stranger with whom he has no connection.

Compassion has been of utmost importance during this pandemic. I am a hospitalist with a background in geriatrics and palliative care. Amidst the peak of the COVID chaos in April, it was extremely challenging watching my patients die alone in the hospital. I found myself having sleepless nights, thinking about the family members who were mourning as their loved ones took their last breaths alone. The necessary lockdown had contributed to feelings of loneliness and helplessness, but I could not endure the thought of isolating people as they transitioned to death.

One morning, I woke up at 3 a.m. unable to sleep as I had a rough day ahead of me. I checked my email to find a recording from the daughter of a patient. The plan was to compassionately liberate this 67-year-old man from a ventilator. He had lived with multiple sclerosis and was now dying from COVID.

“Dad, I just wanted to say that I love you very much and know that it's OK if you're ready to go. I will get through this and I will make you very proud,” she said. I was an outsider listening to the last words her father would hear. I am the last voice that she will remember from his life, expressing my apologies because she cannot visit him. His last words from his daughter will be a voice recording played by me, a stranger with whom he has no connection.

“Dad, I just want to let you know, if you don't want to fight anymore . . . it's OK. I will share your memories when I have children.” After that, her voice became incomprehensible as she cried. My heart ached for this family and I knew that there were many others that suffered the same.

Patients dying alone is against my personal values and the palliative mission, which is to improve the quality of life for patients and their families by integrating not only physical but emotional and spiritual aspects of care. Under normal circumstances, there is a volunteer program called No One Dies Alone, in which volunteers stay with patients when they do not have loved ones available to offer companionship at the end of life. Early in the pandemic, it seemed that this priority was disregarded throughout the country.

Although the risk of spread to the community was an issue, I began to wonder why we were not giving families the option to make an informed decision about the risks they could take if they decided to visit their loved ones at the end of life. I wondered why they were not being given a choice. Perhaps the lack of PPE all over the country was also playing a role.

I expressed my concerns to the leadership at my hospital and I was kindly and promptly heard. They decided that the benefit of visits at the end of life outweighed the potential risks. The same week, we made a set of guidelines that allowed two visitors at the bedside. Families were finally able to have closure. There were no more lonely last breaths if we could help it.