One of the most harrowing challenges of COVID-19 has been the “no visitors” policy virtually all institutions were forced to implement. In order to protect our patients, our staff, our communities, we’ve had to put these visitor limitations into place until the tide turns.
Not too long ago, I woke to my husband lying stiffly on his back, declaring, “I think I need to go to the emergency room.” He’d mentioned vague discomfort the day before, but now, he’d battled frank abdominal pain all night, and even he — a never-really-sick-a-day-in-his-life, hospital-hating, ultramarathoner just past 40 — knew something was not right.
Thirty minutes later, walking up to the entrance of our local hospital’s emergency department, we were prepared. Masks on, hand sanitizer in my coat pocket, a bottle of water, and a phone charger in my purse. My husband was nervous, and I did my best to describe how things would go down. After all, I’d spent my entire adult life inside hospitals. I’d make sure he was well cared for every step of the way.
Immediately upon entering the building, we were asked, “Which one of you is the patient?” My husband hobbled forward, and I was told, “You’ll have to wait in your car.”
While my husband and I had intermittently discussed and debated no-visitor policies over the last month, in our own reality of the moment, the limitation had completely slipped our minds. It wasn’t until I got back to my vehicle that it sunk in what I had done. We had simply shrugged, said, “Well … see you in a bit,” and parted ways. No hug or squeeze of the shoulder, not even a last-minute exclamation of, “I love you!” before the sliding glass doors shut behind him. Back in the parking lot, closing the car door, I cried in fear, disbelief, and rage at my callousness.
While he was in the ED, we didn’t speak over the phone. He was in pain, unsettled with so many strangers in his personal space, and he seemed to be more comfortable communicating via text. Soon, he was caught in a flurry of IV starts, physical examinations, and CT scans. The more I played back his signs and symptoms in my head, the more I expected the diagnosis: acute appendicitis.
No one asked if there was anyone he wanted on the phone when the diagnosis was revealed, and the plan discussed. Still uncomfortable both physically and emotionally, he didn’t ask, either. Surgery was scheduled for the afternoon, and we agreed to FaceTime when he was transferred to his room, where it would be less hectic.
About an hour later, I found myself in a state of disbelief again. In my mind, I can imagine how things played out. The nurse strode into the room, announcing surgery was pushed up. The anesthesiologist entered next, reviewing the standard protocol while trying to keep out of the way of the OR techs who were unlatching bed brakes to start rolling down the hall. In the midst of this, barely awake and out-of-sorts from the narcotics, my husband had time to send me two texts.
“They’re about to take me to surgery.”
“I’ll catch you on the other side.”
I had already failed to convey the slightest expression of physical affection before I left him the first time. Now, I’d lost my chance to even speak with him, possibly ever. All of my positive thoughts about how young, strong, and healthy he was — every positive checkbox for “uncomplicated procedure” and “full recovery” — evaporated.
Over the hours, I waited for the next communication, I thought of all the others who were caught in the same, previously unimaginable circumstance. Being hospitalized, having a loved one hospitalized, both are extremely unsettling and often traumatic events. Even so, a similar comforting experience for most is the fact that they are able to be there for each other. The anguish over the dissolution of this symbiotic relationship should not be lost on anyone, whether ever faced with the situation or not.
While my husband’s microscopically rupturing appendix alluded to the surgeon’s laparoscopic tools until he was opened with a six-inch incision, I created a list of ways my regrets could have been lessened.
1. For those at emergency department entrances, direction about only the patient being allowed to enter should be followed by, “Now’s the time for a fist-bump, hug, kiss or wave goodbye until things are sorted out.” This one reminder to snap us out of our shock would have prevented a world of anguish. This is the most unexpected of lessons I learned, and also the most urgent I encourage you to support in your own facilities.
2. Initial check-in should include discussion about who should be kept updated and how often. “Shall we make sure to call every time we have new information to share?” should be suggested to avoid patients feeling like they are a burden to staff. This should be repeated any time the patient moves to a new location like a different unit.
3. Regardless of the initial answer to the question above, every provider who enters the room to interview, examine or discuss results or plans with the patient should ask again if someone should be included via phone call. No one should assume patients will actively ask for this to happen because odds are, they won’t.
4. Moments when a patient is suddenly whisked off to surgery or an invasive procedure should be limited to when the patient’s life is in danger or their condition is dangerously deteriorating. Outside of these emergency situations, all patients should be offered the chance to contact someone before heading to an operating room or procedural suite. The medical team needs to consistently remain cognizant of the fact that this moment is likely one of the most fearsome and anxiety-provoking in a person’s life — both for the patient and their loved one.
Much more can be said of the routine use of electronic medical records to communicate updates and care plans to designated patient supports; of how nurse matrices and provider coverage schedules should be adjusted to allow for this necessary increase in communication given the circumstances; and how it must be understood that many patients won’t advocate for their own needs because they are racked with assumed guilt that they are contributing to burnout of overworked health care providers during this global pandemic.
If nothing else, please put a protocol in place to remind patients and their supporters that it’s OK to demonstrate affection at the moment one of them is turned away.
Juliet B. Ugarte Hopkins is a physician adviser for case management.
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