Addressing the emotional burden of COVID-19

A few weeks ago, I met Mr. T, a 96-year-old man admitted to the hospital from a nursing home. With numerous chronic medical problems and another hospitalization preceding his nursing home stay, Mr. T had been clear about his wishes. After spending a few nights in the ICU without improvement, he and his wife had opted to pursue hospice care. Following his transfer from the ICU onto my wards team, Mrs. T was finally given permission to visit him in the hospital. Due to the nursing home and hospital’s strict visitor policy during the COVID-19 pandemic, she had not seen her husband for over two weeks.

Their lifetime together had been shattered within just a few weeks: Mrs. T lamented that she had spoken to her husband only once – for three minutes by telephone – during his entire ten days at the nursing home. By the time she arrived at the hospital, he was no longer communicating.

Though we couldn’t have a conversation with Mr. T, his wife offered us glimpses of his life: Hardship as a Japanese-American during World War II. Parents who were forcefully relocated to internment camps. A veteran of the famed 442nd Infantry Regiment, wounded in the battle to save the “Lost Battalion” from Texas. A Bronze Star, two Purple Hearts, and the French Legion of Honor. Marriage in 1946, and then, a child. “Honorary Texan” since 1962.

It was 2:00 AM when his nurse Mary, who had been caring for him for the past few nights, paged me that he had stopped breathing. I walked down the wing’s long, sleepy hallway to a large room with bay windows that gave rise to a city skyline enshrouded in fog. In the corner of the room was his wife, simply sitting and holding his hand.

After pronouncing her husband, I sat down with Mrs. T and asked what her plan was. Even through her grief, she remained dignified and thoughtful. Their son lived a few hours away. She wanted to wait to call with the news, to grant him a few extra hours of sleep. She felt unsafe taking a cab home alone at that hour and planned to wait until sunrise. During the pandemic, visitor lounges in the hospital were closed, so this meant staying in his room. Mary and I glanced at each other, thinking the same thing: neither of us could imagine being alone for several hours with a recently deceased partner of 73 years.

His care team sprang into action. Mary, several nurses on the floor, the on-call chaplain, and I alternated sitting with Mrs. T for the remainder of the night. At dawn, Mrs. T finally departed, and I like to think we alleviated some of her loneliness and suffering.

In times of crisis, it is human nature to want to come together. Ironically, during the coronavirus pandemic, we are forced to stay apart. This disease turns a blind eye to human companionship. That Mr. T tested negative for COVID-19 did not matter. Global pandemics beget feelings of isolation, even if by proxy of well-intentioned and necessary visitor policies: Mr. T spent 15 of the final 20 days of his life separated from his wife – a stark contrast to their 73 years together.

The emotional toll of Mrs. T’s inexpressible grief was compounded by my guilt that the health care system had failed to treat her with compassion. Mrs. T’s experience is not an isolated incident in recent times; we all have heard countless similar stories that challenge our faith in how medicine can hold on to its humanity when it is overwhelmed. What does it mean for health “care” if during a pandemic we have no time to “care”?

Through my experience with Mr. and Mrs. T, I learned that protecting medicine’s humanity during COVID-19 demands an intentional effort. I see that I must communicate with patients and families more than ever before, perhaps leveraging novel solutions to overcome the absence of a physical connection. I have heard moving stories from doctors who witnessed dozens of family members say their virtual goodbyes to a loved one through a video call facilitated by a kindhearted nurse. I am inspired by stories of fellow residents who, while quarantined at home, are calling families to provide updates and emotional support in order to offload their overstretched colleagues in the hospital. These efforts are not without their drawbacks: our most vulnerable patients are often the ones without smartphones, and no technology is a substitute for an in-person bond. But precisely because of these limitations, it seems to me that even the smallest acts of humanity and kindness can be magnified during a challenging time. I now understand that consciously addressing the emotional burden of COVID-19 – or indeed, any illness – is equally as important as searching for life-saving treatments.

I thank Mrs. T for allowing me to share Mr. T’s and her story. I thank Calvin Chou for his mentorship and for encouraging me to share this story, and Eric Lee, Timothy Dyster, and Harry Han for their comments on this piece.

Manoj Maddali is an internal medicine resident.

Image credit: Shutterstock.com

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