Editors’ Note: This article was accepted on April 14, 2020, and was accurate at that time. Because information about SARS-CoV-2 and COVID-19 is evolving rapidly, please verify these recommendations and information.
While we are at our computer desks, as we quickly put in orders and type up charts, we can hear the sounds of a busy emergency department in Brooklyn, New York, but it sounds different this time. An elderly woman with a parched mouth asks for water and a meal. A man asks for a phone charger to call his wife after his phone had died. Another patient asks if their family had called. Patients’ requests are punctuated by beeps and alarms of ventilators, bilevel positive airway pressure (BiPAP) machines, medication pumps, and monitors, in a sea of people struggling to breath. Our nursing staff is already stretched thin, overwhelmed with admitted patients in the emergency department waiting for a bed upstairs for days at a time. Some never make it upstairs. We became increasingly aware that we needed to do more.
In accordance with our state health department’s guidelines and like many other emergency departments across the nation, visitors are not allowed at this time to mitigate the spread of SARS-CoV-2. Unfortunately, this presents a situation where a patient can only contact their loved ones through a phone call. Some patients arrive in our emergency department picked up by EMS in haste, unprepared, without a phone charger, or sometimes without a phone at all. Those who fall critically ill and die, die alone. There have been many times where a request for a phone call or a cup of water became their last request. Many health care workers feel defeated as we are grappling with this unknown disease. Despite our best efforts and best medicine, patients will continue to succumb to this virus, but what we can provide is compassion.
At this time, New York City alone has more than 200,000 cases of COVID-19. We have seen unprecedented issues that may arise in your ED and would like to offer guidance to our fellow EM community.
At New York Health + Hospitals/Coney Island Hospital, we formed the Compassion Committee, made up of residents, nurses, physician assistants, and attendings, dedicated to providing compassion to these patients with COVID-19. We developed “Compassion Rounds” asking each patient three very important questions:
Are You Comfortable?
We know COVID-19 causes dehydration and unfortunately placing patients on BiPAP further dehydrates their oral mucosa. We began handing out bottled water and sitting with patients on BiPAP while monitoring their oxygen saturation. When patient meals arrived in the department, we spent extra time handing out meals, opening packages for the elderly, and feeding patients that could not feed themselves.