Health

Nothing Could Have Prepared Me for Caring Virtually for Dying Coronavirus Patients

During a time when humanity is most needed, I am trapped in a profoundly inhuman situation: swallowed by my couch, discussing illness and death with patients who have the coronavirus and their loved ones, all of whom I have never physically met. We connect through a phone speaker or, if we’re lucky, a blurry screen, both of which protect me in lieu of a mask.

I am a child psychiatrist by trade, now a redeployed virtual-medical doctor for hospitalized coronavirus patients in New York City. My pre-coronavirus self was unaccustomed to seeing people die, apart from what I witnessed during medical school. I was far more comfortable with being physically present for lengthy, wordsmith-y exchanges with very alive children and their families. Now I provide a combination of services, including palliative care, which involves having discussions regarding end-of-life experiences (such as if you want to be on life support); giving in-depth medical updates and recommendations to families and patients; and also assisting others on the medical team (doctors, physician assistants, nurses, social workers, and more).

Each day, my team FaceTimes or calls families, who are often desperate and utterly terrified, for morning patient-room visits. A pair of iPads carried by the masked and gowned team allows families to be in the room for updates and facilitates meetings between me, the patients, and their families. The day closes with a team discussion about each patient’s status and plans for future virtual family-patient visits or medical changes.

Virtual medicine has a steep learning curve, marked by a complicated, disconcerting emotional experience. Not even my psychiatry training prepared me for this. I have never felt so close and connected to a devastating situation while concurrently feeling distanced, confused, and almost dissociated from it.

All through my iPhone, I hear the tears of a daughter who has lost both parents. I palpably absorb the helplessness of a husband who will never see his partner again. I overhear Code Blue alerts and virtually navigate a forest of identical-looking health care workers in N95 masks. These past few weeks, I have had to say “I don’t know” more times than I could have ever imagined or wanted to as a doctor.

Sometimes, somewhat irrationally, I have fantasized about being in the hospital so I could, even for a second, feel less powerless. I know it’s an illusion to think that being physically present would grant me any more power in this unthinkable situation. Still, I realize now I had taken for granted not only the purpose of touch in my role but also of observing someone’s way of being, of exchanging a look, of feeling their presence in the same space. I wish to see the way my patients exist: how the 55-year old fruit seller lies on his bed; how the blunt nurse picks at his lunch; how the retired teacher, now 15th-century-art connoisseur, glances, or glares, or maybe stares, at a passerby. I desperately wish the homeless, non-English-speaking 70-year-old man with no family and poor eyesight could see one non-masked face just once before possibly dying. The mismatch between the quiet and boring ambiance of my New York City apartment and the heartbreaking conversations I am having makes this all feel like some kind of nightmare.

But placed deep inside this seemingly endless sea of devastation are tiny pockets of grit, hope, and unity in the small yet powerful ways my team and I have collaborated to build trust with patients and families. In my daily conversations with patients on gurneys and me on my couch, I learn about the fruit seller’s love for Reggaeton and the nurse’s zest for barbecue, or that the teacher would not want a life in which she couldn’t garden and drive. As I pose no infection risk virtually and don’t have to wear personal protective equipment, a patient once told me, “You’re the only person I can recognize on my team.”

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