Palliative care in the era of COVID-19: a reflection from the trenches
Many of us caring for patients with advanced disease have lived with our patients the shock of receiving life changing news, of a reality that changes quickly and the difficulties this can bring. We see more clearly that, above all, family and close relationships become the most important aspect of life; a vital life-affirming source of strength. In the advent of COVID-19, another layer of change and difficulty is added: isolation, deprivation from close human connection and touch, to a degree we can say could be cruel; comparable to being prisoners of war. In the case of our patients with uncertain or limited prognosis this is further compounded by the fact that time may be limited and decreased connection with loved ones may translate in further moments not lived, moments that are taken away, moments that won’t come back.
As an example of the many of these cases, recently a seventy-six-year-old lady with advanced pancreatic cancer admitted to hospital with a malignant biliary obstruction could not see her healthy son who travelled from Europe just to see her. Despite revising all avenues to make contact possible the only contact that occurred was by phone and a three meter distance good bye from a car as her son passed by the hospital on his way to the airport seven days after his arrival; secured return flight was no longer feasible at a later date. The brief goodbye encounter was only possible after remarkable coordination and help by loyal friends and healthcare providers; but perhaps more could have been done to allow human connection. Nothing can truly compare to the healing power of real human presence; even if it is through personal protective equipment.
Dr. Gimon is an Assistant Professor in the Departments of Family Medicine and Oncology, Division of Palliative Medicine at the University of Calgary and a Palliative Care Consultant Physician at Foothills Medical Centre.