I work at a hospital that, like many others, has taken significant steps to prepare for a surge of COVID-19 cases in the next days to weeks. Many of our residents were sent home while assigned to elective services where we are “nonessential,” to reduce our risk of exposure and deepen the bench of back-up providers. As I sit at home, preparing for what’s to come, my mind keeps wandering back to a shift I worked in the medical intensive care unit this past December.
I was on call, and several new patients had arrived to the unit throughout the course of the day. It was a busier shift than most that month. The first new patient arrived in the morning, transferred from the oncology floor. He was an elderly man who had been fighting an advanced cancer in the hospital for months. It appeared he had contracted pneumonia, and he was showing signs of worsening respiratory distress overnight. He was confused, and his wife was at the bedside when we went to evaluate him.
She had been there beside him all day and every day. When he was transferred to our unit, she made it clear to us that he would never want to be put on a ventilator to be kept alive. We provided him with other devices to support his breathing, and tried our best to diagnose and treat his infection throughout the day.
Several hours passed, and each time we checked in on him, he appeared to be getting more uncomfortable, needing escalating doses of medications to relax him and treat his pain. At the end of my call shift, I walked to the man’s room to check on him and his wife. It was dark by then, and quiet in the unit. His wife was there by herself.
We sat on the couch and watched him struggle to breathe. After a few more minutes, his wife turned to me and said she didn’t want to see him this way any longer. I instructed his nurse to administer more pain medications, and we withdrew the supportive device from his nose. She buried her head in his chest and cried. When his breathing slowed, and his pain gradually subsided, she sat down next to his bed and looked at the ground as he took his last breaths.
I rested my hand on her knee and rubbed her back in a circular motion, uncertain what to say or do next. The nurse sat on her other side with a hand on her shoulder. She asked, “What am I supposed to do now?” I looked at her for a long ten seconds, searching for the right answer. All I could summon was “take a breath in and out,” and we all took a deep breath in together and a deep breath out. We sat on that plastic couch for a few more minutes, until my pager started beeping. Another patient was getting worse. I got up to leave.
I tried for weeks after to understand why everything that happened during this shift was staying with me. I began to understand that the feeling that lingered was loss. His wife lost the love of her life that day. I had only known this man and his wife for one day. I hadn’t taken care of him all those months. The loss I felt, though, was never knowing the life he led, the way he loved his wife for so many years.
I would never know the small things that made him who he was. I sat there being a part of the worst day of his wife’s life, and I felt that I couldn’t console her, that the words of comfort I gave her were generic and impersonal. I couldn’t give her my time, not as much as I felt was deserved. It was a hurried death, unexpected, and without ceremony. There was no time to grieve.
At my hospital, we’ve worked hard to prepare for the possibility of shortages of personal protective equipment. We’ve started to prepare ourselves for the possibility that we may get sick, and we may have to quarantine ourselves from our loved ones. Those possibilities scare me, but I also grow fearful that we must now also prepare to share the overwhelming loss of our patient’s families, without the time to grieve.
I fear what this will do to us as a generation of providers, as we repetitively witness the deaths of patients we will never get to know, deaths that feel sudden, unexpected, and avoidable. We’ll make devastating phone calls to families. We won’t have the words to comfort. We will face thoughts of confusion and self-hatred as we hurry out of rooms where someone has just passed, because we have to. I beg those considering ending efforts to mitigate and slow this pandemic to think of us, to think of this man’s wife, and every COVID-19 patient and family member that will suffer the same loss when making these decisions.
Jackie Hodges is an internal medicine resident.
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