A self-described rural ER and family doctor is going viral after sharing a disturbing image depicting end-of-life goodbyes in the age of COVID-19.
The doctor, who goes by the Twitter handle @roto_tudor, shared a photo of a roomful of iPads on stands. “These are iPad stations being prepared for virtual ICU end of life visits by a palliative care doc I know. Jesus,” he wrote.
The tweet has earned more than 25,000 retweets since it was posted on Thursday. It has also generated a lot of comments.
“How terrible. Let people visit their dying relatives!” one wrote. “I was a patient in a covid room, alone, staring at the iPad on a stand for hours on end knowing full well what it was for. It’s a terrifying experience that I legitimately have PTSD from. Please wear a mask and take care of yourself so you don’t have to experience it firsthand,” another said.
Others shared their painful stories of saying goodbye to loved ones this way. “On Monday my boyfriend said goodbye to his mother on an iPad. He didn’t get one last hug or simply hold her hand. He sat behind glass & held an iPad to try and prevent doing the same goodbye with his elderly father,” one person wrote. “I have rage. I can’t even be sad yet because I’m just so angry.” Another said, “Did the same with my mother Thanksgiving Day. The pain of losing her is almost unbearable and it was so unnecessary.”
The doctor, who did not respond to Yahoo Life’s request for comment, acknowledged the attention in the comments. “So this weirdly got popular, which is not my thing,” he said. “I don’t have anything to promote. But you could give some cash to a food bank, or call an old friend and see how they’re doing.”
The tweet and stories it inspired people to share raise a lot of questions about what it’s like to say goodbye through technology.
Dr. Martha Twaddle, medical director for palliative medicine and supportive care at Northwestern Medicine-Lake Forest Hospital, tells Yahoo Life that the pandemic has completely changed the practice of palliative care. “Palliative care focuses on the seriously ill and their families, looking at patients and family as a unit of care,” she says. “Before the pandemic, families were very much an integrated part of the team. On rounds they would be bedside. That doesn’t happen now.”
Twaddle says that “the whole model of care has been tilted so that we’re trying to provide care to a seriously ill person who we may not know well, who can’t communicate because of the severity of their illness — and we don’t have a family member at the bedside to help us get a bigger picture of who they are and what provides them comfort.”
Related video: Palliative care doctor uses technology to bring patients’ loved ones to them
Dr. Diane Portman, chair of Supportive Care Medicine at Moffitt Cancer Center, in Tampa, Fla., also says standard protocols have shifted. “In normal times, we facilitate discussions to support the patient and the family by organizing family meetings to go over options,” she says. “During COVID, with visitor restrictions in place, we’re providing an even more intense level of personal attention, because we’re among the only links to the outside.”
Portman says her medical center is also relying heavily on tablets, computers and phones to connect families with their loved ones. “We have adjusted to discussing life-and-death matters with patients’ family members over videoconferencing platforms, as we share information and help them and our patients confront life-threatening illness, loss and grief,” she says.
When it comes to saying goodbye, Twaddle’s organization has been able to secure extra PPE to allow two or three loved ones to have a “compassionate visit” to say goodbye. “We’re keeping them safe but allowing them to visit,” she says. Unfortunately, some family members and loved ones still have to say goodbye through tablets. “Whenever possible, we are using these devices, particularly when we have family systems that are quite large or for vulnerable family members where it would not be in their best interest to see their loved one in person,” she says.
Portman says Moffitt’s palliative care has applied “valuable talking maps” when they “need to guide a family member on the phone or video through saying goodbye to a patient at the end of life.” One of those, she says, is the LOVE acronym, which stands for Lead the way forward, Offer the five things that matter to most people, Validate what they want to say, Expect emotion.
Twaddle admits the pandemic — and saying goodbye during it — is hard for everyone, especially when it has to be done remotely. “This video chat is so important,” she says. “Family members need to see what’s unfolding, but I suffer for it. I can’t imagine what that must be like, to drop someone off at the emergency department and then you have to say goodbye over a device.”
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