Love as healing in a pandemic

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.