The One in the Room: Palliative Medicine in the Age of COVID-19

There is an inherent intimacy to treating seriously ill patients. Healthcare clinicians are trained to be right at the patient’s bedside, to touch, to feel and listen and be present. “But to be a steward of the public health, we have to really think carefully about not passing COVID-19 from one patient to another in the hospital, or wasting precious resources like personal protective equipment that we use to enter a room,” says Bob Gramling, M.D., D.Sc., the Holly and Bob Miller Chair in Palliative Medicine and professor of family medicine at the Larner College of Medicine. Gramling says that doctors, nurses, spiritual care providers, and others in healthcare are struggling with the physical distance that COVID-19 has necessitated, both from patients themselves and from patients’ loved ones, who are not allowed to visit during this time. In this environment, Gramling’s research on patient-centered communication measures—learning how to listen to and connect with patients more effectively—becomes even more critical to the discipline of palliative medicine. His team has built a communication intervention called “Talk Vermont” aimed at helping clinicians practice more values-based conversations with patients facing end-of-life decisions. In honoring and providing space for patients’ emotions, healthcare providers are better able to make recommendations that honor their individual priorities, whether it’s pain mitigation, more aggressive treatment, cessation of treatment, or simply making it to an anniversary a few months down the road. The project’s mission is to help physicians communicate in ways that leave patients feeling heard and understood. Since COVID-19 spread to Vermont, Gramling and a small team of practitioners have volunteered to provide care at a local nursing home where many of the staff and patients had already been infected. One thing he will take with him from the experience, he says, is the conversations. “I’ve talked to families of people who’ve died, and they are just thankful to know that when they couldn’t be there, there were human beings there who did know and love their person,” he says. In this setting, he’s been present for some discussions that ordinarily may have happened when he leaves the room. “I’ve been the one holding the iPhone or the iPad to help them communicate with loved ones, and so I’m part of that conversation. I may not be speaking, but I’m certainly there as bearing witness to it. And there’s just a lot of beauty. There’s just a lot of forgiveness, a lot of humor, a lot of almost magical quotes going back and forth between patients and families that I know are going to live for a long time.” What he hopes arises from this experience is a renewed focus on connection. “Our long-term goal is to have our monolith of healthcare be able to value communication, be able to pay for it, be able to incentivize how we train people, how we hire people, how we develop our workflows, how we build our buildings, so that we foster human connection.”