Opinion
When You Die of the Coronavirus, You Die Alone
Containing a pandemic means keeping visitors out of the I.C.U. My patients will suffer in solitary confinement.

BOSTON — As an I.C.U. doctor I’m used to giving bad news, but I was not prepared for this.

I paused outside my patient’s room to watch her for a moment. She lay on the bed, tethered to a ventilator by the tracheostomy tube in her neck. Her husband sat in a small plastic chair beside her with his hand on her leg, smiling at some silly sitcom playing on the TV. I hesitated a beat. And then I entered.

I had to tell him. There was no way to soften the blow. The hospital is changing its rules, I said. No more visitors. When you leave today, you both need to say goodbye.

I watched their faces shift. My patient’s breathing quickened, and her ventilator alarm sounded. Her husband quickly moved his hand to her shoulder and her breaths slowed; the alarms silenced. He knew how to calm her. He had been there through all of it — hospitalizations for cystic fibrosis, the transplant, the bouts of rejection. When we took away her voice with the tracheostomy tube, he spoke for her.

But now, as we tighten our protocols to protect our patients from the threat of Covid-19, she’s alone. Here in my hospital, as in so many others throughout the country, we’ve banished most visitors. It’s a tough decision that leaves our patients to suffer through their illnesses in a medical version of solitary confinement. And I’m worried for them. Because those of us on the front lines simply don’t have a plan for this.


The isolation is, of course, even more profound for those who are infected with, or are being evaluated for, coronavirus. I took care of one such patient who was intubated when he started coughing up blood on the general medical floor. He was alone in his room, on FaceTime with his daughter, when it started. So that 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.

Or even if she will be able to see him. The devastating image of the lonely deaths of coronavirus patients in Italy hangs over us all. Talking with one of the nurse practitioners in our hospital’s new Covid-19 I.C.U. one recent night, I asked what worried her most. “Patients dying alone,” she replied quickly.

A doctor next to her nodded in sad agreement. On a recent shift, he had intubated an elderly husband and wife, both of whom had severe respiratory failure from coronavirus. Their daughter asked if she could come in to see them. Though we will make exceptions for many end-of-life visits, in this case, he had to say no — they all lived together, the daughter had a fever herself, and as a result could risk infecting other hospitalized patients. Which means that if her parents die of this, they will do so in separate sterile hospital rooms, far from anyone who loves them.

So it’s up to us, the health care workers who are seeing these patients at the front lines, to find ways to maintain connection, to balance our fear with tenderness. This won’t be easy. I think of myself as the kind of doctor who sits at a bedside, who holds a hand, who explains what is going on slowly and gently even to my intubated patients because I can’t know what they will remember. I want to be the doctor who is always willing to spend a few extra minutes despite being stressed or rushed.

Lovely piece of writing I must say.