Saying goodbye to Leo

They held his hand and stroked his hair and told him he wasn't alone.

The first death I ever witnessed was my father's. Lying on the living room floor, receiving CPR from a police officer. That image was so seared in my mind that I can recall it with photographic detail even 18 years later.

Since then I've come to know death intimately as a physician. I've stood at the foot of the bed and pronounced time of death after resuscitative efforts. I've talked patients and families through the transition to comfort care. Most of the time, after those conversations, the actual process of allowing my patients to die entails me sitting at a computer and placing orders. Typically family is present as well as their nurse, but when they die, I am notified by phone.

This was not my experience with Leo. He was a middle-aged man admitted to our COVID unit. While he had significant comorbidities, including a traumatic brain injury that left him largely nonverbal, for the first 72 hours he remained stable with low oxygen requirements. However, over a 24-hour period, his condition rapidly declined, and on high-flow nasal cannula at 100% FiO2, he was still struggling to maintain his saturations. His family had previously relayed his wishes not to be intubated and placed on a ventilator. In our conversations during those 24 hours, they came to the decision to focus on his comfort, knowing that despite all interventions he was dying of COVID.

Our hospital has a no-visitors policy for COVID patients, even at the end of life. As Leo's nurse and I waited for the medications that would keep him comfortable to arrive from the pharmacy, she promised me she would stay with him and would not allow him to die alone. I stood outside Leo's door as she and another nurse set up the drips and removed his high-flow oxygen and monitors. They held his hand and stroked his hair and told him he wasn't alone. I could see he was still air hungry and gave orders through the door for additional medication to make him more comfortable. Then I put on my PPE and joined the nurses at his bedside, feeling that I too should bear witness to his passing since his family could not. We got several family members on speakerphone to say goodbye. At the sound of their voices I could see Leo's brow relax and his breathing slow.

I stayed there and held his hand for 90 minutes. As a hospitalist I rarely have so much time to devote to one patient, but in this extraordinary moment, when Leo needed to be surrounded by people who cared about him, I had the immense privilege of helping him pass peacefully.