I asked nurses, technicians and secretaries where it was: the iPad for patients who wanted to speak to their loved ones. COVID didn’t allow visitors. A few days into our peak, it was likely this patient had COVID. They were gasping for air, but could still speak, somewhat. I was hoping to save them an intubation. I told them I may need to put them on a ventilator but assured him I had some tricks I could try before I committed him to that path. They spoke Spanish, and I was afraid that they might not have a physician who spoke Spanish if they went upstairs. I was afraid if I didn’t get them that iPad, they might not talk to their family again. Everything felt so fragile yet rushed with COVID.

They couldn’t find an iPad. I just used my personal phone. I set up the call, updated the family then held the phone to their face so his family could see them. They were kind and grateful. The patient seemed relieved, and I even think their breathing improved. It was one of those shifts where you actually felt as though you had achieved a small win.

Three months later, I received a call from my father: “your grandfather is not well.” My heart sank. Although in his 90s, my grandfather was my idol and the stalwart family patriarch.  We would FaceTime on Sundays, a proud mark of his technological savviness. He spent his days researching our family’s ancestry on the internet and constructing spreadsheets for the nuns at his facility. He decided in his late 80s he wanted to learn the cello, so he did. As a doctor, I’m acutely aware that any day over a certain age is borrowed time. I just didn’t think that it would happen so soon for my grandfather, the FaceTimer and the cellist. It miraculously wasn’t COVID, but the virus would still be what stopped his family from heading home to our tiny island to say our farewells. As a physician, you know how risky it would be for you and for them. COVID would rob us of the ability to fly back home and say goodbye in person.

I was now going to be the one on the other end of that virtual call. I was now that family member praying the connection would hold, that my family’s schedules would have an opening to give us this time together. Slowly those familiar faces that always managed to come together within 24 hours despite any distance popped up on screen: together virtually. The definition was grainy, and the connection collapsed a few times. The anguish in my family’s voices and faces every time the connection dropped was heartbreaking. At first, there was visual without sound. The sound would break away abruptly.  But then, there he was in a tiny box on a 12inch screen. The irony of this role reversal was crushing.

Although I was used to FaceTiming with him, this virtual meeting felt odd and uncomfortable. Everything felt far away, and it was. We all went around the virtual room and spoke to him. We were being given seconds to summarize a lifetime. No words could express that here was one of my favorite humans shrunken by illness. Through that tiny screen was one of the difficult truths of being a doctor. You know more than you wish you did when a loved one is dying. You have been trained. You can identify a soul who is tired of living, as well as you can identify a heart attack on an ECG. Your training, though, will not serve you here. You were never taught to be the patient, let alone the family. His skin was now sallow. His voice, which typically filled a room, was now thin, and I could hear the fluid in his lungs. There would be no recovery or new baseline; this was it.

I am eternally grateful technology allowed us this chance to see him before he passed.  However, the role reversal was too poignant. I had stayed after shifts to make sure I called families that couldn’t visit in the ED during COVID. I made sure to try to find the iPads when they were available. I just didn’t think that I would be the one separated at the end of life a few months later and only together through a screen. I recognize the privilege of this moment. We were able to sneak in a laptop and find WiFi, and although spread across the mainland, our family was all able to connect together and say our farewell. He deserved so much more. My patients did too.

Catalina D. González Marqués is an emergency physician.

Image credit: Shutterstock.com