Duke University
Medical Center
Durham, NC
This is part of our series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
The ICU is a tough place in the age of COVID.
Imagine half an acre of rooms filled with some of the sickest people on earth. Behind each room’s protective pane of bleach-stained glass, a COVID patient is attached to any number of life support devices as they lie silently in states of recovery, purgatory, or dying.
Nurses, doctors, and respiratory therapists can barely recognize each other as they shuffle quietly from room to room to adjust machines, investigate alarms, and hang intravenous medications. Hallways are filled with people either slowly slipping on layers of protective equipment before entering a room or peeling the sweaty gear off after exiting from a Bikram yoga-like patient care experience.
There are no families or visitors. It’s weird. It’s also intensely sad.
I began to wonder what this severed family cord meant for our patients. Researchers have reported that familiar voices or music have therapeutic effects among ICU patients. Many families believe that their presence can expedite recovery.
I would usually call each patient’s family while I tapped out my daily progress notes on the computer. After a brief update, I would ask if there were questions. Strangely, most didn’t have any questions. They seemed almost catatonically resigned to whatever would come. One day during an extended pause on a family call, I changed direction.
“Well, is there maybe a message I could pass on to Alejandro?”
“Like what do you mean?
“Like something you might say if you could be in the room with him now.”
Silence for a few seconds.
“Well… he is a little crazy about his dog. Can you maybe say that Princesa loves him and is missing the way he brushes her hair?”
Not what I was expecting.
Later I found myself leaning awkwardly over a deeply sedated older man on a mechanical ventilator who was doing poorly. I whispered, “Princesa says hi” into his left ear. It didn’t sound right without his wife’s exact words. I even found myself adding some improvisatory detail. “Princesa is just not the same without you. She really misses the way you brush her hair when you’re holding her in your lap. She loves you. And your family loves you so much and knows you can do it.”
Through the rest of the week I started delivering news about graduations, anniversaries, and birthdays that were being missed. Room by room, television channels were changed to wrestling, 1960s sitcoms, or the Antique Roadshow. Norteño, Motown, and country music began to drown out the soulless white noise of monitors and medication pumps.
COVID is dehumanizing. It is not clear that these messages and sounds registered with most patients. And carrying such personal words from people separated by critical illness spills some of the grief on the deliverer. But at a time when so little is within our control, it is what we do for Alejandro and Princesa.
Christopher Cox is a Professor of Medicine at Duke University in Durham, North Carolina. He is also the director of the Program for Supporting People and Enhancing Recovery (ProSPER), a research collective that builds creative solutions for people who experience serious illness.