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‘It’s Really a Gift’: Israeli Hospitals Let Relatives Say Goodbye Up Close ‘It’s Really a Gift’: Israeli Hospitals Let Relatives Say Goodbye Up Close
(32 minutes later)
JERUSALEM — A few people had already died alone of the coronavirus at Tel Aviv’s Sourasky Medical Center when the hospital spokesman put to his bosses a question that had been gnawing at him.JERUSALEM — A few people had already died alone of the coronavirus at Tel Aviv’s Sourasky Medical Center when the hospital spokesman put to his bosses a question that had been gnawing at him.
Why had it been permissible for him to let a few journalists put on protective gear and come see the coronavirus ward, the spokesman, Avi Shushan, asked, but families of the patients were being kept out entirely, denied the chance to bid their loved ones a final farewell?Why had it been permissible for him to let a few journalists put on protective gear and come see the coronavirus ward, the spokesman, Avi Shushan, asked, but families of the patients were being kept out entirely, denied the chance to bid their loved ones a final farewell?
No one had a good answer.No one had a good answer.
Israeli hospitals were neither so overrun, nor their supplies of masks and gowns so depleted, that compassion had to be another casualty of the crisis, said Ronni Gamzu, the chief executive at Sourasky.Israeli hospitals were neither so overrun, nor their supplies of masks and gowns so depleted, that compassion had to be another casualty of the crisis, said Ronni Gamzu, the chief executive at Sourasky.
And so on the spot, the hospital’s management committee unanimously voted to change its policy.And so on the spot, the hospital’s management committee unanimously voted to change its policy.
Across the globe, hospitals have been reflexively refusing relatives the opportunity to visit patients dying of Covid-19, fearful that family members could contract the virus at the hospital or that relatives might unwittingly carry the virus with them when saying their goodbyes, infecting hospital staff.Across the globe, hospitals have been reflexively refusing relatives the opportunity to visit patients dying of Covid-19, fearful that family members could contract the virus at the hospital or that relatives might unwittingly carry the virus with them when saying their goodbyes, infecting hospital staff.
Shortages of personal protective equipment have only added to the reasons for rejecting deathbed visits.Shortages of personal protective equipment have only added to the reasons for rejecting deathbed visits.
A New England Journal of Medicine article last week lamented the dilemma for hospitals and described “creative workarounds,” like nurses holding phones up to patients’ ears or using their own smartphones to let relatives see patients over Skype, WhatsApp or FaceTime.A New England Journal of Medicine article last week lamented the dilemma for hospitals and described “creative workarounds,” like nurses holding phones up to patients’ ears or using their own smartphones to let relatives see patients over Skype, WhatsApp or FaceTime.
But it said these stopgaps sometimes ran afoul of privacy rules or poor connectivity, and called for new national guidance.But it said these stopgaps sometimes ran afoul of privacy rules or poor connectivity, and called for new national guidance.
A few days after the Tel Aviv hospital changed its policy, Elisheva Stern, 42, got a call at her home in Bnei Brak. Her father, Simcha Ben-Shay, 75, was on his deathbed. Did she want to come see him?A few days after the Tel Aviv hospital changed its policy, Elisheva Stern, 42, got a call at her home in Bnei Brak. Her father, Simcha Ben-Shay, 75, was on his deathbed. Did she want to come see him?
Ms. Stern hesitated; she has seven children of her own, and feared infecting them. But the hospital promised to cover her in protective gear. She called her rabbi, who urged her to go. And so she went.Ms. Stern hesitated; she has seven children of her own, and feared infecting them. But the hospital promised to cover her in protective gear. She called her rabbi, who urged her to go. And so she went.
“None of us want to say bye to our family,” Ms. Stern said. “But it’s really a gift.”“None of us want to say bye to our family,” Ms. Stern said. “But it’s really a gift.”
Mr. Shushan, the Sourasky spokesman, said that as a non-physician, he normally was too shy to offer his opinions at meetings of the hospital’s management. But on this, he said, he could not hold his tongue: “I said, ‘This is the moral thing. Nobody needs to die alone. I don’t understand the logic of this.’”Mr. Shushan, the Sourasky spokesman, said that as a non-physician, he normally was too shy to offer his opinions at meetings of the hospital’s management. But on this, he said, he could not hold his tongue: “I said, ‘This is the moral thing. Nobody needs to die alone. I don’t understand the logic of this.’”
The hospital’s revised policy, which several other Israeli hospitals have now also embraced, limits visits to one or two relatives per patient and half an hour at bedside. Most are in and out in 15 minutes or less, officials said.The hospital’s revised policy, which several other Israeli hospitals have now also embraced, limits visits to one or two relatives per patient and half an hour at bedside. Most are in and out in 15 minutes or less, officials said.
Dr. Gamzu said that in barring family visits entirely before April 2, his hospital, like countless others worldwide, had taken what he called the international “default position.”Dr. Gamzu said that in barring family visits entirely before April 2, his hospital, like countless others worldwide, had taken what he called the international “default position.”
But this was not purely rational, he said.But this was not purely rational, he said.
“We had anxiety, narrow thinking, a little bit of hysteria and we were too conservative,” he said. “We’re putting all our energy into medical issues, and too little into loneliness and compassionate care.”“We had anxiety, narrow thinking, a little bit of hysteria and we were too conservative,” he said. “We’re putting all our energy into medical issues, and too little into loneliness and compassionate care.”
While Israel’s hospitals have not been overrun like those in some countries, Dr. Gamzu insisted that supply shortages were not an adequate excuse.While Israel’s hospitals have not been overrun like those in some countries, Dr. Gamzu insisted that supply shortages were not an adequate excuse.
Family visits, he said, require “less than one percent” of all the personal protective equipment the hospital uses. “You don’t want to invest one percent for being human?” he asked.Family visits, he said, require “less than one percent” of all the personal protective equipment the hospital uses. “You don’t want to invest one percent for being human?” he asked.
At peaks in the numbers of critical patients, Dr. Gamzu said: “You could say, ‘We are sorry, we do not have the capacity now.’ But to take that as a standard?”At peaks in the numbers of critical patients, Dr. Gamzu said: “You could say, ‘We are sorry, we do not have the capacity now.’ But to take that as a standard?”
At her father’s bedside, outfitted head to toe, peering at him through a clear plastic mask, Ms. Stern said the Shema, the Jewish declaration of faith. She recited confessional prayers on her father’s behalf. And she told her father that she loved him.At her father’s bedside, outfitted head to toe, peering at him through a clear plastic mask, Ms. Stern said the Shema, the Jewish declaration of faith. She recited confessional prayers on her father’s behalf. And she told her father that she loved him.
He died overnight, and was buried hours later in a minimalist ceremony.He died overnight, and was buried hours later in a minimalist ceremony.
Ms. Stern said she and her father, a retired diamond dealer, had for years shared lunch a few times every week. A few weeks ago, he seemed disoriented on the phone, and she worried he might have had a stroke. She never suspected the virus.Ms. Stern said she and her father, a retired diamond dealer, had for years shared lunch a few times every week. A few weeks ago, he seemed disoriented on the phone, and she worried he might have had a stroke. She never suspected the virus.
Ms. Stern said she feels more and more grateful for the 10 minutes she spent at his bedside.Ms. Stern said she feels more and more grateful for the 10 minutes she spent at his bedside.
“It’s not a nice picture in my head, because you’ve got all the tubes and machines around,” she said. “But just to see my father’s face — it just looked like my father sleeping. It kind of gives it a better closure, rather than, you know, the person just disappears from your life.”“It’s not a nice picture in my head, because you’ve got all the tubes and machines around,” she said. “But just to see my father’s face — it just looked like my father sleeping. It kind of gives it a better closure, rather than, you know, the person just disappears from your life.”
Dr. Gamzu said allowing deathbed visits did not just benefit the relatives, it provided an enormous psychological relief to hospital workers.Dr. Gamzu said allowing deathbed visits did not just benefit the relatives, it provided an enormous psychological relief to hospital workers.
“Imagine the stress and emotional burden on people who see the patient dying, and the relatives are outside, and you have only a remote connection with them,” he said. “Once you let the relatives in, then you let your staff disconnect a little bit. They are not the focus of the burden.”“Imagine the stress and emotional burden on people who see the patient dying, and the relatives are outside, and you have only a remote connection with them,” he said. “Once you let the relatives in, then you let your staff disconnect a little bit. They are not the focus of the burden.”
Howard Oster, chief of the internal medicine ward that is handling coronavirus patients, described that precise feeling.Howard Oster, chief of the internal medicine ward that is handling coronavirus patients, described that precise feeling.
“We had a patient come in who shortly afterward passed away, and I had to tell his two sons that their father had just died,” he said. “We were standing in the hallway with masks on. And I had to tell them, ‘If that’s not bad enough, you won’t be able to see your father.’ That was horrible. That was an experience I will never forget.”“We had a patient come in who shortly afterward passed away, and I had to tell his two sons that their father had just died,” he said. “We were standing in the hallway with masks on. And I had to tell them, ‘If that’s not bad enough, you won’t be able to see your father.’ That was horrible. That was an experience I will never forget.”
Updated June 12, 2020Updated June 12, 2020
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
By contrast, Dr. Oster said, watching a relative at a patient’s side “gives me some sense of comfort — not full comfort, because it’s not as it should be, but some sense of comfort that we did our best to ensure the patient didn’t die completely alone.”By contrast, Dr. Oster said, watching a relative at a patient’s side “gives me some sense of comfort — not full comfort, because it’s not as it should be, but some sense of comfort that we did our best to ensure the patient didn’t die completely alone.”
Dr. Oster said there could well be some benefits to patients from compassionate family visits, though he was cautious. “Ask me that,” he said, “if it turns out, by some stroke of grace of God, that one of these patients actually rallies.”Dr. Oster said there could well be some benefits to patients from compassionate family visits, though he was cautious. “Ask me that,” he said, “if it turns out, by some stroke of grace of God, that one of these patients actually rallies.”
But Rinat Vita-Dishlo is convinced of the benefits.But Rinat Vita-Dishlo is convinced of the benefits.
On Thursday, her two siblings visited their mother, Batsheva Vita, 74, after the hospital let them know she was rapidly failing.On Thursday, her two siblings visited their mother, Batsheva Vita, 74, after the hospital let them know she was rapidly failing.
On Sunday, her mother was still holding on, and the hospital bent its rules to give Ms. Vita-Dishlo, 41, her own chance to say goodbye.On Sunday, her mother was still holding on, and the hospital bent its rules to give Ms. Vita-Dishlo, 41, her own chance to say goodbye.
That is not exactly the message she delivered, however.That is not exactly the message she delivered, however.
“You are not alone, we are here,” Ms. Vita-Dishlo said through tears, bending over her mother’s hospital bed and caressing her face with a gloved hand. “Mom, my life, my beauty — fight, be strong. We’re here for you. Always.”“You are not alone, we are here,” Ms. Vita-Dishlo said through tears, bending over her mother’s hospital bed and caressing her face with a gloved hand. “Mom, my life, my beauty — fight, be strong. We’re here for you. Always.”