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As an emergency physician, I talk about life and death often, but never like this.
I met Mrs. B in the emergency department where she was sent with a sore throat and cough. There was a COVID-19 outbreak in her retirement home. I pulled up her chest radiograph and stared at her lungs’ new hazy white spots, a spring snowstorm. After nearly a century of beating, her heart was now newly skipping beats.
I worried about her. I knew we’d have to talk about death.
Standing in Mrs. B’s curtained room, I wanted to ask her about her life, her loves, her values, and how she saw her future. I had a familiar urge to sit down next to her, to hold her hand, to give her time to let the questions, and sometimes the answers, sink in.
But COVID-19 preys on these comforts. Every moment I spend near my patients and every touch increases my chances of getting sick and potentially infecting others, too. Every day, I am pulling my end of a tug-of-war rope, trying to stay in the safe zone.
To stay safe, I have to build space and layer personal protective equipment between my patients and I – a yellow gown, a blue mask, white gloves and a clear face shield. Only then can I cross the red line on the ground into their room- the hot zone. My patients are alone in the hot zone. No visitors are allowed. At a stethoscope’s length, I try to resist the urge to examine them too closely for long, limiting the time spent listening to the way air moves in and out of their lungs while I unconsciously hold my breath.
It is not lost on me that at a time when patients most require my presence and comfort, I am most constrained, and frankly scared, to give it. This virus is trying to teach me new ways of caring for them.
Talking to Mrs. B about life and death was never going to be easy, even before the pandemic. On that day, she couldn’t hear me, her hearing aids forgotten on a counter at home. We got by with a mixture of loud single words – “pain?” – and miming symptoms. Exploring the intricacies of life and death in these improvised theatrics and with all this space between us seemed absurd at best, barbaric at worst.
In normal days, I wouldn’t be wearing a mask – there is much we hear with our eyes and read with our lips. I would have gotten closer to her, crouched next to her good ear – which one was it? – and lowered the timbre of my voice to be heard. I learned that trick before the pandemic, watching family members translate my voice to an audible one. I thought of her family waiting at home and the solace they would give us both, in normal days, by being here. I didn’t know how to give her the comfort of her doctor and of her daughter. It didn’t feel fair to any of us.
They teach us how to comfort in medical school. It is both intuitive – the simplicity of a warm smile – and structured. When I was in second year, they taught us how to have difficult conversations. I practised the skill with simulated patients with fake cancers and fake fathers who died, weighing my words and facial expressions carefully. I practised getting comfortable with the liminal silence that comes after shattering someone’s world, realizing it never does get comfortable. I learned early on, from my first patient’s death, the therapeutic value of touch, the comfort of holding a hand. “Cure sometimes, treat often, comfort always,” said Hippocrates.
At a time when health care workers like me are being lauded as superheroes, I worry that my patients are deprived of the simple power of comfort. In the past few months I have been wondering whether what I do is enough, whether my worry and my care are felt across the chasm of personal protective equipment, whether the tone of my voice and the choice of my words could sufficiently envelope them in my care.
The truth is, I have never felt so vulnerable, so aware that I, too, could catch this disease and become the patient. I try to think about what might give me comfort, beyond medical treatments, and I try to give them that, never sure if it’s enough. The instinct to get closer to my patients tugs against my primal need for safety.
Mrs. B looked so small in her hospital bed. Like me in my PPE, she did not look like herself. Her short white hair was dishevelled from the ambulance gurney and the transfer to her hospital bed. Her sun patched hands rested on her belly, her wedding band loose on her thin finger. I held her hand and made a telephone sign with the other; I was going to call her daughter to give her an update and ask about any advance care directives. She squeezed my hand, not quite ready to let go. I held on a bit longer. She’d been alone so long.
I parted the curtains of her room, carefully weighing my decision to remove my layers of plastic armour. I wasn’t sure how long I’d been in her room; time, like space, had transformed during the pandemic. It felt at once too short and too long.
“Don’t you leave just yet.”
I turned back around.
“How are you doing?” she asked me.
And in that moment, I knew she saw me as I was, a scared doctor doing her best, that maybe the tug-of-war rope I had been wrestling with was never meant to be pulled, but just held in each other’s presence, a delicate bond between us. Maybe that was enough.
Sarah-Taïssir Bencharif lives in Ottawa and Brussels.