Like most ICU physicians, I’ve witnessed my share of death and tragedy, both pre- and post-pandemic. Despite that, watching a longterm outpatient succumb to their illness — this is what always hits me the hardest. It feels like such a profound loss, and in my younger days, my rational mind could never understand it. They aren’t family or a close friend, so why does it hurt so much?
Reflecting on this, I think most outpatient physicians are fortunate enough to have a handful of patients whom they’ve seen for years; and through those years, our patients regularly cheered us up, made us smile, hugged us, shared their lives with us, respected us and made us feel important and valued. Maybe it isn’t all that different from an old friend after all.
I put one such patient on hospice recently, in the midst of the seemingly never-ending COVID pandemic. She sat there in clinic in her wheelchair, barely recognizable. But somehow, underneath her frail body, rapid breathing, silver hair and masked, tired-appearing face, I could still see her bright and slightly mischievous eyes. Her lungs were clearly struggling. And now her heart was failing, and there was little else to do.
I lingered for a bit, not wanting the appointment to end. When the time came, I couldn’t even give her a final goodbye hug because of the ongoing fear of COVID. Instead, we sat there with our masked faces blowing endless kisses to each other as I told her over and over again in my broken Spanish that she was “Mi Amor.”
As the tears started falling, my focus shifted to not letting my mask get too wet for fear it would be ruined for the rest of clinic. I quickly looked over at her loving daughter, who earlier was also fighting back tears but now was crying freely. Her tears flowed under her mask, over her mask, down the sides of her cheeks. In that moment, I realized how much sadness one can see even with masks — it’s all in the eyes. Our grief-stricken eyes met for a brief moment of shared compassion and understanding.
COVID-19 has undoubtedly changed every single relationship in every one of our lives. We often can’t even hug or kiss our own friends and families. But the way it’s ruined people’s ability to say a final goodbye to those they love is one of the great tragedies in this pandemic. No one will ever get these lost moments back.
Though my sincere hope throughout this entire crisis is for these experiences to somehow make us better and kinder people — and physicians — in the long run, it doesn’t change how incredibly heartbreaking and unbearable it is. We are not going to be able to count the number of times that we had to witness the unthinkable sorrow of a loved one who can’t sit with and say goodbye to those most dear to them as they leave this world.
Or, maybe, if they’re lucky and the timing is right, one or two people could visit as an exception to hospital restrictions, restrictions that are sadly in place to try and prevent the spread of infection from getting even worse. But even seeing the anguish of families forced to choose one or two people has brought my most resilient ICU physicians to tears.
In the end, the closeness and intimacy of these last moments also isn’t the same. There are often no hugs, no kisses, no closeness. I’m grateful that I at least got to see my dear patient in person one last time. But what I wouldn’t give for a final hug with “Mi Amor.”