Covid-19 has forced all of us to question what we often take for granted, and the pandemic will have a lasting impact on healthcare in America. While the pandemic is certainly not over, cases are declining while vaccinations are on the rise. Empathy has taken on a greater role in the wake of Covid, as hospitalized patients are left unaccompanied due to the fear of infecting family members and caregivers. I had the privilege of speaking with Dr. Rana Awdish about the role of kindness and empathy in the wake of the pandemic, and the lessons we can learn from caregivers on the frontlines. Dr. Awdish is a critical care physician, director of the Pulmonary Hypertension Program at the Henry Ford Hospital in Michigan, and author of the LA Times bestselling book In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.
Being in the hospital for any illness presents its own challenges, but Covid has complicated care even further. My conversation with Dr. Awdish began by asking her how these additional challenges materialized at the beginning of the pandemic. Dr. Awdish said, “Covid presented real challenges because we couldn’t be the kind of healers we wanted to be—healers who knew the patient as a person, knew the patient’s family, and understood their values. At first, we didn’t know how Covid spread, or if our masks would really protect us, so all of us limited our interactions with patients. What surprised everyone about this was how much that truly took away from our sense of purpose… We had come to really need that connection with our patients.”
Not only were the connections weakened between clinicians and patients, but caregivers also had to witness some of their patients’ last breaths. In a powerful piece published in Intima, Dr. Awdish writes about her staff’s reaction to their patients’ deaths: “We leaned forward and bowed our heads in order to redirect the flow of tears. We couldn’t risk touching our faces and we need them to fall onto our scrubs. We couldn’t ruin our masks.” When I asked Dr. Awdish how hospitals could show greater empathy towards healthcare workers on the frontlines, she said, “Organizations can show empathy to their staff by building an infrastructure of resilience into the system.” She explained how the current system for many hospitals stretches staff too thin during times of adversity. Healthcare is a high-emotion service, and staff must be able to take breaks when needed. But when there are not enough staff, there is not a buffer present when something like a pandemic strikes. Dr. Awdish compared this preparatory mindset to the way our own parents buy groceries and cook for us before we actually get hungry, saying, “If our parents waited to buy groceries until we were hungry, that system wouldn’t work very well. Similarly, hospitals have to have anticipatory love…They have to put the infrastructure into place before they need it.”
In the realm of kindness are the stories of true self-sacrifice demonstrated throughout the pandemic. Dr. Awdish shared a story of one patient who came into the hospital in respiratory distress at the peak of the pandemic in Detroit. When he was told he was going to have to be put on a ventilator, the patient very clearly said, “If someone needs the ventilator more than me, you need to give it to them… because I have lived my life and made my peace. Don’t prioritize me.” Dr. Awdish said that this “level of sacrifice is something we saw again and again,” and it drove home the point that “Individual health means nothing in the context of a community that is unwell.”
Throughout the pandemic, hospital visiting hours have been substantially limited and often nonexistent. But when PPE is available, Dr. Awdish strongly advocates for families to be allowed to visit patients in the hospital. When I asked Dr. Awdish to describe the impact she’s seen when families are given the chance to visit their loved ones, she said, “It has been a real awakening for all of us to see how much the family contributes to the care of ICU patients. There’s so much that they do – even just their presence and familiarity at the bedside helps to prevent delirium.” She made clear that “A family member’s role is not that of a visitor… and it is so reductive to think that they are anything but essential members of the care team. By separating patients’ families, we are doing a tremendous disservice to patients.”
Visiting rules also affected healthcare staff who had family members who were ill. Dr. Awdish shared a heartfelt story of her friend—an ICU nurse—who couldn’t visit her sister who was dying of Covid in a hospice. When Dr. Awdish asked the nurse how she was holding up with working in a unit full of Covid patients, the nurse said, “This is the easy part. Here, I can be there for the patient. Here, I can do the work of nursing, but my sister is dying, and I can’t be there… and that’s so hard for me.” Without a chance to be at her sister’s side in the hospice, the nurse clung to the glass of the hospice for 9 hours while her sister passed away… hoping that her sister could feel her presence. The powerful story teaches all of us a lesson on having humility about others’ experiences. Dr. Awdish says, “We think we can assume what is hard for someone when, in reality, the sharp edges of their life are totally hidden from us.”
Before finishing our conversation, I asked Dr. Awdish to share her thoughts on whether she thinks the pandemic has effectively motivated us to raise the wages of frontline essential workers who are often forgotten, such as hospital housekeeping staff. The average hospital housekeeper earns about $30,000 a year, which is right at the Federal Poverty Level for a 5-person household. These staff have been particularly stretched thin during the pandemic, as the focus on proper cleaning has intensified. Dr. Awdish said, “I certainly hope that we have begun to recognize that without grocery store workers, environmental services (hospital housekeepers), teachers, and others, we can’t survive. We are interdependent on each other, and I think society has done a terrible job at recognizing that work. We have undervalued so many people for so long.” Dr. Awdish continues to work on the frontlines of this pandemic, and she continues to show us how to value the humanistic element of patient care. Her story is one we can all learn from.