A family doctor’s touch to the pandemic - Dr. Manoranjan

After a very tiring day with much of it spent inside the cumbersome PPE, managing patients with COVID-19 along with my colleagues in a 200 bedded block, I was having my dinner at around 11 pm, all alone and away from family (which is a common occurrence today with most doctors). That’s when I got a call from the ICU asking me to go in person and break a piece of bad news to one of my patients. It was to convey that her husband had passed away a few minutes ago in our ICU.

I knew that this would be a tough experience for me, but I decided to do it in a proper way as per my training in 'palliative care' during my DNB course.

I reached there and tried to call the wife to the common area (as I need to wear a PPE to go inside the ward rooms and also because I didn’t want to disturb the other patients). I didn’t get any response. Unable to wait any longer, I quickly got my shield and apron and started towards her room.

I wondered myself whether she was the same person whom I had been seeing during my ward rounds for the last five days. She had been interacting with me on a positive note as she was impressed with my bedside counseling skills. This made my heart heavy, making it difficult for me to break the news in person to such a confident woman with great self-esteem. Finally, I did my job (as per the SPIKES protocol) in the quickest and shortest way possible and I conveyed the message that her husband had passed away a few minutes ago in our ICU.

There was a profound silence for a few seconds, and it broke with a deep moan, clearly showing the pain she felt in her heart unable to judge whether it was real! It was in continuation of the fear of hearing such bad news as she was going through this turmoil for the last few days since he was shifted to ICU. She had been waiting for a routine call from the hospital regarding her husband’s situation and today she hadn’t got any, until the time I declared the news.

She had probably been anticipating this because of the delay in her routine call.

I tried to spend a good amount of time with her to share her grief and a few minutes later she asked me, “What now doctor?”

I replied, “Pardon me Madam, I didn’t get your question!”

“Please give me the discharge papers. I need to go home with the body for further rituals,” the voice was so low and in pain.

At that time of the pandemic, I knew that the existing protocols recommended the bodies not allowed to be taken home by the family (which has been relaxed in many places now). So, with much difficulty I conveyed to her that the body will be handed over to the government authorities for further proceedings as per the protocol.

She went into further shock, unable to accept and understand the reason as to why she can't have the body of her husband!

She left the place and went back to her bed in denial.

I left the ward thinking that I could not do anything more than that in such a helpless situation. While I was doffing myself from PPE, something flashed into my mind which further changed everything. Why can't I try to show the body which is there in the same hospital? I rang up the ICU and got to know that the body had already been moved to the Mortuary. Immediately I called my Director and asked him to permit me to do this. I got an ambulance ready in minutes and followed it to the mortuary.

She could not react to whatever was happening around her, but she was just following my instructions. However, I did not tell her clearly what I was trying to do as I was not sure regarding the outcome of my attempt. I just requested one person, who happened to be her neighbor to accompany her with PPE.

We reached the mortuary and were informed that the body had just been shifted inside. After my request, the support staff went back in to bring out the body.

She came out of the ambulance and saw her husband covered up fully. She looked at me in a stunning stare, speechless. For a transitory fear of missing her husband’s body forever, this unexpected act of allowing her to see him for a moment brought great relief to her.

I told her in a dignified tone that this was the best I could do for her and asked her to spend a few minutes with him.

Everything was over and we were ready to give her discharge on her request as she appeared better. When we returned to the ward, she said one thing which I can never forget.

“Doctor, this might be the reason why we consider doctors next to God! This is not a part of your treatment, but you gave me the most precious opportunity to see my husband one last time, which is not possible in the current situation. I am indebted to you for the rest of my life for what you gave me today.”

Now it was my turn to be speechless for a while! What drove me subconsciously to do this?

I realized that having trained in the discipline of Family Medicine, empathy is the cornerstone of the practice of Palliative Medicine. My boss once told me, “We can never be entirely sure if the treatment we give to the patients will work always as it is greatly biased. But what surely works is the bedside manners and empathy we show towards the patient. This is possible only when we try to substitute ourselves in a patient's situation and feel the pain. It’s just a natural reflex. It is already there in our minds. We need to bring it out. That’s all!”