Dying Alone in the Intensive Care Unit

Greyscale hand placed delicately against a window.

As I was peeling off the personal protective equipment in the emergency practice, I was on my way to pick up my things and leave to go home. Just at that moment, Ingrid came rushing down the stairs. I have worked with her in the intensive care for 20 years, where she is one of the most respected and experienced nurses.

“This is a horrible situation,” said Ingrid. “You have to help me here.”

“What is it?” I asked.

She thrust her cell phone toward me. “Look,” she said. “This is my friend Lucia. She is a marvellous musician from Portugal, a world-renowned pianist. She just sent me a WhatsApp message to say that her husband had to be rushed to the emergency room. He was immediately intubated and ventilated for coronavirus.

They live in France, and the hospital was over-flooded. So he is being flown here to the Basel University Hospital.” I looked at her phone. Here was a beautiful blonde-haired woman, in her early 40s, wearing a very simple design dress, sitting at the piano, turning her head over her shoulder towards the camera.

“Can you please talk to her?” Ingrid asked. I nodded, and in almost the same instant Ingrid pressed the call button on WhatsApp, and brought up her friend on a video call.

The woman I saw in the video looked much older than her real age. Her hair was undone, she looked like she had not slept for several days, and she was beside herself.

“Hello,” I said. “My name is Dr. Jan Bonhoeffer, I have known Ingrid for 20 years. She asked me to come on the call. Is that all right with you?” She agreed immediately. “Look, I am one of the physicians at the University hospital in Basel, and maybe I can help you understand how the system works, and what you can expect.”

“ Thank you,” she replied. “That would be marvellous, because I have no idea, and I’m feeling very afraid.” I explained to her briefly that Basel has excellent hospitals, cutting edge intensive care equipment, and all the medications that could possibly be required are available and in stock. I reassured her that this was one of the best places on the planet to be, when you have a condition like this.

She heard me, but I could see that my words did not really touch her.

Her shoulders were still up to her earlobes, and her arms were crossed in front of her chest. She was looking down. So I asked her to tell me a little bit more about when she last had contact with her husband.

“A few days ago, he was fine. Then he developed a little cough, and at some point he had difficulty breathing. We took him to the hospital here in Strasbourg, and within a few hours he was in the emergency unit, and he was intubated. They put him to sleep, and prepared him for transport.”

I could see from the way that she was telling me this that she was completely in shock. “I am so sorry,” I interjected. “This must be incredibly stressful.”
“It is. They tell me that there has been massive deterioration. They did not allow me into the ward. Now he’s being flown into another country, and I feel completely handcuffed. They would not let me see him in Strasbourg, and I don’t know what will happen in Switzerland. I asked them, ‘what happens if he is dying, will he have to die alone?’ They told me that this would be the case.”

I paused. I didn’t really know exactly what to say. “You know, Lucia, I was talking about exactly this kind of situation with one of the other doctors at lunch today. We talked about this, and we reflected how inhumane the current situation can be. We are putting hygiene as a higher value than love and connection. There is something wrong with this situation. I wish I could change it, but I can’t.”

There was another pause. I decided to take a big risk, with someone I did not know. For some reason, I felt she might be able to handle it.

“I see that you are in fear, and also in pain. May I ask you a bold question?”

“Yes,” she said tentatively.

“Would you be ready to look into the eyes of your own panic?”

Again, she looked at me in bewilderment. Then she said quietly, “Yes, I would.”

“Okay,” I said. “Can you actually really feel this feeling? Can you allow yourself to fully experience the feeling of panic?”

“ Of course,” she said. “That’s all I can feel.”

“ Well,” I asked her. “Can you also feel the love for your husband?” She started to cry.

“And you also feel this sense of helplessness?”

“Yes,” she answered through the tears.

I went through many other different experiences that she had told me she was having. We touched on many different emotions. “Can you see that each of these emotions is very different from each other one? Do you recognize that they actually don’t talk to each other directly?”

“Kind of,” she said. “But they are kind of altogether. I can always feel them.”

“ Do you actually feel all of them, all at the same time?”

“Yeah,” she replied.

“Please look very carefully,” I went on. “Is that really the truth?”

“Well no, actually not,” she corrected herself. “They are actually coming one after the other, in quick succession.”

“ Isn’t that interesting?” I said. “So who is noticing that?”

“ Me,” she said quickly. “I am.”

“ And who is the one who wants to manage the situation and change it and make it better?”

“That is also me,” she said.

“Is that the fearful part of you?”

“No,” she replied.

“Okay, so there is one part of you that is fearful, and there is another part of you that is very bold and rational and wants to get things done?”
“Yes,” she said. “That’s right.”

“Can you see that you have different parts of you, that show up as these different emotions? They take turns in showing up, in very rapid sequence.”
I noticed that her body language was relaxing as she paid more attention to her inner state. Her attention was shifting from the external story to becoming aware of what was happening inside of her.

“So can you see that these are very different parts, who are active right now?”
“Yes,” she said. “That is right.”
“Do you recognize that you are talking to someone right now in Switzerland?”
“Yes,” she said. “I can see that.”
“So who is aware of all of this? Who can recognize these different parts, inside of you, as well as this external character on the other end of WhatsApp?”
“ Me,” she said.

“ Where is that part of you?” I asked. “Is that just another part, or is it different? Just look, just look very closely. Turn the attention from all of this difficult situation to becoming curious about who or what it is who is seeing all these different parts that are active right now.”

“ I don’t know,” she said. Now her voice was surprised, almost like we had uncovered a long-forgotten secret.

“ This which is aware of all of it. What is that like?”

“ It is just white,” she said. “It is quiet.”

She became completely quiet. Previously, her body had been nervous and fidgety, but now she was calm. “From this part of me that is observing everything, I feel completely connected with my husband.”

She became much calmer, and was even laughing and smiling. We soon ended the call, I gave her my number if she needed me again, and I went home.
About an hour later, she sent me a WhatsApp message.

“Thank you so much. I managed to turn panic and fear and anger today into hope and a loving attitude towards myself and my beloved husband. Tomorrow I will make my way to Basel to actually try to be with him, so that he can feel me.”

Lucia did somehow make it through the border the next day. She went to the hospital in Basel, and rang the bell at the door of the intensive care unit. She asked to see her husband.

“ Unfortunately, that is not possible,” replied the nurse. “We cannot allow any visitors of patients in our coronavirus unit.”
“ He is my husband,” Lucia replied. “I am told that he is in critical condition, and that he might die.”
“ Sadly, that is the situation for almost all the patients in intensive care,” the nurse replied. “Our policy is that we need to protect people from being infected, and therefore there is no access for anyone, including relatives.”
“ Are you telling me that my husband might die alone on a ventilator, with his wife standing just outside the door of the intensive care?”

“I am sorry,” said the nurse. “I’m afraid that is the situation.”

Fortunately, Lucia did get message later that day that her husband had stabilized, and his condition was improving. She sent me a message to update me.

“But I do want to tell you, I truly and deeply appreciated the call with you. Not only did you provide me with the information I needed, but as of yesterday, I am a different person.”

This happens almost every day now, during these challenging times. As a physician, I am called to heal the body, but I am also being called on every day to calm the spirit.

Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of the Heart Based Medicine organization.  They are not intended to diagnose, treat, cure or prevent any disease. They are the expressed opinion of the author for the sole purpose of educating the public regarding their health and wellbeing. Individual results may vary. Seek the advice of a competent health care professional for your specific health concerns.



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