Umberin Najeeb is a Staff Physician in the Division of General Internal Medicine at Sunnybrook Health Sciences Centre in Toronto.
I clean the phone at the nursing station with an antibacterial wipe and call the family members to provide an update.
While sharing the declining medical status of their mother and discussing goals of care, I wonder how I sound to the family through the phone and from behind my masked face. The family members can only hear my voice. Do I sound compassionate and caring or do I sound mechanical and clinical? Is my voice going to be imprinted in their minds for the rest of their life? Their mother is not going to make it and I am the person who is sharing this information. Unfortunately, in the current COVID-19 pandemic, these crucial conversations are happening on the phone.
The family decide to pursue comfort care. They ask me, “Is she awake?” “Can she talk?” “Can we see her?” I sign the comfort care order sets and look for our social worker to facilitate a FaceTime call with family members. He’s helping another family so I decide to call the patient’s family from my personal cellphone. Time is of the essence here. I place my phone in a plastic hazard bag. I dress in my PPE (gown, gloves, mask with face shield) and enter the patient’s room. My phone is now on speaker and beside the patient’s ear. Family members are saying their goodbyes and sharing their love. Tears can be heard. Regret can be felt for the inability to kiss and pay final respects. I am part of a very private conversation. The patient is drowsy, she opens her eyes briefly to look at me and then closes them forever.
Did I appear human to her in my mask, face shield, gown, and gloves? I hold her hand. I am her last human contact, perhaps her last visual memory. I feel overwhelmed, humbled and honoured.
After what feels like a lifetime, a few moments later I come out of the room. I had stayed as long as I could to allow more time for the family. However, my pager had been buzzing continuously. I remove my PPE and take out my phone from the bag. I clean it and sanitize my hands. I update the nurse and ask the social worker to help allow her family more time with her on FaceTime.
I now have to call another family. I remind myself to be humble and humane in these conversations.
(This reflection was inspired by themes of various end of life conversations I had during the pandemic. It is not a recollection of one patient’s story.)