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Patient Care Reflection

It is human nature to yearn for safety, protection, support, and love when one is scared or sick—a familiar face, the touch of a loved one, a family member’s soothing voice. The SARS-CoV-2 pandemic with its associated limitations on hospital visitation has stripped patients of these vital human needs. There are new innovative avenues by way of FaceTime or Zoom calls to connect patients and loved ones from a distance; nonetheless, there is no substitution for in-person human presence.

During this time when visitors are extremely limited and oftentimes not permitted within hospital walls, the bedside staff are the sole bridge connecting patients and loved ones. Prepandemic, it was a common sight to walk by a critically ill patient’s room and see a loved one perched in a chair with their hand blanketed overtop the patient’s fingers. Albeit sometimes in silence, hearing the hum of the ventilator, their presence provided a sentiment of comfort and familiarity. The pandemic created a starkly contrasting reality. Once a SARS-CoV-2 patient becomes ill enough to require ICU care, their fear is borderline insurmountable. They are in a closed room, isolated and alone, and their only human compassion and support is the frontline providers at the bedside. Suddenly strangers become family, and the importance of human care surpasses that of medical care. Taking the time to sit in a patient’s room and quietly keep them company so they feel safe to close their eyes is the most valuable intervention you can provide.

Once a patient deteriorates enough to require ventilator support, many do not survive. One occurrence that has been pivotally impactful has been the number of times that I as a frontline provider am the last person to speak with a patient. Generally, SARS-CoV-2 patients are completely lucid, just extremely hypoxemic. Once the hypoxemia progresses beyond the limits of noninvasive oxygen support, intubation is the next step. There is chaos and buzzing activity around the patient’s bed including gathering supplies and setting up machines in preparation for placing the patient on the ventilator. Meanwhile the patient sits in the hospital bed, terrified of the uncertainty and staring down the barrel of mortality. Once SARS-CoV-2 patients get intubated, it is typically a tumultuous and long recovery, including prolonged periods of time on the ventilator, significant muscular atrophy, and almost always severe encephalopathy. Many of the patients suffer complications leading to death or never wake up to full neurologic functioning. It dawned on me that there is a “golden window”—this period of time just before intubation may be the patient’s final moments awake in life. Secondarily, it dawned on me how significant it is during this “golden window” to put forth great effort in connecting the patient with the family via telephone or video call, as it may be the final time they speak. Honoring the “golden window” is now incorporated into my intubation checklist.

In a time where it is extremely busy, hectic, ...

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