During the crush of the pandemic, ED clinicians have little time to spend with patients beyond that needed to assess their condition, provide early treatment, and determine whether to admit. In the ICU, patients are often intubated and unable to interact with staff. The COVID floor I work on lies between these two. Because COVID strips away diagnostic and therapeutic uncertainties, and my hospital is well staffed, my time is something I can give.
All this week, I started rounds with Ms. Hernandez because I worried that she could not sustain her twice-normal respiratory rate. When I slipped into her room, I found her lying on her side, covers pulled to her chin, the lights and TV off. I sat with her and asked her how she felt, her response always the same: “God will take care of me. It's in His hands.” A devoutly religious woman, she customarily read her Bible daily. However, it had sat untouched for days. Some days when I asked her about herself, searching for a way to ease her isolation, she stared at me without responding and we'd sit together in silence. Other days, she'd give me glimpses of her life, telling me about her beloved husband, to whom she was so devoted that she gave him one of her kidneys. Occasionally, as I pulled the door closed behind me, leaving her alone in darkness again, I heard her phoning her daughter, Maria.
I called Maria each day after rounds and we talked about her mother's depression and sense of abandonment. Maria told me her mother was like this only once before. When her husband died, she became severely depressed, eventually needing a psychiatric hospital. Though she's done well since, her effort to breathe, anxiety about mortality, and isolation have conspired to pull her back into darkness.
Our hospital has had far more patients admitted with COVID than internal medicine practitioners could handle. Selflessly, clinicians from other specialties volunteered to help; they were understandably nervous. In a Zoom meeting, a radiology resident asked if we should avoid entering rooms to preserve PPE and reduce exposure. After a moment, I answered that I like to sit with patients for as long as it seems they need me. Our patients are alone for hours in wrenching isolation. We have few treatments and the intervention that might best alleviate suffering, a familiar face and the warmth of a partner's hand, we cannot offer. Though poor substitutes at the bedside, we must try to bridge the separation that COVID creates between our patients and their families.
Yesterday, my call to Maria went unanswered. Today, after 17 days, I walked with Ms. Hernandez arm-in-arm across her room, a smile crossing her lips for the first time in weeks. I left the room and called Maria, who, without an update yesterday, worried that maybe her mother had become sicker. As I said goodbye, she cried softly and said, “Tonight I think I'll be able to sleep.”