Several years ago, a patient asked me if I wanted to know how she first learned she was dying. As a new palliative medicine physician, I braced myself—would it be a story of a blunt delivery, or vague prognostic statements without a clear meaning? Instead, she stared intently at me and said, “My doctors used to check my heart and lungs every visit. They stopped checking. That's how I knew.” I still carry those words with me. How often do we demonstrate that we care simply by touching stethoscope to skin, or cradling a wrist to examine the pulse? What do the absence of those touch points mean? Breaking bad news is tremendously difficult, even when we are able to sit face to face with a patient. We concentrate so much on the words we choose, knowing our words will likely echo well beyond this conversation, and sometimes forget that our non-verbal cues mean just as much. In the midst of a pandemic, safety mandates gowns, gloves, eye protection, and masks that obscure almost every part of us. We feel the loss of our non-verbal tools acutely. We try to convey emotion with our eyes, our tone of voice, with our gloved hands, knowing that a swarm of people in masks and gowns standing over the bed must be disorienting to someone who is already isolated. A few months in, some clinicians start printing photos of their faces and attaching them to their protective gowns so people can see what they look like without all the gear. Families are not allowed to come to the bedside, so tablets are repurposed for video calls. It can be hard to find a way to bridge the silence across telephone updates, or to see the cues in real time—falling tears or a shift in body language—signals that we need to pause and give space for the emotion. Family members plead for an exception to come into the hospital. Don't we understand how important family being at the bedside is? Why can't we make an exception just this once? We wish we could. One consequence of minimising physical contact for safety is that some patients' only touch points might be a set of physical exams, a lab draw, some vital signs. I am reminded of my patient's words. Before COVID-19, families holding vigil at a bedside often expressed surprise when medical providers walked into the room and reached out for the patient's hand, talking directly to them even when they appeared asleep. Families asked, “Do you think they hear us?” Expressions changed when we explained that yes, while they might not absorb every word, they can likely hear the voices in the room and feel physical touch. That we would encourage them to continue talking to them, holding their hands, even in their last moments. So now, when physical touch from loved ones is limited or not present at all, medical staff across the country are trying to provide it through layers of personal protective equipment. Clasping the patient's hand, gripping the tablet so the video call is possible, pointing out the various tubes and lines to family while explaining what's going on. Letting our own tears fall silently underneath the face shields as yet another family says goodbye. Attending team rounds virtually because we can't all safely inhabit the same room. Getting re-fit for N95s because more than 6 months in there still aren't enough supplies and feeling lucky to be fit tested at all. Turning off the news because it is too painful. The effects are cumulative and isolating. Even as we urge people to stay home, avoid crowds, to wear their masks, we too are craving more human contact. We try to create space for connection even though we are exhausted. There are not enough debrief sessions or wellness activities to counteract what we have seen. Even when restrictions ease and more frequent visits are possible, there will never be enough time to grieve. The end comes too quickly, none of it fair. We hold our patients with us, their faces and voices follow us home even though we try our best not to bring sorrow back to our families. Breathing deeply before crossing the threshold, a new mask replacing the fabric one. We leave our shoes at the door, peel the scrubs off into the washing machine, and shower before we feel safe to touch anyone without the layers. I declare no competing interests.
Search from 250 M+ research papersSearch from 250 M+ research papers
Open Access
Sep 1, 2021
Thomas C Erren + 1
