To My Patients’ Family Members, My Apologies

But now you were at home, just a few miles that must have felt like worlds apart when I called and told you that his breathing was getting worse, and we might have to intubate. I tried to say it gently. I hope you could tell that I was trying. But I wanted to balance kindness with clarity, and I needed to make sure you understood how serious it all was without being able to see him — but of course you understood.

I could have worked harder to prepare you, but I didn’t think of that until you started to cry. In the hospital on occasion, we’ve seen family members collapse under the news we deliver — literally fall onto the floor — and I imagined you doing that alone in your home. If you were with us in the family meeting room, I would have passed you a box of tissues. If it seemed right, I might have touched your shoulder or even offered you a hug. But the meeting room is eerily empty. And it has been months since I offered a patient’s family member a hug.

On the other end of the phone line, I waited silently. “Just promise you’ll take good care of him,” you said. “We’re doing everything we can,” I replied, though I was aware of how hollow these words must have sounded coming from a faceless stranger. How could I expect you to believe me? “I’m sorry you can’t be with him,” I continued. “I’m so sorry.”

I’m sorry to you, too, for the night I called at 2 a.m. to tell you that your father was dying. You were startled, your voice thick with sleep. I’m sorry that you could not come to see him, but you knew that our hospital rules at that time dictated that only one person could visit, and that one person would be your mother. Which meant that you would say goodbye on FaceTime.

I hope I held the iPad still enough so that it didn’t shake while you were saying the things you would regret not saying. I wanted you to feel as though you were alone in that room, to forget for a moment that your surreal farewell was being facilitated by a doctor you had never met, who was also thinking of her own parents and hoping the seal on her N95 was tight enough.

I should apologize to your elderly mother, too, left alone at the bedside in her grief as her husband died. In a different time, you would have been with her. You would have been together for that sad walk out of the unit when it was all over.

The rules seemed to make sense at the start. In the initial days and even weeks of fear and unknown, the only rational response was to prioritize safety above all else. Hospital visitors, any of whom could be asymptomatic or pre-symptomatic carriers, threatened to sicken their own loved ones and the hospital staff. Social distancing would be impossible with patients’ visitors jammed into cramped elevators, sharing meals in the cafeteria, crowded into family waiting rooms. The safest way to minimize contact would be to keep all visitors out, with limited exceptions at the extremes — during a birth or, even for those with coronavirus, a solitary loved one at the end of life.

Now, it has been more than two months since my hospital banished most visitors. We are in a different place. And as the tide of coronavirus admissions recedes, we find ourselves wondering how these rules can safely begin to shift. At my hospital, our policies have recently changed to allow two visitors instead of just one at the end of a patient’s life and over a longer time frame, three days instead of just in the moments before dying.

Still, visitors have to check in at security in the lobby and answer questions before they can enter — do they have a fever or a cough, or shortness of breath? A yes might mean that they could bring coronavirus into the hospital and so they can’t proceed. If they are allowed in, they must go straight to their loved one’s room. There, we outfit them with the appropriate personal protective equipment and make sure they stay in the room — masked and gowned — until they are ready to leave the hospital. It is a strange way to be with the person you love when that person is dying. But it is something — a meaningful step as we move cautiously toward a new version of normality.

But isolation continues for most of our patients. The restricted visitor policies apply not only to those who are diagnosed with coronavirus, but to everyone — people with cancer and transplants and heart failure. I should say I’m sorry to them too, then. Scared and sick and alone in solitary rooms in the cancer wing of my hospital, bald and nauseated from chemotherapy, awaiting news of bone marrow transplants or another round of treatment, looking out the window waiting for someone they love to drive by so that maybe they can wave. Their hospital course will inevitably be harder without an advocate at the bedside.

And it doesn’t end when a patient leaves the hospital. So I should apologize to my patients at the long-term rehab hospital where I sometimes work, to the woman who has not seen her family for six weeks, who woke up from her intubation alone, was transferred from room to room by a fleet of masked health care workers, phone briefly lost, glasses misplaced, vulnerable and increasingly delirious. To the man whose wife used to bring him a cup of ice every time he asked, who sat at his bedside and played board games with him late into the night, I know you are unimaginably lonely there in your room at the end of the hall. We have tried to balance your safety with your humanity, but that too has been a casualty of this pandemic.

Daniela Lamas is a critical care doctor at Brigham and Women’s Hospital.