Doctors report heartbreaking separation at the end of life as elderly face quarantines

With family members barred from hospitals to prevent the spread of coronavirus, doctors worry about being forced to deliver difficult news over the phone and patients dying alone. (NanoStockk/Getty)

For Simone B. Benatti, M.D. it was an excruciating conversation.

The Italian doctor had to tell a woman, married for 55 years, that her husband hospitalized with coronavirus-caused pneumonia and who had Alzheimer’s disease, was now refusing to eat and would not survive.

Instead of taking place in person, the conversation took place over the phone, as the two elderly people, who had spent their lives together, were separated: He in the hospital, she quarantined at home.

“One of the most painful aspects of this pandemic is the irremediable separation of patients from their families at the end of their lives,” Benatti, a member of the infectious disease department at Hospital Papa Giovanni XXIII, in Bergamo, Italy, wrote in the Annals of Internal Medicine.

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In her piece entitled “Love in the Time of Corona,” Benatti recounted her conversation with Mrs. Rota, wishing she could see her face.

It was part of what the Italian doctors began calling “telephonic relatives' round." She described it as "a sad ritual that we've begun to initiate every day, because it is impossible for quarantined families to make visits to the hospital,” she said.

Northern Italy has been especially hard hit by the coronavirus, where hospitals have been overloaded with patients and doctors have been forced to make life and death decisions because of a shortage of ventilators and supplies.

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Mrs. Rota told Benatti that when the family brought her husband to the ER, her nephew was afraid he would give up once he was left alone and the nephew was right. “Oh, doctor, it’s because I’m not there. He needs me, you see. We have been married for 55 years,” the wife told her.

She asked the doctor for a favor: That the next time she talked to her husband, Pietro, to tell him that she was not allowed to stay at his bedside, but that she loved him.

"Because of pandemic containment rules, a couple who have shared their whole life—including the last years of a painful, relentless cognitive decline—are separated forever in the final decisive hours without even having had the time to grasp the moment (and while Mrs. Rota herself has probably already been infected with coronavirus, too),” wrote Benatti.

“On the other side, a demented old man with no possibility of recovering from this pneumonia or the complications that would invariably ensue afterward is tied to his bed; left alone in a foreign place; and surrounded by people he has never met before who attend to him entirely covered with masks, gloves and gowns in the name of providing him with oxygen supplementation of doubtful advantage,” she wrote.

In the pandemic—with its increasing number of patients, less time for each and the burnout of nurses and physicians—it becomes more difficult to be there and ensure each has a chance for a decent accompaniment to death, she wrote.

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But the struggle is a reminder. “Where medical science fails, medicine can still succeed. After all, this and nothing else is the driving force of medicine's progress across centuries. Long before the advent of antibiotics, pain medications and oxygen masks, what drove human beings to care for the sick and dying was the urge to dignify and alleviate the abandonment of our common human condition,” she wrote.

U.S. doctors are now struggling with the same heartbreaking circumstances. A Boston doctor, who works in the intensive care unit at Brigham and Women’s Hospital, also wrote about the impact that barring most families from the bedside has had.

Daniela J. Lamas described the effect in an opinion piece in the New York Times.

“It’s a tough decision that leaves our patients to suffer through their illnesses in a medical version of solitary confinement. And I’m worried for them. Because those of us on the front lines simply don’t have a plan for this,” wrote the critical care doctor.

The tale described by Benatti haunts doctors here, as family members can’t see their loved ones.

“The devastating image of the lonely deaths of coronavirus patients in Italy hangs over us all," Lamas wrote. "Talking with one of the nurse practitioners in our hospital’s new COVID-19 I.C.U. one recent night, I asked what worried her most. ‘Patients dying alone,’ she replied quickly.”

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