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. 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.