Monday, March 23, 2020

"Bugle Notes" - They Are Not Alone

Years ago, I watched an interview on TV with nurses who cared for a man dying of Ebola.  Their words and actions continue to ring as true today during the on-going Coronavirus - 19 pandemic as they did then. 

I was deeply moved by their compassion for this man dying a horrible death. They did all they could for him not only medically but also emotionally. They spoke of the fear that gripped them knowing the personal risks they faced. Yet, each voluntarily chose to care for him. When asked why they would put their lives at risk, they gave the answer you would expect - I am a nurse, this is what I trained to do; I’m a professional; but the answer that moved me to tears was, “He was alone because his family could not be with him.” Each of these nurses did not want him to be alone, to die with no one to love him, comfort him, care for him. They described how, despite wearing all the protective gear, they would hold his hand, speak words of comfort and reassurance, and toward the end simply hold him. The nurse caring for him when he died said that there were tears coming down the patient’s face after being placed on the ventilator. She tried to reassure him that everything would be okay but 15 minutes later he died. The nurse cried and said,” It was the worst day of my life.”

Each of these remarkable nurses, risked their lives to care for a man they did not know. Sure, part the reason was that it was their job, they were trained to do this. But as you listened to their words, the emotion in their voice, saw the trembling of their chin, and the flowing of tears from their eyes, there was a much bigger reason. They truly had compassion on this man and “He was alone because his family could not be with him.” So they became his family. They lovingly cared for him; wash his face with a cold wash rag; dealt with the copious diarrhea and vomiting; changed his clothing and linen; and administered his medications and fluids despite the risk to themselves. More importantly, though, they simply loved him by their words and actions. When medical treatment fails and nothing else can be done, then the real “art of medicine” begins - the compassion, caring, and love of wiping his face, speaking words of comfort, and simply holding him.

Watching these interviews took me back to the earliest days of my internal medicine training during the 1980s. I trained at the peak of the AIDS epidemic before there was any adequate treatment. I cared for scores of young men with HIV or dying of AIDS.I and was present until they died of AIDS despite our best attempts. This was a time, much like with the Ebola scare, where there was much fear, uncertainty, and unfortunately prejudice. As a result, we, the nurses and house staff, watched repeatedly as these young men were abandoned by their families - parents, wives, siblings, and friends out of fear and ignorance. As a result they were alone as well. I will never forget how dramatically that impacted me. No one deserved to be abandoned like that, no one should be left to suffer and die alone. We gave them the best treatment possible knowing that they would still die. When nothing more could be done, we sat with them, held their hand, comforted them and let them know we cared, that they were not alone.

Is this not what medicine should be about? Is this not why we went into medicine? There’s so much more to medicine than simply the medical/surgical treatment side, as important as that is. There’s the human side - the compassion, caring, and loving warmth of a human touch; the knowing that at a patient’s time of greatest fear, helplessness, and need, that they are not alone, we are there for them.

Medicine is hard, very hard. There are times when we need to be reminded why we went into this profession, this calling, lest we forget in the busyness of our days with all the many demands placed upon us. Sometimes we need to step back and remember the last time we were there so they would not be alone. Thank you for the sacrifices you make each and every day for your patients, for your community, and for your families. You’re not alone in this.

Andy Lamb, MD

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