We were only a few miles away from the hospital, but we might as well have been in another galaxy. Normally I wouldn’t have minded that feeling since I’ve spent most of my adult life in hospitals going through the different larval stages a medical trainee must on their way to their final form of an attending physician. But this current feeling of disconnect from the local hospital was unsettling because my normally healthy 19-year-old sister-in-law had suddenly found herself in the hospital in the middle of a pandemic.
The abdominal pain she had been experiencing the entire weekend was getting worse by the hour, and now she was reporting pools of dark red blood every time she used the bathroom. Symptoms that would usually prompt a no discussions visit to the ED were now being heavily scrutinized by everyone involved, most of all by my sister-in-law. I tried to reassure her about the low risk of transmission of SARS-CoV-2 while in the hospital and about the precautions hospitals were taking to keep everyone safe. And as I spoke to her, I could see the tears welling up in her eyes as she finally said what was lost on me but clearly weighing on everyone else in the room, “I don’t want to be alone in the hospital.”
As hospitals adjust to their new normal in this pandemic, most have instituted strict, even draconian hospital visitor policies. Most hospitals have not allowed any visitors unless a loved one was at death’s door for most of the pandemic. And only recently, select hospitals have shown to be more flexible and allow visitation for a limited time window. The CDC does not give specific recommendations regarding hospital visitor policy other than to say hospitals should limit visitors to those who are “essential for the patient’s physical or emotional well-being and care.” And it appears that we have collectively decided that almost all patient visitors in the hospital are non-essential.
While these policies are well-intentioned, they at best are a source of emotional distress and, at worst, compromising the care we provide to our patients. The modern hospital is a complex and flawed ecosystem where everyone must play their part, and a family member at the bedside is an integral part of that ecosystem. From warning us of a potential allergy that was not noted on EMR, to aiding in small tasks with their loved ones at the bedside as to decrease the load on an already overtaxed nurse, they can help grease the levers of an awkward and disjointed healthcare machine. But by far, their biggest impact is in the comfort, warmth, and companionship they provide our patients at a time of great need for them. They provide strength when our patients are facing impossible decisions and a hand to hold when there’s not much else to hold on to. These are not luxuries to be discarded so easily and completely but rather are an essential aspect of the care our patients need to heal. And try as we might, what we provide in their absence is just not the same.
And the care I provide my patients is just not the same.
My 85-year-old patient whose hospital stay was complicated with severe delirium while his wife stayed on the phone, desperately trying to break through his mental fog. Both of us wondered if the situation would have been different had she been at the bedside. Or my 35-year-old patient who looked at me with a blank stare when I told him that he had heart failure. His wife was on video call propped up on the table next to him. After my usual heart failure spiel, I asked if he had any questions. But there was only silence as I was certain he heard very little after the words heart failure. I looked over at his phone and the screen had gone blank too. After several unsuccessful attempts at reaching his wife, we came to the realization that her phone must have died. I assured him we would try again and that I would come back later. So I left him there in the silence of his room, and the blankness of his phone screen still propped up.
My sister in law’s experience wasn’t much better. No number of phone calls to the nursing station or messages left for the different services caring for her were adequate enough to feel like a true advocate for a family member in need. We have been so swift in our decision to severely restrict hospital visitors and have put little thought into making up for it with established protocols for better communication with families.
Communicating with families of hospitalized patients pre-COVID-19 was haphazard at best, but now more than ever, we need to work on establishing standardized protocols for communicating with patient families so that the level of communication is less dependent on who happens to be on service that week. But more than that, we need to be more critical of our blanket visitor policies and more creative on how to accommodate for our patients’ needs.
At the start of the pandemic when hospitals were overrun, testing and PPE were scarce, and unknowns about COVID-19 transmission abound, such restrictions were reasonable, perhaps even essential. But we have made progress since then; most hospitals test most if not all admitted patients for COVID-19; most Americans own a mask, and hospitals are able to provide to those without one. We must still take reasonable precautions. Allowing only one visitor at bedside, placing restrictions on movement of visitors throughout the hospital, and ensuring they practice social distancing from other hospital staff. With this, we can maintain patient and staff safety but also prioritize a part of care that is currently being undervalued.
And as hospitals and cities across the country continue to try and get a handle on the pandemic, we must also continually re-examine what aspects of care we determine to be essential and must preserve in some way. And we must realize that family at the bedside is part of that essential care our patients need to heal.
Taimur Safder is a cardiology fellow.
Image credit: Shutterstock.com
