The unprecedented medical realities of COVID-19 are being continuously documented. However, the collateral damage is more difficult to measure, especially when considering the psychological toll on patients and families separated from loved ones due to present mandates. The isolation can be particularly difficult in nursing homes, where separation is magnified by illness and geography.
This is one of many reasons it has been a challenging month in the 112-bed skilled nursing facility where I am the medical director. To address the spread of COVID-19, we have restricted access, halted visitation of families, discarded communal dining along with recreational activities and group therapy, and implemented reflex testing of patients and staff. And, not surprisingly, with this has come understandable uncertainty regarding our patients, our staff, our nursing home, and our future. The degree of concern is obvious throughout.
However, 6 words, “I love you, I miss you,” have shed a ray of light. For the past 5 years, I have taken care of the patient at the VA Boston Healthcare System who uttered these words. He was status post a stroke, with resulting hemiparesis and aphasia. In all the years I have had the privilege to care for him, I have never heard him speak. Each morning when I greet him, I lift his hand with the understanding that he may or may not have some recognition; I then pivot to his wife to talk about his care. His wife has been at his bedside constantly during those years despite not being a resident herself. She pores over his medications, recommends adjustments, lovingly moisturizes his body daily, and sings to him most days. She lets the staff know when she thinks care has gone well and when there is opportunity for improvement. And despite foul weather or difficult circumstances, she boards 3 buses daily, and arrives at 10 am, ready to hear the care plan and offer input.
And then 1 month ago, we stopped in-person visitation in the skilled nursing facility due to COVID-19. His wife was heartbroken; the routine they had both counted on was withdrawn. It was devastating. The entire clinical staff, the patients, and their families all felt the pain, the loss, and the consequences of this shifting landscape. This result necessitated us to broaden our capabilities to maintain these relationships, from phone calls to virtual meetings.
Then last week, as a nurse held a phone to his ear for his daily call with his wife, he uttered, clear as day, “I love you, I miss you.” We all stopped in our tracks. Having been involved in thousands of previous interactions with him, we were thoroughly unprepared for this. I took the phone, expressing my amazement for what I just heard. His wife, matter-of-factly, replied on the other end of the line, “Good morning, Dr. Ruopp, how's he doing today?”
For his wife and so many others, the tragedy of not being with loved ones who are suffering is palpable. We know how important their support is in recovery; its absence requires us all to step in to fill the void by developing dedicated and innovative outreach methods to inform and to connect our patients with their families. It requires available technology for virtual visitation to decrease isolation and reinforce family presence. It necessitates increased access to activities for stimulation previously provided by families and may also require increased staffing to accomplish these tasks.
Despite these novel challenges surrounding us, we know there is incredible power in maintaining relationships, whether in person or remotely, even when we are social distancing. As my valued patient illustrated, we must take time to provide resources for our patients to dampen isolation, and remind families and each other that we “love them and miss them.”