Connection

 

We had turned to leave, the ICU machines and monitors beeping their goodbyes.

Working at the University of New Mexico’s Hospital as a family physician, I had come to visit this patient with a colleague who is a physician assistant upon the request of the ICU team.

Our patient, Ms. Armijo, an elderly woman who'd been hospitalized in critical condition after emergency abdominal surgery for abdominal pain called out after us: “You know, the thing I am really worried about is being all alone.”

As we turned around, and I saw Ms. Armijo’s fright amidst her frail, failing body.

I had thought that our lengthy, pathology-driven questioning had covered all of the bases pretty thoroughly. Where do you hurt? How do you hurt? Are the pain meds working for you?

Now, frozen in mid-stride by her question, I realized that we had neglected the most important thing: Connectedness.

COVID had forced our hospital to adopt a no-visitors policy. On every floor, the hand-holding and bedside banter that partners, siblings, neighbors and coworkers normally lavish on hospital patients was replaced by a sickening silence. Even I, a family physician, couldn't visit my own patients who'd been hospitalized or sent to skilled nursing facilities due to COVID.

Imagine yourself in that ICU bed. Scared for your life, feeling so weak that you cannot even lift a spoon to your mouth--and suffering all of this alone, without the comfort of your loved ones at your side.

This was the situation Ms. Armijo was facing. Not only that, she didn't even have her connection to her family and the outside world with her cell phone missing. No wonder she was distraught!

Our team went back to her bedside. This time we did the listening, not the talking.

“I have no idea what happened to my cell phone in all of this,” she started.

“Have you been able to talk with your sister and family?” I asked.

“No, and that’s what I am really worried about. My sister who takes care of me and she must be going crazy not knowing how I am doing. Sitting here, I don’t think they even know if I made it out of surgery alive! If it weren’t for the pandemic, they would be sitting right here by my side.”

I was being taught, the physician as the student, my patient Ms. Armijo as my teacher.

“Thank you for sharing”, was all I could muster.

“This is not a ‘no news is good news’ scenario for them,” she added.

Listening to her speak, both what was spoken and lay in the pauses and expressions, I was not ashamed but more eager to be her student. To me, it felt like a direct, visceral reminder [or some such] that asking Ms. Armijo about her sense of connectedness, or otherwise, was as important as probing into her abdominal pain and lab results. We were being taught that you cannot have full health or healing if you're disconnected from those you love.

I've started to realize that connectedness can actually be considered as yet another vital sign--as important, in its way, as any heart rhythm or puff of breath.

And in these extraordinarily difficult times, loneliness can almost be considered a new medical condition, one affecting close to 100% of our hospitalized patients, one requiring its own treatment plan. This was true, I realized, not only for Ms. Armijo but for all of our hospitalized and nursing facility patients.

The phone was found by her family, discarded in the chaos that led to her ambulance ride to the hospital. Over the next few hours, with painstaking effort, it was delivered to the hospital - passed like a hot potato to the security guard at curbside, then to a nurse courier, past the badge-access checkpoints and, finally, safely into the hands of Ms. Armijo.

Her body still had a long way to go in terms of healing. But she was now connected back into her world, her support system.

Heading to the next patient on our list, we all knew which question we would ask first. It would not be about pain level, appetite, or bowel movements. Those would wait for later. First question would be simply, “How can we help connect you to those you love?”

* This piece was first published July 28th, 2020 by Pulses: Voices from the Heart of Medicine.