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Matthew Cardinal and his mother, Dianne Desjarlais Cardinal, in their downtown Regina neighbourhood on April 26, 2021.

MARK TAYLOR/The Globe and Mail

Intubated and drifting in and out of an induced coma over six days inside Regina General Hospital’s intensive care unit, Matthew Cardinal felt completely alone.

Though his brother and father had come to see him, they were forced to stand behind a pane of glass, watching him unconscious. Each was allowed just one, meagre, five-minute-long visit. When Mr. Cardinal, 34, briefly stirred from his sedation, he saw his older sister holding a letter up to the glass. Everyone sent love, the letter read; their mom was okay, and his cat, Cleo, was being tended to.

“I could tell she wanted to start crying when she saw me. She looked so worried because she saw me hooked up to all that stuff,” said Mr. Cardinal, a waiter and bartender who is recovering after contracting the potent B.1.1.7. variant of the COVID-19 virus last month.

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His mother, Dianne Desjarlais Cardinal, wasn’t allowed to visit. Because the two live together, she was forced to isolate at home instead. Pacing and losing sleep, she called every day.

“The need to be with your child and them being there by themselves, it was so helpless,” she said.

Sicker and younger: Toronto ICU copes with pressure during third wave of pandemic

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As ICUs across the country fill with patients sick with highly transmissible variants, nurses and doctors are having to make ever tougher decisions about family visits – trying to balance risk with compassion in the pandemic’s third wave. Strict visiting rules can feel cruel to families desperate to see the people they love as they struggle to survive, alone. Harsh visitors’ rules are also taking a punishing mental-health toll on the front-line workers charged with meting them out.

When a patient is dying at Toronto’s Sunnybrook Hospital, staff allow two people to look in through a glass door.

“They can speak into the room through a baby monitor but it’s really not the ideal in any shape or form,” said patient care manager Gerry Hubble. “It’s trying to make the best of a bad situation.”

To mitigate the risk of transmission, COVID-19 patients who aren’t in dire condition get no in-person visitors at all – only virtual visits through a computer or smartphone screen.

Staff need to “balance many risks in a single decision,” a process that can be gruelling, said Aaron Watamaniuk, patient care manager of the hospital’s cardiovascular ICU.

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“There are instances that will stick with us probably for the rest of our lives, thinking about the decisions we’ve made and the positions we’ve been put in,” he said.

“We want families in here. ... But for right now, we’re in an unprecedented time that is pushing us to places we haven’t been before.”

Some family members grow hostile, leaving staff to de-escalate the tension. After Ms. Hubble denied a granddaughter entry – the current rules only allow children and spouses, to reduce the number of people flowing through the ICU – a relative launched into a profanity-laced conspiracy theory about the virus being government-manufactured.

The strict visiting rules are also limiting access for families of patients who are hospitalized but do not have the virus. Some relatives demand entry, saying they’ve been vaccinated. Others grow distraught.

“We have had families throw themselves to the ground sobbing because they can’t get in,” Ms. Hubble said. “Can you imagine not being able to touch, comfort and kiss your loved one while they are struggling for their life?”

Some are stoic, speaking quietly to the sick through the glass, using the baby monitors provided.

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“We had one wife who had a special phrase she and her husband shared before they went to sleep,” Ms. Hubble said. “She whispered that to him over the baby monitor before he died.”

When they can’t visit, families send in photographs, drawings from grandchildren, music and headphones, favourite objects and stuffed toys.

“These are desperate times and we do what we can to comfort our patients and families,” Ms. Hubble said.

At Kingston Health Sciences Centre, two people are allowed into the room to say goodbye when a dying patient has days or hours left. A visitor can be anyone the patient chooses, from a relative to a best friend. Visitors are screened, dressed in protective gear and escorted to the room.

“We ask that they keep a distance as best as possible. It’s hard though,” said Daniel Roy, a charge nurse in the intensive care unit. “It feels like these families have been robbed of something.”

The hospital has seen a surge of patients transferred from other regions in Ontario – 93 since March. Some families aren’t able to travel the distance, relying on virtual visits instead. Relatives who make it in can be shocked.

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“The last time they saw them might have been at home as they were being transferred to hospital. The next time they’re seeing them in person, it’s in an ICU room as they are passing away,” Mr. Roy said.

“We try to give them some private time with their loved one. We’ll step out of the room.”

For front-line health care workers, the emotional fallout of such intense interactions is mounting, according to registered nurses Amie Varley and Sara Fung, who host the Gritty Nurse podcast and check in regularly with a network of ICU nurses across Ontario.

“They’re holding up an iPad to a patient who is not going to make it. You’re the go-between with the family, having the very last conversation with their loved one. When you do that over and over again, it takes a big emotional toll on you,” Ms. Fung said.

“Everyone’s in survival mode. We don’t even know what the fallout is going to be, if and when this is over,” she said of nurses’ mental state, a year in.

Dr. Hussein Kanji, a critical care physician in the ICU at Vancouver General Hospital, is seeing the psychological wounds among colleagues who are “taking the brunt of responsibility” in these last moments between patients and their families.

“It’s really a trauma … to take that on and go home and think about people being alone in their last days, you being the only one who can provide them any form of comfort,” he said.

His hospital now allows one family visitor a day to see COVID-19 patients through the glass of their single isolation rooms in the main ICU. When a patient is dying, Dr. Kanji said they assess each case and try to let in more than one person. For patients in the closed-off COVID-19 units, however, relatives must say goodbye virtually, through an iPad screen.

To Dr. Kanji, it all feels starkly different from the way many people died in hospital before, surrounded by those who love them most.

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“End of life looked very different – very beautiful, very peaceful in a lot of ways,” he said. “Now, it’s often very lonely.”

After death, the patient’s breathing tube is removed. Only then does the hospital allow family members, outfitted in protective gear, into the room to be with their person, to touch them through gloves.

Grieving visitors aren’t told how long they can stay, Dr. Kanji said, but get “enough time to say goodbye and have peace.”

Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters and editors.

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