I got my first dose of a Covid-19 vaccine on Dec. 16, and was surprised at the feeling of relief, hope, almost exhilaration it brought on instantly. It was an unexpectedly emotional experience. It’s been more than two weeks since my second jab so I am, in theory, pretty well immune to Covid-19.
Shielded behind an N95, visor, gown, and gloves, I reckon I’m now about as safe as I can be. So when my day’s work as an anesthesiologist is done, I’ve started sitting with Covid-19 patients. At first I tried chatting with them, but when someone is breathing 30 times a minute through an oxygen mask, it’s difficult to be a great conversationalist. Now I talk to them, hold a hand, get them water, arrange their pillows. Sometimes I just sit there because I have this nagging, incompletely explored belief that just a human presence, someone bearing witness to their ordeal, has value. Afterward, I call the family because they are victims of this virus too.
I also realize that, as much as this is about patients, it’s about me, too. I’ve put breathing tubes into enough Covid-19 patients who went on to die that I’m a little punch drunk. And the insidious tedium of the Covid-19 world with its constant petty annoyances — mask wearing, sanitizing, backing away from people — and the profusion of well-meaning but misguided rules is taking a mental and emotional toll on me. Sitting with patients lets me push back against a virus that affects almost every aspect of my day.
Dying alone behind closed hospital doors
My wanting to sit and talk with Covid-19 patients stems from what happened to a patient during my first job as a junior doctor in England. Its memory follows me today.
We were caring for an old, old gentleman during his last days. We were doing what we could to keep him alive so his son in Australia could fly back and see him before he died.
At the time, British hospitals kept patients in bays of four or six beds, a vestige of the huge Nightingale wards of the Victorian infirmaries. But as my patient neared the end of his life, he had been moved to a single-bed side room.
One morning as I came in to round on my patients, a nurse took me aside to tell me that my patient had died during the night, before his son’s flight had arrived. That was tragic, but the full story was far sadder.
As is common in people nearing death, my patient apparently became agitated and tried to climb over the bed rail. In doing so, he fell to the floor. Anyone who has worked in a hospital or nursing home knows the sickening sound of an old person falling: a faint cry, the scrape of a grasped nightstand, the horrible thwack of failing limbs and an undefended skull meeting hard floor.
But, of course, the only thing worse than hearing a fall is not hearing it. Behind a closed door, my patient lay on the ground for perhaps hours — no one exactly knew — until he was found by a nurse during the morning medication round. Distraught, she called for help. They put him back into the bed, where he died a short time later.
There are so many things about his death that still make me angry and upset. But my overriding feeling was this: If we can’t offer a dying man something better than passing his last hours on this planet alone, crumpled on a cold hospital floor, then we might as well all pack up and go home.
Fast forward to 2021 in the Massachusetts hospital I work in, but it could be any hospital in the U.S. When I’m on call and all my duties are done, I walk through the hospital to get my head around the Covid-19 pandemic. In the operating rooms, where I spend most of my time, all patients are Covid-free. It is on the medical floors that you see signs of the pandemic: countless shelves of bagged PPE for the next shift, nurses in N95s, and closed doors — rows and rows of closed doors.
Behind every door, a person with Covid-19. Alone. We treat them with the few tools we have in our armamentarium — antiviral drugs, the steroid dexamethasone, oxygen — and we wait. They see their nurse periodically. A food service worker comes in three times a day with a tray of food. Other than that, no human contact.
Throughout the pandemic, interacting with all patients, not just those with Covid-19, has been difficult; more so since the November surge began and hospitals once again stopped allowing visitors. And because going into a room housing a Covid-19-positive patient requires putting on an N95 mask, a secondary mask, and a full-face visor — along with a gown and gloves, which must be changed between rooms — health care providers keep visits to these patients to a minimum.
Behind each closed door is a patient: breathless, exhausted, often confused, perhaps scared, always alone. Behind each patient is a family, also confused and scared, and unable to visit their loved one. This heartbreaking scenario is replicated behind countless closed doors in almost every hospital across the country.
The implications of immunity
2020 was a dreadful year and 2021 has started off even worse. But those of us who have been vaccinated have a rare opportunity, a privilege, perhaps even a moral duty, to use our immunity to connect with patients, to connect with families, to bear witness. It allows us to regain some control over a seemingly uncontrollable situation. We can gain agency and rediscover the reason so many of us went into medicine in the first place.
So I’m asking anyone who has been vaccinated to think hard about what your newfound immunity represents. One thing it means is that being physically present with people who have Covid-19 is possible again. We need an army of vaccinated volunteers to support patients and be a conduit for their families, to help them through the worst days — sometimes the last days — of their lives. This can’t come from way up in the hospital hierarchy. After all, any act of true altruism is the preserve of the individual, not the hospital system. It must come from the nurses, doctors, cleaners, technicians, and others who want to dedicate a few minutes at the start and end of their shifts to human contact.
If we can’t hold the hand of a dying person in their last hours on this planet, we might as well all pack up and go home.
Ben Moor is an anesthesiologist and pain specialist who lives and works in Massachusetts.
What a wonderful anesthesiologist and pain specialist you are Dr. Moor! What a humane idea, something I would love to do. However, my question: Do we know enough to make an evidence-based decision on this that it would be safe? I thought the current vaccines provide 94-95% efficacious immunity to severe disease in clinical trials but unknown levels of effectiveness in real life and little is known about their effective immunity to infection/transmission. Can experts in immunology, vaccines, and epidemiology please reply to assess whether this is indeed a safe idea to put vaccinated volunteers (in full PPE I presume) in contact with covid-19 patients? What special precaution could make this a viable option?
Your question is a good one and there is little data at this point (but it is coming). I’ve discussed this with various infectious diseases people at a few hospitals. It is possible that vaccinated people won’t have neutralizing antibodies and could be vectors even if not symptomatic themselves.
My fear is that one of our volunteers will either get Covid or pass it on. To that end we have insisted that volunteers wear the same PPE that nurses have been wearing throughout this pandemic. We believe that this in combination with full vaccination is pretty robust. My infectious diseases person, incidentally, feels this is over cautious.
Crudely, and I’m sure a statistician will burn me for this, the probability of getting SARS-CoV2 through full PPE is very, very low. If the virus gets through, the chance of being infected must be reduced by the person’s immunity post-vaccination by – 60%, 90%, 95% – we don’t know how much exactly. But I’d say those are good odds. Also, it should be remembered, all our volunteers are clinical workers and of working age so their personal risk of a poor outcome is low to begin with.
You are right to raise this and be cautious. Take all the precautions, get the infection risk as low as possible. Then go into the patient’s room.
Just my thoughts. Good luck and stay safe!
I appreciate this article and the call to action. My only question is what is the implication for bringing the virus home to my unvaccinated family? Is that possible if I’m vaccinated?
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