SEE RELATED ARTICLES, p 16747 and 16756.
After more than 2 years of waxing and waning, the COVID pandemic is quieting down. We are all holding our breaths and hoping that another variant does not appear and lead to another surge of hospitalizations. The pandemic has caused global chaos, pain, misery, death, and economic deprivation. Hospitals were stressed to their limits, and face to face events disappeared. During hospitalization peaks, quarantine measures resulted in periods of “no visitors.” Locking out visitors and family increased levels of misery for patients and their significant others. During my inpatient attending rotations at that time, I was witness to a cascade of painful episodes involving critically ill and dying individuals whose only contact with their families was by phone or tablet. These situations were agonizing for patients, nurses, and physicians.
In this issue of The American Journal of Medicine
, two reports document hospital collateral damage done to patients and their loved ones by the pandemic. The palliative care team at the Tokyo Medical Center in Tokyo, Japan, reported that during the time of restricted visitation, total doses of narcotics given for pain relief increased significantly compared with a similar period before the COVID-induced limitations.
Palliative care team, COVID-19 solution team, and Clinical Research Center of the National Hospital Organization Tokyo Medical Center: Do hospital visit restrictions cause increases in the doses of morphine in terminal care?.
This study observed that restricted visitation increased patient spiritual pain factors and caused significant patient stress at the end of life. Iness and co-workers at the Virginia Commonwealth University in Richmond, Virginia, report a systematic review of available data concerning the impact of restrictive hospital visitor policies on patient, family and visitor, and healthcare provider well-being during the period of COVID hospital lockdown.
- Iness AN
- Abaricia JO
- Sawadogo W
- et al.
The effect of hospital visitor policies on patients, their visitors, and healthcare providers during the COVID-19 pandemic: a systematic review.
Like the findings of the Japanese study, these investigators found that restrictive hospital policies were associated with failure to address the needs of patients, their visitors, and healthcare providers in various clinical environments.
These observations were consistent with what I observed on numerous occasions during hospital lockdown. One example was particularly poignant. An 86-year-old woman who only spoke Spanish had a large and supportive family. She was nearing the end of her life secondary to hepatic and renal failure. My ward team and the palliative care consultant were very uncomfortable with the fact that no family member was allowed to be with the patient during her final hours of life. We appealed to our hospital administration asking for an exception to the imposed visitor restriction. The administration granted a compassionate allowance, and the patient's oldest daughter stayed with the patient during her last 48 hours. Many on our team and the staff caring for this woman were moved to tears by this episode. Unfortunately, many other patients never had this merciful opportunity.
During this period of painful lockdown, I was constantly reminded of Portia's soliloquy in Shakespeare's The Merchant of Venice
The quality of mercy is not strained;
It droppeth as the gentle rain from heaven
Upon the place beneath. It is twice blest;
It blesseth him that gives and him that takes:
'Tis mightiest in the mightiest; it becomes
The throned monarch better than his crown…
It made me hope that if we are ever forced to repeat the events of the COVID pandemic, we would somehow devise an original and merciful solution to alleviate suffering and dying alone. Perhaps, unique protective protocols for visitors or holographic visitations
might alleviate some of the misery that we observed during the height of the lockdown.
As always, I respond to all communications about this or other commentaries at [email protected]
Palliative care team, COVID-19 solution team, and Clinical Research Center of the National Hospital Organization Tokyo Medical Center: Do hospital visit restrictions cause increases in the doses of morphine in terminal care?.Am J Med. 2022; ()https://doi.org/10.1016/j.amjmed.2022.04.011
- Iness AN
- Abaricia JO
- Sawadogo W
- et al.
The effect of hospital visitor policies on patients, their visitors, and healthcare providers during the COVID-19 pandemic: a systematic review.Am J Med. 2022; ()https://doi.org/10.1016/j.amjmed.2022.04.005
- The Merchant of Venice, Act 4, Scene 1; The Complete Works of William Shakespeare, First Folio. London,
How Things Work. Working of hologram: how holograms work. Available at: how-does-things-work.blogspot.com/2010/02/working-of-hologram.html. Accessed March 28, 2022.
Published online: May 14, 2022
Publication stageIn Press Journal Pre-Proof
Conflict of Interest: None.
Authorship: The author is solely responsible for the content of this manuscript.
© 2022 Published by Elsevier Inc.