In the time of COVID-19, everyone dies alone.
Last month, a man who was locked in — trapped in his own body by damage to the part of the brain that allows us to move and speak and swallow — decided he was ready to die. Our patient made it clear with tiny nods and shakes of his head as we confirmed the living will he had written weeks earlier, the one that stated, “I would never want to live like this.”
Our patient did not have COVID-19, but by the time he was ready to die, almost half of the beds at Boston Medical Center were filled with infected patients, which meant a hospital-wide ban on visitors. He received an exemption, but his only family was his elderly mother, who was too afraid of the disease to visit. On morning rounds, we asked whether he wanted to see his mother once more via video, as he could not speak. He shook his head no. We smoothed his brow with our blue-gloved hands, and then — pagers screaming — we rushed to another bedside.
By the afternoon, he had died, alone. The last faces he saw were ours, half-hidden behind paper masks.
I am a neurologist, far from the COVID-19 front lines where many providers are battling. I see COVID-19 patients only when they also have neurological diseases. But I work at a public safety-net hospital that cares for the marginalized populations most affected by this pandemic, and I can see every day that it has changed how we practice medicine in ways large and small, too innumerable to fully comprehend yet.
In the hospital, we see as little of our patients as possible, calling into their rooms by telephone to check on them rather than risking exposure. In our outpatient clinics, we try to piece together a physical examination from video screens, looking for clues to a diagnosis in the clarity of a patient’s voice or the symmetry of her smile. At Boston Medical Center, where one-third of patients are non-English speakers, we struggle to call medical interpreters on iPads, our voices muffled by masks and lost in translation.
Perhaps most devastating is the way this deadly virus has isolated our patients from their families in their final moments.
Recently, we met with the family of another patient, a man who has been in the hospital for months. He has already died multiple times, his heart falling still if he so much as coughs too hard. Each time, his doctors shock him back to life. He has 17 brothers and sisters and innumerable nieces and nephews. They tell us he is stubborn, fiercely independent, whip-smart. They tell us he hates doctors.
Before the coronavirus crisis, his family threw him a birthday party in the hospital, filling his room with balloons. Now, we meet in the hospital lobby. The family is banned from venturing farther inside, let alone congregating at his bedside. We sit in chairs positioned 6 feet apart, tugging at our masks as we talk. They decide that the man they knew would want us to stop reviving him, to let him die gracefully. They are weeping, and I move to embrace them, but I stop, sit back down, pull my mask over my nose. They ask to see him, and the hospital allows just one niece to come to his bedside, just for 15 minutes, just to say goodbye. She brings her phone and with it the faces of his entire family, loving him from afar.
In our new, pandemic world, we only ever touch our patients through layers of latex and paper — yellow masks keeping us from breathing them in and Plexiglas shields obscuring our vision, our skin chapped as we wash person after person off our hands. In the time of COVID-19, I feel farther away from my patients than ever before, but at the very end, there is no one else.
Pria Anand is a writer and physician. She cares for patients at Boston Medical Center, where she is an assistant professor of neurology. Send comments and 650-word submissions to email@example.com. Please note: We do not respond to submissions we won’t pursue.