Mental Health Experts Facilitate Talks Between Families, ICU Patients

May 8, 2020
Originally published on May 8, 2020 10:54 am
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So it is really hard to help people in the hospital with severe cases of COVID-19 communicate with their families. Doctors and nurses have to set up phone and video calls while wearing masks, face shields and gloves. And a lot of patients have trouble talking, holding the phone or even breathing. NPR's Rebecca Hersher reports on how mental health experts are trying to help here.

REBECCA HERSHER, BYLINE: Dr. Miguelina German is a psychologist at Montefiore Medical Center in the Bronx. Usually, she works at an outpatient clinic, mostly with sick kids. She's not a medical doctor, and she certainly isn't used to treating people with highly infectious diseases. But she and her colleagues are experts in treating people and families who are experiencing trauma. And so when the hospital asked her if she could help in the ICU, she said yes.

MIGUELINA GERMAN: It makes sense that they were tapping mental health experts because this is very traumatic for these families, and their loved ones are very ill.

HERSHER: Psychologists and social workers are doing similar work at major hospitals in Boston, Baltimore, New Orleans and Los Angeles. They say a big part of the job is just guiding the conversation because a lot of people in the ICU are intubated or on a ventilator. They can't talk.

GERMAN: We started these calls and the family members are often saying things like, you know, I love you. You know, this is your wife. You've got to fight this. I believe in you. I need you to come home. And it's a little hard for that family member because you're not getting a response back. It's almost like you can run out of things to say.

PAUL BULMAN: Sometimes, the family will kind of ask me, what do I say? Like, what do I do?

HERSHER: Paul Bulman is a pediatric psychologist, so he's used to talking to scared family members.

BULMAN: What I'll often say is something to the effect of, even if your loved one can't speak back, there's still something about your voice in the room making this connection which is - which can be very, very powerful and meaningful.

It was really poignant. Yesterday, an interaction I had - I facilitated this FaceTime connection between a patient and her family. And this is a patient who's on his ventilator and sedated. And the patient's son told me that when he and his siblings were growing up - their mom, our patient - she'd always woken them up in the morning by playing her favorite song to them. And as he was talking about it, he asked me to play the song for her, which I was able to do on the iPad. And it was - I just brought such comfort to this patient's family.

HERSHER: Part of what German and Bulman are doing in the ICU is helping families create moments of ritual and reflection, even though they can't be together physically.

GERMAN: Human beings have developed all these ritual around illness, around death. And these rituals help us cope and they're all disrupted right now.

HERSHER: Because a lot of the people who are in the ICU are dying without their family members there. Last week, Bulman was in an ICU when one of the nurses called him over. One of the patients was critically ill, unable to speak.

BULMAN: His daughter wanted to be able to connect in that way via FaceTime. And so it was very serendipitous actually having to come to that unit for a different purpose. Just at the moment, when this daughter was on the phone, and it was her father's like final hours, final minutes perhaps.

HERSHER: Bulman helped her speak to her dad to say goodbye. Sometimes, people in the ICU do get better. And German says helping patients connect with their families can help.

GERMAN: We know that loneliness and social isolation is not good for your physical health.

HERSHER: Like the week before last, she helped a man and his nephew connect via video chat.

GERMAN: The patient was intubated but he was awake.

HERSHER: The patient had improved since the last time the nephew had checked in.

GERMAN: He had his eyes open, and it was clear that he was understanding. And then, you know, I asked the nephew to talk about something that they're looking forward to doing when his uncle is out of the hospital. And he started talking about this beach that the family all loves to go to and how this cousin was waiting for him, and they're all going to go to the beach together.

HERSHER: The uncle listened, as the nephew described the family in the water and the son.

GERMAN: I saw a tear come out of the side of his eye...

HERSHER: ...As he imagined the future. German says the complexity of these conversations is why it's important for hospitals to have mental health experts inside their ICU's. It's why she and her colleagues have agreed to do work that puts them at higher risk for contracting the virus.

GERMAN: So many of us are being asked to do things that we were not hired to do and yet, here we are.

HERSHER: Rebecca Hersher, NPR News. Transcript provided by NPR, Copyright NPR.