She Went Home: End of Life in the Era of COVID-19

The mother had delivered a healthy newborn. After a careful instrument count and exchanging pleasantries, I headed for the shower. It was getting late, and I had unfinished business.

On to the ICU, but not for my usual reasons. I heard sounds of beeping intensify just before I entered the room, and I felt an ache inside. My eyes focused on the vital signs on the screen. I sat down. “Good evening,” I said.

A smile spread across her face. Struggling, she said,  “Good evening, I love you.” I was relieved, at least for the moment. Until then, I did not know if I would ever talk to her again.

I remember the way she looked at me: as through a haze. I remember regretting not having spent more time with her. I remember reassuring her that it was all going to be okay.

When I asked my mother how her day had been, she said “Okay.” But the look on her face suggested otherwise.

I knew my time was running short. I wasn’t even supposed to be there as Coronavirus had swept the globe. I was only there through subterfuge, under the guise of a physician. In truth, I was a concerned family member. When the staff figured out I was there as a “visitor,” I was asked to leave. I understood, but it was hard to digest. As I walked away, I wondered if this was the last time I would see her.

Whether she recovered or not is a matter of opinion. She was moved out of the ICU, but after a prolonged hospital course the decision was made to transition her to her hospice care. The options were to send her to a skilled nursing facility with a No Visitor policy or to come home. At this point, barely able to communicate, she came home.

Watching the deterioration was extremely difficult. The slurred speech, the family stories echoing around her that she could no longer participate in, and the realization that every beginning has an ending. Her last words were, “I love you”.

We practice in a climate of checklists, standardization and protocols. Yet, there is an art in the practice that is undeniable, that is innately human. Perhaps in this season of unpredictability, fear and anxiety, this art could never be more profound in the quality of care we provide to our patients.

Nathan Keller
Lebanon, Pennsylvania