No Visitors Allowed

In 3 months, I will finish my last stage in training. Nine months ago, I became a cardiologist and then decided to do one more year in heart failure and transplant in New York City. The first 9 months were just growing pains of training until the COVID-19 pandemic caused patients to inundate our hospital. The constant motion and fast pace that defines Manhattan was now even faster. Since the first case of COVID-19 was confirmed on March 1, 2020, things—and perspectives—have changed. Our hospital is now divided into COVID-positive and -negative wards. For my transplant and heart failure patients, avoiding cross contamination with COVID-19 is critical for their survival as they are considered a high-risk population. We now have trendy concepts like social distancing, PPE (personal protective equipment), and a “no visitor” policy. No visitor policy. He was there, sitting and waiting, wondering in the midst of his own delirium why his family had not stopped by, why was he surrounded by strangers—strangers who would not show their faces. Everyone around him was wearing masks, face shields, and gowns. The last thing he vaguely remembered was having chest pain and losing consciousness. His dear wife had asked him multiple times to go to the hospital, but he was afraid that he would get COVID-19 sitting in the emergency room at the hospital. So he waited. He waited for the chest pain to go away. Now he was connected to something that looked like a machine and there were tubes coming out of his chest. At least he felt no pain. I was called to evaluate a new overnight admission who had presented in cardiogenic shock requiring mechanical circulatory support. I was told that he presented “late,” after a few days of symptoms suggestive of a myocardial infarction. Two weeks had passed and visitors were not allowed. I decided to include in my daily prerounding a video call with the family. I covered my phone in a plastic bag and walked into the room. My patient was connected to an extracorporeal membrane oxygenator, renal replacement therapy, and a ventilator. I brought the phone close to his face, holding it for 5 to 10 minutes. I listened to his family talking to him, giving him words of encouragement. In those moments, I could see glimpses of his prior self. I could see past the messy hair and the unkept beard. I could see past the hospital gown and the multiple dressings that covered his chest. I was finally able to see Mr. X, and to hear the love of his family, the words of encouragement, the tears of his children. For a moment, I allowed myself to be part of this, and not isolate myself from their suffering and longing to be there with him. He was crying after the last call from his family. He had a moment of mental clarity; the uremia had resolved. He understood what it meant to be in the hospital and not recovering fast enough. Despite all the precautions, Mr. X developed a fever during his fourth week at the hospital and tested positive for COVID-19. Just like that, after taking care of him for 4 weeks, I was not going to see him again. I had learned about his hobbies, his favorite books, the songs that made him relax. He was transferred to the COVID unit. In a few hours, he decompensated and died. No visitors allowed

Chest pain · Delirium · Face shield · Health care · Medical emergency · Political science · Population · Psychiatry · Sitting · Social distance · Visitor pattern · Wife · COVID-19 and Mental Health · Law · Medicine · Psychology · Surgery