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The Gift of Saying Goodbye

June 11, 2020
by Barbara Steinberger

One of the most heartbreaking aspects of the COVID-19 pandemic is that it has prevented hospitalized patients from having visitors, leaving patients to die alone and depriving families of a chance to say goodbye to their loved ones. But the nurses and clinical staff on EP9-5, the infectious disease unit at Yale New Haven Hospital (YNHH), have made it possible for many patients and families to actually have that final goodbye—even when the family is half a world away.

During the first weeks of the pandemic, Erin Wilson, RN, MSN, patient service manager for EP9-5, asked her online neighborhood group in Milford if any of them had electronic tablets that they could donate. One neighbor bought four small tablets on Amazon and donated them to Wilson’s unit at the hospital. Other neighbors donated old iPads and laptops that they were no longer using, for a total of about eight donated devices.

With those devices in hand, the nurses on EP9-5 began working with families to set up face-to-face calls with patients who were classified as “comfort measures only” (CMO) – patients who were very sick and did not want extraordinary measures to keep them alive. The families of those patients had resigned themselves to never seeing their loved ones again and were thrilled when nurses offered to connect them.

“They said ‘Oh my gosh, you mean I can see Mom? I can see Grandma?’ That’s what really pulled on my heartstrings,” Wilson said. “The fact that we were able to do this was just magical.”

Reuniting Families Around the World and Next Door

One of the most poignant moments came when the hospital staff was able to use Zoom to connect a patient in his 90s, who was comfort measures only, with 15–20 family members living in different parts of South Korea. Marietta Khalil, RN, the charge nurse on EP9-5, said staff members worked with the patient’s son, who lives locally, and with the hospital’s Information Technology Services team to set up the complex Zoom call and make sure everything was HIPAA-compliant, all under very time-sensitive circumstances.

“It was really emotional for everybody there. The one thing that stuck with me is that they (family members in South Korea) said ‘this is priceless,’" Khalil said. The patient was not able to speak, “but he knew his family was there. He cried a little when he saw them.”

Khalil helped arrange another emotional reunion that didn’t involve any technology at all. When a COVID-positive woman in her 70s was admitted to EP9-5, Khalil recognized her last name and realized that the woman was the wife of a patient who had been admitted to the ICU several days earlier. When the man was transferred from the ICU, hospital staff arranged for him to be in a room on EP9-5 next to his wife’s room.

Hospital clinicians, together with the couple’s son on the phone, had to break the news to the wife that her husband of about 50 years had very little time left. They wheeled her next door to his bedside, and the couple was able to spend several hours saying goodbye to one another—a rarity during the pandemic.

“She was extremely grateful--it really meant the world to her,” Khalil said. Hospital staff became very close with the woman during her stay at YNHH, and checked in on her frequently after her husband died. “We all comforted her when her family couldn’t,” Khalil said.

No Longer Feeling 'Useless'

In the early days of the pandemic, before receiving the donated electronic devices, the nurses and clinical staff on EP9-5 had to watch patients die alone, without having any contact with family members—an experience Khalil described as “horrible.” “They never imagined dying alone in a hospital. Having a nurse by their side to comfort them is good, but it doesn’t at all compare to seeing and hearing your family.”

During those times, Khalil said she was feeling “pretty useless. I felt like there was nothing we could do for these patients.” But once she and her colleagues started setting up Zoom meetings with their loved ones, Khalil felt that “finally I can do something that means something to them and that can really help them.”

The staff on EP9-5 has always been incredibly strong and compassionate, says Sheela Shenoi, MD, MPH, a physician specializing in infectious diseases. The unit has historically treated patients with HIV/AIDS, many of whom have complex social, psychological, and medical needs.

“Staff on this unit are accustomed to managing a lot of non-medical issues and serving patient needs that go beyond tests and medicines and more traditional medical interventions,” Shenoi says. Once the pandemic began, EP9-5 was the first unit at YNHH to care for COVID-19 patients.

As a truly historic medical event, the COVID pandemic has naturally inspired a huge amount of research. “There are a million minds working on the science,” Shenoi says. “But sometimes we get lost in the science. That human element is so important. There are incredible human stories that we don’t spend enough time thinking about.”

Submitted by Jill Max on June 10, 2020