S. F. quarantines travelers amid record state deaths
Aching words: Final goodbyes delivered online tear at providers
The dying man did not want to say goodbye. Not like this. Alone in a hospital room, he gasped for air as the coronavirus slowly took over his lungs, shutting off his airway. He would likely be intubated.
After some encouragement from his medical team, the man relented. A nurse brought in an iPad.
“With the last air in his shattered lungs, he says goodbye to his family. Over an internet connection,” wrote Dr. Mark Shapiro of St. Joseph Health Medical Group, a specialist in the care of hospitalized patients at Santa Rosa Memorial Hospital. Shapiro, who treated the man, documented the moment on Twitter earlier this month, a dark glimpse into the world of frontline health care workers across America.
Shapiro, 44, has lived out these somber scenes amid a pandemic that has taken more than 300,000 lives nationwide, shattering families who could not be at their loved ones’ bedside. Visitors are largely barred from seeing COVID19 patients because the virus is extremely contagious and often unpredictable. Some hospitals have found safe ways to allow a few visitors inside, though it’s unclear if that will change as cases and deaths continue to climb. Across the country, many COVID19 patients are forced to live out their final moments in a hospital bed without loved ones at their side, a handheld digital device their only way to say goodbye.
These moments have become all the more gutwrenching for doctors and families, and devices like iPads have taken on a dark new role, as the deadliest coronavirus surge
continues. Goodbyes, like so many other intimate moments that define human connection, are often done virtually.
“It’s just very sad, for so many reasons,” Shapiro told The Chronicle. “One of them is just that huge space between people who love each other and people who care about each other in a moment of extremity.”
Shapiro said his tweets were inspired in part by the many health care workers who have shared similar experiences throughout the pandemic.
“It’s also important to give voice to how we feel and how these traumatic experiences make us feel,” he said. “We do the best we can for people, but also bear witness to what horrible things people are having to go through during the pandemic.
“It’s something that we have to acknowledge and support because it’s profoundly impacting,” Shapiro continued.
Earlier this month, Dr. Eric FeiglDing, an epidemiologist and health economist, shared a viral photo of dozens of iPads stockpiled in a hospital room. “Was not something Steve Jobs foresaw,” he wrote.
More than 308,000 people have died of COVID19 in the U. S., including more than 2,187 in the Bay Area. California this week ordered 5,000 additional body bags to help hospitals cope with the surge and recorded another 393 COVID19 deaths on Wednesday alone, the latest in a string of tragic records. The loss of life surpassed the state’s previous oneday record of 295, set Tuesday.
A day before José Jesús Arroyo died of COVID19 in a Riverside County hospital, his eldest niece, Veronica Hernández, and other members of the closeknit family said their final goodbyes from afar. The hospital allowed Arroyo’s wife and five children to be at his bedside when he passed, Hernández said.
“They got us all on Zoom and we were able to say goodbye,” said Hernández, 44, a Santa Rosa resident, through tears. “That was really hard. But it was a gift, too. To have that moment was special because none of us could be there.”
They told Arroyo they loved him and thanked him for everything he did for the family. They told stories. They cried.
Arroyo, 60, was hospitalized with COVID19 on Nov. 7. He died a month later, unable to breathe on his own as his organs failed. A proud Mexican immigrant and superb storyteller with a big heart, Arroyo lived out the American dream with his family, working hard in construction to purchase a oneacre ranch in Perris ( Riverside County) with horses and chickens, Hernández said. He put his four daughters through college and stopped working to care for his ailing mother. When a family member was sick, Arroyo was the first to call or visit, she said.
“He had his horses and he would just always be outside,” Hernández said. “Yet he liked to be at home. He had his rancho. He would take care of the horses and his chickens, and he would raise crops. He had oatmeal and corn, chiles and nopales. So, it was the Mexican dream in the United States, actually.
“He was the heart of our immediate family,” she said.
Many like Hernández have had to grieve in new and difficult ways. But in the absence of family members are doctors and nurses who step in during the end of life, holding hands, saying a quiet prayer, playing a favorite song and virtually connecting the dying person to loved ones.
Naomi Tzril Saks, a palliative care chaplain and associate director of the Parnassus inpatient palliative care team at UCSF, said final goodbyes were much more stressful and complicated at the beginning of the pandemic. At that point the virus was still new, millions of Bay Area residents were sheltering in place and iPads weren’t readily available to accommodate so many virtual goodbyes. Many patients died without loved ones near them.
“For many of us, when there is no cure left, a healing process begins at the end of life,” Saks said. “That healing process is so dependent on family and friends surrounding the loved one. So at the beginning, it was almost like we had to relearn what end of life and this experience was like.
“We all had to learn how to feel the room and how to feel emotions and have empathy, and then we were on telemedicine and going on Zoom and video conferencing,” she said.
Since those early days, the hospital has brought on inpatient video navigators who call every family that has a loved one in the hospital with COVID19 to ensure they have access to Zoom and a way to communicate, Saks said.
“We even have the priests come to the door of the room, and they pray outside the window,” Saks said. “We’ve had people who’ve had the priests give the holy water to the nurse who is in the COVID room so that they make sure that they get the sacrament. There’s so many people that are working together, calling the family and seeing what their favorite music is and putting up pictures of their dog and putting up pictures of their favorite football team.”
But at this point in the pandemic, it’s rare for a COVID19 patient to die alone at UCSF, Saks said. The hospital formed a visitor policy committee that creates safe ways for family members to visit and say goodbye, with input from nursing, physician, social work and spiritual care leadership, she said.
“Everyone is really joined together to say, ‘ How do we make this as humane and as compassionate as possible?’ ” Saks said.
Dr. Lekshmi Santhosh, assistant professor of pulmonary, critical care and hospital medicine at UCSF, said the pandemic has also been difficult for nonCOVID patients who can only see a small number of visitors. Some family members are hesitant to say goodbye in person for fear of contracting the virus at the hospital, she said.
As a patient approaches the end of their life, no matter their illness, Santhosh said, she practices one important ritual.
“I, and most of our ICU and hospital providers, always talk to the person, even if they’re on sedating medications, even if they can’t visibly hear or understand what we’re saying,” she said. “I always hold their hand and say to them, ‘ You’re not alone. We’re here for you.’ ”