As the pandemic unfolded in New York City and other major metropolitan areas, it was evident that Houston would not be far behind. Houston Methodist leadership began rolling out policies to prepare for surge conditions. I, along with many of my critical care colleagues, volunteered to serve in the newly formed Highly Infectious Disease Unit. We did it without hesitation but not without fear. We knew that there were significant risks to ourselves and our families. In particular, I worried about my two sons.
Dr. Faisal Masud, director of Critical Care at Houston Methodist, called me late one night; I had finished my seventh consecutive shift in critical care, and before answering, I knew what he needed. In a way, I felt like a soldier receiving their orders to mobilize. After all of the preparation, I would finally be caring for critically ill patients with COVID-19: intubating, proning, and getting very close to them, uncomfortably close. That night, I wondered if I would be able to get my protective equipment, and I thought about my family.
A year ago, we began creating a virtual intensive care unit—a vICU—where high-resolution video equipment would allow physicians to evaluate patients without stepping foot into the room, even from thousands of miles away. Although innovation is deeply intertwined in the history of Houston Methodist, it was met with some skepticism; what could a physician possibly do better remotely from an office than they could from the patient’s bedside?
COVID-19 answered that question with roaring certainty: a vICU would allow us to assess patients and adjust medications and ventilator settings, all without entering their room. We would reduce our contact with the patient and reduce the spread, all while preserving protective equipment, a commodity that seemed worth its weight in gold.
The five days after we began seeing patients are a blur, a “Groundhog Day” loop of waking up, gearing up, and treating critically ill patients. As I worked, I watched the calls for people to flatten the curve. COVID-19 patients die alone in a hospital bed without a family member to hold their hands, a viral post on social media reminded people, asking them to stay home.
And there’s the rub: our patients were alone. They were frightened, with no one to turn to except the medical workers covered from head to toe in protective equipment. This is not to downplay the awe-inspiring contribution of our nurses, respiratory therapists, physicians, and other clinicians, but there is no replacing family. Dr. Masud and I were feeling the same pain, the same guilt, over the anguish of these patients and their families. A mere week after we began this, he called me at night with an idea; we could use the video platform of our vICU to let patients see their families.
Within minutes of that call, I contacted a vICU nurse, and we were connecting a patient to his family. My first COVID-19 patient also was our first vICU patient to use the video platform. He is a pastor, a man of God, who contracted COVID-19 early in the pandemic after traveling to preach the Word. We were able to connect him to his wife, two daughters in different states, and grandchildren multiple times. He is currently doing well. In the next days, we connected over 40 families to their loved ones in the COVID-19 ICU.
We received a call from a teen who was caring for her two younger siblings while their mother and father were both patients with us. The children were able to talk to and sing songs for their mom, intubated and unconscious. Near the end of the conversation, their mother opened her eyes and followed a few instructions, so her kids knew she was listening. Everyone cried happy tears that day; no matter how many times we tell a family that their loved one is doing well, there is no comparison for being able to see it for yourself.
To analyze this patient relief we witnessed, our outcomes research team analyzed how families and patients responded to the video connections by thematically coding calls.
Families’ post-call comments and testimonials showed that they had positive experiences with their virtual visits. The experience wasn’t perfect; families still wished that they could actually touch their loved ones, but the vast majority expressed feelings of joy, relief, and peace. Our data, overwhelmingly, suggest that this video connection is invaluable.
Supporting what our research team found, I asked a nurse who had been working in the vICU since it opened how she would feel without the video connections. After a pensive silence, she began to cry. She fields dozens of calls from distraught family members every day, she told me. Before the pandemic, she would hug those people and support them through the worst days of their life. Now, she sits miles away from them and tries to offer comfort through a phone. She explained that the best thing she has to offer them is to see their loved ones. If she couldn’t do that, the job would feel impossible.
One young man explained that he was getting married, but that could not happen without his mom, a critical patient in our ICU. We coordinated her presence at her son’s wedding through the video platform. He and his new wife were married in a ceremony full of love, including that of his mother. Sadly, this patient didn’t recover; she passed a few days after the wedding.
These stories are bittersweet to me. As critical care practitioners, there is very little we won’t do and won’t give up to protect our patients. We feel honored to be filling a void for these patients and their families, but know that we are not removing their sorrow. This pandemic has taken so much from all of us. Still, the vICU and video connections have allowed us to give families back a few of these stolen moments.
Houston Methodist. Leading Medicine.
Houston Methodist is ranked by U.S. News & World Report as the No. 1 hospital in Texas and among the top 20 hospitals nationwide. Houston Methodist is the only nationally ranked Honor Roll hospital in the state and is designated as a Magnet hospital for excellence in nursing.