They couldn't say goodbye in person, so ICU patients are using tablets instead

A nurse assists a Covid-19 patient during a Zoom video call at Stamford Hospital ICU in Stamford, CT, on April 24. John Moore/Getty Images

Some hospitals are stocking enough iPads to rival a modest Apple store. But the reason for this reflects a grim reality: They're being used to connect Covid-19 patients with their families -- sometimes, for the last conversation they'll ever have.

When Dr. Mark Shapiro posted about a patient saying goodbye to his family via an iPad, he wanted to communicate to others the severity of this pandemic.

"As the ICU (intensive care unit) team makes ready, there's a key step we mustn't forget," Shapiro, who is a hospitalist at Santa Rosa Memorial Hospital in California, wrote on Twitter. "At first he says "No," but we encourage him. The nurse brings in the iPad. With the last air in his shattered lungs, he says goodbye to his family. Over an internet connection."

Hospitals have been overwhelmed by the thousands of patients coming in every day after contracting coronavirus. Across the US, there's been a shortage of hospital supplies for medical staff and beds for patients.

And the contagious nature of the illness has forced hospitals to limit, and often forbid, visitation rights to mitigate its spread. The latest solution has been the implementation of iPad stations and other virtual technology so patients can communicate with their friends and family -- often, for the last time.

Shapiro's Twitter thread is littered with comments from family members who have had to communicate with their hospitalized loved ones through a computer screen. And it's just one of several social media posts that have shared this new practice.

A photo posted Thursday of iPad stations being prepared for patients in the ICU has gone viral on Twitter, amassing more than 115,000 likes and 27,000 retweets in just days.

Shapiro says iPads are often used right before patients are intubated. At this point, there's no guarantee that the patient will have an opportunity to speak to their loved ones again.

"We intubate when their lungs are injured to the point where they just can't sustain organ function," Shapiro told CNN. "They're not getting enough oxygen on their own. And we understand that we may be facilitating their last conversation."

Shapiro says that posts like his are a rare insight for nonmedical staff into the severity of the virus.

"When it comes to the messages around wearing masks, physical distancing and washing hands, there comes a point when you're playing the same key on a piano," Shapiro told CNN. "These sorts of first-person accounts are just a different way of conveying that similar message."

'The best way to connect people ... during the pandemic'

Santa Rosa Memorial Hospital isn't the first to use these tablets during the pandemic. Houston Methodist Hospital also used them until they switched to a different technology.

Farzan Sasangohar, who is the division chief of Health Systems Engineering at Houston Methodist Hospital, said they used similar tablets before adopting the virtual intensive care unit (vICU) for its patients.

A vICU connects the technology to a camera installed inside each room. Patients don't need to touch any screen or keyboard, and are able to communicate through a large display. The original intent of the technology was to let physicians, who were in short supply, visit patients remotely. But once the pandemic began, the technology has been used to let families virtually visit their loved ones in the hospital.

"(Visitation) was an unnecessary risk," Sasangohar, who is also an assistant professor of industrial and systems engineering at Texas A&M University, told CNN. "Our hospital still doesn't have visitation, but it's the best way to connect people more efficiently during the pandemic."

Sasangohar began interviewing family members after they used the vICU and has published his findings in a study. He says the feedback he's received has been positive.

"I've gotten some emotional comments from patients who saw their family members passing," Sasangohar said. "But they were also happy to be there, to get that closure. Otherwise, they wouldn't have been able to see it."

Dr. Atiya Dhala, the medical director of the vICU at Houston Methodist, has published her own study on their use. She considers them to be a better alternative to tablets.

"Most clinical settings do not have the benefit of built-in hardware and thus have to rely on iPads or other similar devices," Dhala told CNN in an email. "As most institutions move to adopt these technologies, dedicated iPads will be required for each patient because of the infectious nature of COVID-19 and patient privacy concerns."

And while vICU can be more affordable and easier to install than iPads, Dhala said neither option compares to seeing a patient in person.

"The main disadvantage of course was that the virtual meetings are still less than a perfect substitute for family presence and direct physical contact with loved ones," Dhala said. "The socioeconomic inequality and the corresponding unequal access to technology meant that not all patients' families would be able to utilize this great feature."

'It's sad that we've had to come to this'

For Carolyn Booker, the chief nursing officer at Northside Hospital in Atlanta, Georgia, iPads are the best option the hospital has. Like other hospitals, Booker says Northside had some tablets, but the sudden surge in coronavirus cases led to a demand for more.

Until recently, the hospital didn't even have enough tablets to go around until a former patient raised money to purchase 25 iPads for the hospital.

"When it came to Covid, hospitals basically barred visitors," Booker told CNN. "If a patient is positive with Covid, we don't want to run into the risk of someone else contracting it, so this is the best way for patients to still get to be with their loved ones."

"It's sad that we've had to come to this," Booker said. "Just from the standpoint of our situation, some of this is what we've created for ourselves by virtue of not following the science, not social distancing, not wearing the masks. Because those things are still happening, we're also still putting our loved ones at risk."

Still, Booker looks to the use of these tablets as an innovative solution to a common problem. And she, like others, says the iPads will continue to be used years after the virus subsides. She recalled a patient who used an iPad for more than six hours with a family member. The two sat in silence for the majority of that time. The patient later told Booker that just seeing each other's faces was enough.

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