Opinion by Daniela J. Lamas, New York Times, June 3 2021
BOSTON — I thought it would be different by now. Yet once again I’m standing outside my patient’s isolation room while I update his wife over the phone. I tell her about the events of the night, how her husband is starting to wake up, and that we hope he will need less support from the ventilator soon.
Then comes her question. Her tone is resigned; she knows the answer. But she asks anyway. “Can I please come in to see him?”
I hesitate. It has been so long since she has held her husband’s hand. And she is now fully vaccinated. What is the risk? But hospital rules forbid the visit. His coronavirus test is positive, so unless he is at the end of his life, I cannot let her in.
Here in Boston, I walk to work outdoors without a mask. Our sports stadiums and nightclubs are now open. Yet in the hospital, we are still restricting family members from visiting the people they love in the name of safety. While there’s need for greater caution in hospitals, and visiting policies throughout the country have relaxed some since last spring, the harms of remaining visitor rules now outweigh any benefit. It is time for hospitals to reopen their doors to visitors.
When visitor restrictions began more than a year ago, we accepted the decision to keep patients and the staff safe. Though staff members were pained by the Zoom vigils and solitary deaths that will be one of the saddest legacies of this pandemic, upholding these policies was a necessary evil in the setting of a public health catastrophe. But we are no longer in that place.
The country is reopening. Vaccination rates are increasing — more than half of those eligible in my state are fully vaccinated. Masks and shields can prevent transmission of the virus, and hospitals now have enough supply to offer them to visiting family members.
Family members are not just visitors; they are essential members of the care team. Family presence has been shown to decrease delirium, the waxing and waning mental status that can plague patients after critical illness, and those of us at the bedside know the power of a familiar presence for calming an agitated patient. To say nothing of the pain experienced by the family members themselves, these innocent bystanders, forced to wait by the phone and struggle with limited access to the people they love.
And yet the rules remain. While each hospital or hospital system makes its own policies, these largely follow guidance from states’ departments of health and broad recommendations from the Centers for Disease Control and Prevention.
At my hospital, there are still no family members allowed in the emergency department, whether or not the patient might have the coronavirus. In most cases, people say goodbye to their loved ones at the door, and hope they will be able to see them again soon. Once patients are admitted to the hospital, most are allowed only one visitor daily between certain hours.
It’s worse for those who have, or are being tested for, Covid-19. These patients are still prohibited from having any visitors unless they are at the end of their life. And even then, we must negotiate to bring more than two people into the room at a time.
“Who am I to decide this?” asked one of the nurse managers who is charged with accepting or declining exceptions to visitor restrictions in the intensive care unit. Another nurse, so desperate to find a way for her patient’s five adult children to say a brief prayer all together at the bedside, wondered if she could find a side door to sneak them in. She could not. They had to pray in shifts.
My colleagues and I, who work in the intensive care unit, find leniency and secure exceptions where we can. But there are unmeasured harms here, too. Looking back, I know that I have fought for some patients and families more than for others. Perhaps it is the family that pushes the most, perhaps it is the family that resonates in some way with my own. It shouldn’t be so arbitrary. That’s why we need rules that allow all our patients to see the people who love them. Until we do, there is a real risk that our exceptions and inconsistencies will deepen the inequities in access that already plague our health care system.
Hospital policies also need to shift the focus away from the end of life as the time when visitors are most essential. I’ve frequently found myself caring for lonely and scared Covid-19 patients for weeks, just to have them worsen and finally be allowed visitors when they are so sick that they can barely communicate with their loved ones.
This needs to end. There will, of course, be challenges to fully reopening our hospitals to visitors. Before visitors can enter, they are screened by security for any coronavirus-related symptoms, and a flood of visitors could be logistically difficult. Before the pandemic, our intensive care unit waiting rooms were filled with loved ones who camped out on the couches and even on the floors. I understand that it will be some time before hospitals feel comfortable reopening these spaces to visitors, who may or may not be vaccinated. But surely we can do this. We have grown to accept isolation as the narrative of this pandemic, but that can change.
And it can change safely. Visitors, regardless of their vaccination status, should be able to make their own decisions about risk when it comes to visiting a loved one with coronavirus, and hospitals should offer them personal protective equipment to visit as safely as possible. When it comes to patients without coronavirus, if there’s low community spread and a continued mask mandate in hospitals, we don’t need to drastically limit the number of visitors. The C.D.C. and state departments of health can take the lead on encouraging this shift.
A few days after my conversation with my patient’s wife, he developed a new pneumonia, and his oxygen levels started to plummet. My team sedated him once again. When he had worsened enough that we grew worried that he might die, we called his wife and told her that — finally — she could come in to see him.
As I watch her in her mask and shield, holding her husband’s hand, I think of the time that she missed. Those moments of wakefulness that she did not get to see. It’s too soon to know if he will recover. But what I do know is that it’s impossible to get that time back, not for my patient or his wife or for countless others who have suffered needless isolation. We have sacrificed humanity in the name of safety long enough, and now hospitals must make the change necessary to prevent further harm.
Daniela J. Lamas, a contributing Opinion writer, is a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston.