The Intensive Care Unit at Brigham and Women’s Hospital is far from still these days.
Doctors and nurses go about their work, all the while adapting to the added procedural changes and new patients brought on by the rapid spread of the novel coronavirus. The beeping and whirring of medical equipment remains the same.
But there exists another type of silence these days; a void so palpable that there was only one word Dr. Daniela J. Lamas, a critical care doctor in the hospital’s ICU, could think of to describe it: “Different.”
What’s missing, she said, is the presence of loved ones who would typically fill the unit.
“In an odd way, it’s more quiet," said Lamas, “because there are no families."
Like many hospitals across the region, country, and the world, Brigham and Women’s is no longer allowing visitors except under special circumstances, according to its website, “because the spread of COVID-19 is a threat to our patients, their loved ones, and the Brigham community.”
Though many patients in intensive care are being treated for other illnesses, the risk of a COVID-19 outbreak is too great to allow visitors.
Lamas wrote about the impact that barring most families from the ICU is having in a powerful Opinion piece that ran in The New York Times last week.
“It’s a tough decision that leaves our patients to suffer through their illnesses in a medical version of solitary confinement,” she wrote. “And I’m worried for them. Because those of us on the front lines simply don’t have a plan for this.”
Without visitors around, there can grow a kind of disconnect between patients and medical workers, Lamas told the Globe in a telephone interview.
In the ICU, she said, doctors and nurses often meet patients when they’re intubated, and so they don’t know them through conversation. Instead, they truly form connections to patients through their families.
Loved ones will fill out “get to know me" boards that say things about the person, and maybe provide a nickname, she said. They bring in pictures and regale staff with stories that paint a broader picture of who that person was before being in critical care, confined to a hospital bed.
Due to the threat of the coronavirus, that has all changed.
“Currently we are meeting patients without any of that," she said. “There is something intangible that is lost in that, when you just don’t have that view of who this person’s people are."
During more normal times, Lamas would walk the halls and think about how remarkable it was that people would stay by a patient’s bedside all day, watching TV with them quietly, or maybe holding their hand and talking to them or comforting them.
If there was a case where nobody was ever in a patient’s room, that always struck her as particularly sad.
“Now, that’s the way it is for everyone,” she said.
This new loneliness and isolation, she said in her New York Times piece, is, of course, “even more profound” for patients being treated for COVID-19, or who are suspected of having the illness.
In her column, she recalled a father who began coughing up blood on the general floor of the hospital as he talked to his daughter on FaceTime in his room. Lamas, who tended to the patient, said the man had to be intubated.
“[T]hat is the last image she has of her father — on a shaky computer screen, blood staining his hospital gown. I offer her updates over the phone, but the truth is that I am not sure when she will be able to see him again," she wrote. “Or even if she will be able to see him.”
Lamas did not say if that patient has COVID-19. But she told the Globe that the hospital’s ICU currently has “a handful” of patients being evaluated for the virus, including him.
If a patient does have the coronavirus, the severe illness not only keeps families at bay — it also impacts the way someone like Lamas typically conducts herself on the job.
Lamas said the COVID-19 patients she has seen to personally during shifts are intubated, so they’re not at a point where they would be able to talk to her. But she can’t even prolong her presence around them as with other patients.
“I generally like to spend time at the bedside even for an intubated patient, you know, talk to them a little bit,” she told the Globe. “In this situation, it’s different. You really don’t want to linger — not because you’re being careless or lazy, but because you can’t. It’s really not safe.”
Lamas said in her column that because of the isolation — for COVID-19 patients and otherwise — it’s more important than ever for those in the ICU to maintain strong communications with people’s families as best they can, a task that will surely be difficult as the number of possible patients threatens to grow over the coming weeks or months.
“Now, we have to make sure . . . that we take dedicated time to make sure [families] are updated,” she told the Globe. She’s even considering doing that via FaceTime if she can.
In a recent conversation with a colleague, they talked about how, under the duress of the coronavirus pandemic, there is a great sense of purpose in the hospital, and a beaming pride in what they’re doing to support each other through this ordeal.
“Finding ways to reproduce that remotely for our patients and their families will be important,” she said.