more_vert
I BEGAN my journey as a freshly minted doctor in September 2021, during a city-wide outbreak of the highly virulent Delta strain of SARS-CoV-2.
As case numbers rose, my hospital made the difficult decision to deny access to visitors. Precious time with loved ones at the end of life was tragically taken away from some. However, there were others for whom the label of being at the “end of life”, and the exemption to visitor restrictions that came with it, was life-saving.
One of my patients during this time was a doting mother and grandmother who had lived with her daughters and grandchildren until she contracted COVID-19. When she arrived in hospital, she was struggling to breathe, exhausted from coughing and in constant pain from myalgias. She was started on antiviral therapy, but given her age and multiple other medical problems, her family was informed early on that her chances of survival were slim.
Over the subsequent weeks she developed a spontaneous pneumothorax and became increasingly confused and agitated. Repeated testing at this time surprisingly showed that the antiviral therapy had worked, with no sign of ongoing COVID-19 disease. However, her chest x-rays showed irreparable lung damage and a hospital-acquired pneumonia. Despite intensive treatment, she soon became entirely bed-bound and dependent on oxygen therapy. She lost interest in eating and was too weak to engage with nursing staff in their efforts to maintain her cleanliness and dignity.
An appeal was made to allow her family to spend precious time with her before she died. They came bearing home-made food, clean clothes, personal items and, most of all, love. I watched as her children cared for her, feeding her spoonful by spoonful just as she had carefully fed them decades ago. They adjusted her blankets and pillows to help her sleep, held her hand, and spoke to her about what was happening at home. They showed her photos of her grandchildren, shared stories, and held family video calls so that she could see loved ones who couldn’t be physically present. She slowly recovered and, 2 weeks later, the seemingly impossible happened: she went home.
She was not the only patient who experienced an unexpected recovery after loved ones were allowed to come into the hospital and care for her.
He was a gentle, loving father, who loved tennis and was still playing the game until late into his 80s. One day, he was admitted to my hospital after a fall, and was started on treatment for a urinary tract infection. Despite antibiotics clearing the infection within a few days, he became increasingly agitated and aggressive. He started to wander the ward at night and became verbally and physically aggressive towards other patients, requiring sedation on several occasions. During the day he was drowsy and near-catatonic, a state which persisted even after sedation was ceased.
He soon became bed-bound and dependent on nursing staff for all his personal care. He lost interest in eating and drinking. Despite intensive physiotherapy and encouragement from his nurses, he needed two people to help him just to sit up in bed. From a medical perspective, nothing further could be done for him. Given his steady deterioration, an appeal was made to allow his wife to come into hospital and spend time with him in his last days.
I’ll never forget the first time I saw her. He was sitting in his bed, which had been lowered to the ground for safety. A patient with psychotic symptoms of dementia approached him, yelling, with two nurses in pursuit trying to redirect her. Next to him, his wife knelt on the ground, holding his head to her chest in a protective embrace. With her back turned to the other patient, she created a physical barrier between them, protecting her dear, demented husband. She wore a surgical mask, a meagre defence against the COVID-19 that was spreading through the city at the time.
Over the next few weeks, he experienced a slow but steady recovery. One particular morning, I was discussing another patient with a fellow intern on the ward. The patient and his wife, arm in arm, strolled down the corridor. He stopped, recognising us, smiled and waved pleasantly, then kept walking. I couldn’t believe the contrast between the delirious man I had seen a few weeks earlier and the neighbourly one I saw now. The gentle, loving father had returned.
As doctors, we are often under significant emotional and physical strain while looking after our patients. We have to constantly strike a balance between making time for genuine emotional investment and maintaining a professional distance, lest we neglect our other patients, our families or ourselves.
As COVID-19 case numbers continue to necessitate visitor restrictions in our hospitals, the barrier of distance between our patients and their families persists. It is therefore a good time to remind ourselves that loved ones should be seen as part of a patient’s therapeutic circle. Patients are often discharged into the care of their families, sometimes into the care of mainly just themselves, but never into a void.
Sadly, not every person who comes to hospital has a supportive family waiting for them at home. In such cases, anyone who they consider to be a significant other might possess unique knowledge of the patient that can inform and optimise their care. Even the simple recognition of such relationships may have therapeutic value, by promoting a sense of identity that is too often threatened in the delivery of medical care. This can entail something as simple as asking the patient who they live with, if their loved ones know that they are in hospital, or who they would like us to update on their care.
Patient-centred care is often promoted as the ideal approach in medical practice. The therapeutic role of love, and its expression through family involvement in patient care, is less well recognised and researched. Despite its enigmatic nature, love can be the ultimate healer when our best medical efforts have failed. By acknowledging family as therapy, regardless of whether they are physically present, we can start to harness the benefits of love in the healing process.
Anna Stroud is a junior doctor at Westmead Hospital. Prior to obtaining her BMed/MD in 2020, she completed a Bachelor of Health and worked as a Disability Support Worker.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
Like others before me, I commend you Anna for taking time to observe and report on observations of the healing effects of care and love. The root meaning of care is ‘to suffer with’: empathy and love its offspring. Beware of bureaucratic and Government structures that, in the name of efficiency, propagate fear and irrationality, which the Covid-19 pandemic has amply illustrated. Harsh rules put our human predilection to care, show kindness and express joy at risk. Thank you for giving us salient examples of care and common sense; triumphant over fear and irrationality. Best wishes on your journey through medicine as you keep love and care, of patients and colleagues foremost.
(PS. For encouragement, read “The Soul of Care: the moral education of a doctor”, by Arthur Kleinman)
Such a beautiful reflection and reminder of an essential but lost part of medicine in these recent times. As an obstetrician, I have mourned for my patients the inability for visitors after the most significant moment in their lives (birth of their first baby) and for the parents who themselves have not been able to visit their own babies in NICU because of COVID and associated restrictions. Utterly devastating. I hope we have all learned that the presence of loved ones can be more significant than any medical treatment. Thanks again Anna.
Hi Anna
You are just starting out on your medical journey
I am recently retired after 30 years in General Practice
You have absorbed the essential component of good medicine early
I wish you all the best in your career
Thank you Anna for the really important message you share. Heart to heart connection with love shared is the vital ingredient. While the focus on helping the body, attitude and focus of mind are truly of great value, it is the love connection that can wonderfully reawaken the will to live. As your stories so aptly showed.
Once again thank you !!
Yes, the covid response in Australia was extremely harsh and punitive to the elderly, the cancer patients, and the dying. I am fortunate to have experienced care overseas, where patients were allowed 1 relative to stay with them, and ability to rotate relatives once a week. Those who were dying were given exemptions for extra visitors. Yes, cumbersome testing, admin paperwork, but the exceptional patient experience wasenhanced greatly. I believe that we need to examine our decisions objectively, so this does not happen again. Elderly, sick, and dying need protection, but they also need CARE, and care includes love. I am sorry Australians had to experience a cold clinical decisions sometimes without humanity. I am glad I experienced a different aporoach to care in covid times, with a little love in the everyday care.
Hope all the Premiers and state CHO’s read this.
Beautiful. Thank you for writing and sharing.
It is powerful medicine we all need to be reminded of.
Thank you Anna for this comment and the reminder of the power of human contact. During COVID many palliative care workers (my specialty) and other health workers across Australia and the world have identified the significant consequences for their patients and their families, and for themselves, of decisions to restrict access to the basic human need for (and therapeutic benefits of) the loving embrace of touch and a familiar voice.
While we may have thought that triage decisions have not really been necessary during COVID in Australia, these stories are a reminder that difficult choices have had to be made. Decisions to delay surgery and other treatments, to slow investigations and to restrict access to hospitals are all triage decisions that prioritise one set of patient needs over another. These are complex choices made in the interests of the community as whole, and cannot be painless. I think that our community has shown that it can accept them as such, and they should be openly discussed as part of a public consultation about how we make difficult resource allocation decisions.
We can learn from the pandemic how to better manage these issues during disasters. Including a much more open discussion of the realities of the choices that must be made when the resources available cannot meet the demand, even in what we hope will soon be more normal times.
Very instructive piece . The word “ love “ may be intimidating . You certainly have to attach and interconnect as a positive Organismic Process to not only Patient and Colleagues but also the Philosophical Ecological process that articulates holistic purposeful therapeutic activity .
Thank you for these beautiful stories. Brought to mind a favourite comment from Avedis Donabedian the father of quality assurance in health on the importance of love for health professionals too.
‘Systems awareness and systems design are important for health professionals, but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essential to a system’s success. Ultimately, the secret of quality is love. You have to love your patient, you have to love your profession, you have to love your God. If you have love, you can then work backward to monitor and improve the system.’’1
(17) (PDF) Avedis Donabedian: father of quality assurance and poet. Available from: https://www.researchgate.net/publication/8150403_Avedis_Donabedian_father_of_quality_assurance_and_poet [accessed Mar 07 2022].
Nicely written Anna. In hospitals and aged care facilities, we have been too draconian in the name of supposed health protection.. and still remain too inflexible. I hope you and others like you consider geriatrics as a profession… your attitude and care would be much welcomed.
I only wish some of your more senior colleagues and hospital administrators (not to mention aged care providers) could be as insightful as Anna about the importance and therapeutic value of family and friends.