Alumna Keeps Families In Touch During Pandemic

Alumna Keeps Families In Touch During Pandemic

We’ve seen the images.  We’ve read the stories.  COVID-19 patients are dying in hospitals alone; there are medical professionals all around, but they are dressed in what one COVID-19 patient called “spacesuits.”  There is no personal contact from the medical staff or from family members because almost every hospital has instituted a no-visitor policy due to the contagiousness of the coronavirus. 

Because of this, many nurses strive to find ways to bring loved ones into the room with the dying patient. They are doing this virtually.  Dr. Deena Drake, PhD, ‘19, a clinical nurse specialist at Sharp Chula Vista Medical Center, did what she could to bring the family into the room with their dying loved one; she used Zoom and face-timed with family on her personal phone to make that difficult time just a bit less difficult.

“What we see is the patients feel isolated, they feel something of a burden; the doors are closed, the hospital is silent especially on the COVID units,” Drake said. “But for the patients that are actually dying, to feel that isolation, I can’t even imagine it. I think we all start to say something like ‘I understand what you must be feeling now.’ But, with the families, I always stop myself and say, ‘I don’t know what it’s like to be in your position right now. If this were my loved one, I would be going crazy trying to get into this hospital.  I would probably be that person outside you were calling the police on and it takes a toll on everyone to hear that suffering.’”

When hospital administrators heard what nurses were doing, they put a stop to it. It was, among other things, a violation of HIPPA, the Health Insurance Portability and Accountability Act, which is the federal law intended to give you control over your own personal health information.  So Drake did the only thing she could think of.

“I have this great executive leadership team here, so I went to our chief nursing officer Christine Basiliere and our senior vice president and chief executive officer Pablo Velez (PhD ‘06) and I said, ‘so I’ve been zooming and I’ve been face-timing, am I going to get in trouble for that and if so, what can you guys do?’ Literally two hours later, Dr. Velez called our senior analyst who immediately set up an iPad for me so I could do telemedicine visits on a secure network.”

Deena Drake

She now does many of those types of visits but admits it is a difficult process.

“It’s difficult because it is a very long involved process to set up the visit to get into the PPE, go into a room, oh my gosh it’s not working so I have to go out, try to call the family again, so it’s not an easy thing,” Drake said.  “But it can be really critical for the family who is in distress because they cannot see their loved one and here we are, asking them to make a decision about whether to continue this really aggressive care that may or may not be futile.”

By connecting patients and family members via iPad, nurses allow family members to see what that aggressive care really looks like.

“With the COVID patients, it can be manually laying them face down on the beds or putting them in the rotating beds, chemically paralyzing them, or doing continual dialysis in a room that is completely isolated,” Drake said. “And while families see the images on the news, they probably don’t realize what COVID patients really go through. To actually see their loved ones placed in these circumstances can be really shocking but can also help them make decisions as to whether this is something their loved one would want.”

Drake did not start out doing telemedicine with COVID-19 patients.  She was on a palliative care task force to create a dedicated end-of-life unit for Sharp Chula Vista.  The unit opened in February 2020 and team members were just starting to refine their practice when COVID-19 hit. Rather than encouraging families to visit their loved ones, Drake and her team suddenly found themselves having to tell family members to stay away.

AIM Team

Drake (r) and AIM Team

“We had really come to welcome the family involvement and participation and caring for people at end of life. Suddenly it was difficult to get hold of family and the families we were able to contact were suffering and emotional and angry – they were so angry at us for separating them from their dying loved ones or when they were trying to make these difficult decisions.”

As a clinical nurse specialist on the Advanced Illness Management or AIM Team, Dr. Drake works hard to connect with the patient and family on an emotional, heart-to-heart level.  She says that has become a challenge since the onset of COVID. Prior to the pandemic, communication with patients and families was done at the bedside, in person.  Now, communication is done primarily by phone. 

“I have talked about this with several people, but you don’t realize how much of your communication is non-verbal until that’s all you have is verbal communication,” Drake said.  “And so how do you convey your compassion and your true feelings in trying to make this trusting and open-hearted relationship with the family over the phone? It is really difficult, and it is not the best way to communicate bad news.  It is absolutely one of the worst ways to communicate bad news.”

But that has not stopped the team from doing all they can to make even the most difficult requests happen.  Dr. Drake talked about a patient who was brought to Sharp Chula Vista from another facility.  The patient had cancer and had recently begun to deteriorate.  Her only wish was to return home to the East Coast to be with her family before she died.  However, because of her condition, she was not able to travel.  The AIM team stepped up.

“We worked with doctors to get the patient’s pain under control and treat the symptoms that were treatable,” Dr. Drake said.  “Five days after she arrived, we were able to get her onto a medical flight home.  She passed away a few weeks later, but she was home and surrounded by her family, which was all she wanted.”

But the constant procession of COVID patients is taking its toll on everyone, including and perhaps, especially, the nurses.

“We try to support each other as best we can.  Just a couple of weeks ago, a travel nurse came to me and both of her patients were dying. That nurse said she felt privileged to be with a patient when it was their time. But she told me she was going to quit after this assignment; she was done with nursing,” Drake recounted.  “So I asked for chaplains to start rounding on our nurses because I think it is wearing us all down; patients pass away who have been here a while with COVID and new ones come in. We had a brief period in May before we reopened where numbers seemed to be going down and now that’s all changed.  And I think it will continue like this and that’s where the exhaustion sets in because it doesn’t feel like it’s ever going to end.”

Click this link to hear what Dr. Deena Drake has to say about wearing your mask to prevent the spread of COVID.

begin quoteThe families we were able to contact were so angry at us for separating them from their dying loved ones.
Dr. Deena DrakeDr. Deena Drake

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Carol Scimone
cscimone@sandiego.edu
619-260-4730

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