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It was the middle of a busy telehealth shift and a paediatric case entered my virtual waiting room. A mother was calling about her well-appearing toddler with low-grade fever and cough. This would have been a mundane encounter had it not been for the history that the father, a healthy man in his 30s, was critically ill with COVID. Initially stoic, the mother recounted his course, beginning with dry facts that morphed into an emotion-filled narrative of her husband, his illness and their relationship. She exposed fears about her own health, fantasies of hospitalisation and the fate of her daughter should this occur. It was apparent this call was not about a child with a viral Upper Respiratory Infection (URI). I provided reassurance that she and her daughter would be fine. I hoped I was right. She seemed consoled, but ‘One more question, doctor’, she asked, ‘can I hug my baby?’ Yes, I told her, you can hug her. She cried. The encounter ended. I cried. Prior to COVID, this presentation would have been given a diagnosis of generic viral syndrome. Now a 2-year-old toddler with viral symptoms is more ominous. This encounter is now about a toddler who may lose her father. It’s about the mother who may lose her husband and the fear of her own hospitalisation. It’s about the danger of a hug.
It was 20:00. A 77-year-old woman with metastatic breast cancer and hypertension had worsening shortness of breath. The home pulse oximeter read 83%. The elderly woman was lying in bed with a cross mounted above. Against the back wall was a dresser with photographs of loved ones and a wedding portrait of her and her late husband. Blanca was pale, diaphoretic and panting. I advised that her daughter call 911; Blanca objected. I explained the hospital would be the safest place for her. Still, they did not call. While I felt a pressing urgency, the family seemed frozen. What were Blanca’s fears? The daughter looked at me, a doctor whom she had never met but whom she invited into her home and trusted with her mother’s life, and said wearily, ‘My mom is afraid if she goes to the hospital she will never return’. This is the underlying fear of many telehealth patients during this pandemic. My role on telehealth is to supplement medical advice with comfort and virtual hand-holding as they navigate this confusing time. I have been overwhelmed by the raw and intimate connection I make during each encounter and the meaningful impact these visits have on the patient’s life. I eased Blanca’s concerns as she left for the hospital. My connection, however, continued long after our virtual visit ended. Through frequent check-ins with her hospital course, I followed her disease progression for 2 weeks until, in the end, her greatest fears were realized and Blanca died of COVID-19.
A previously well 55-year-old man called about cough, sore throat and fever. He looked well. ‘What if I get pneumonia? How will I know if I am short of breath?’ I reassured him he had a normal respiratory rate and reassured myself he had no signs of distress. He sang the ABCs and walked effortlessly around his messy apartment. You will know if you are short of breath but, if you are worried, you can call back tomorrow. The next day and the day after that he called back, without change in symptoms. I realised he may just have needed someone with whom to connect. He lives alone; I am the only person he had seen for days. His exam unchanged, he insisted on a refrain of the ABCs. He walked around his apartment, then even messier. He speculated about the origins of his illness, about friends who had vague viral symptoms, and provided exhaustive details about his medications and oral intake. The third time he called, he asked me to be his private doctor. Although I was states away, on a telehealth platform, the patient–doctor connection was close, deep and even intimate as I examined him for the third day in his home, wearing pajamas, discussing his life, navigating his illness. Starkly different from the chaotic, loud ED, our visit was quiet. It was the two of us. I talked him through his fears. I reassured him his breathing was normal and this time I said, confidently, that he was stable and should recover uneventfully. Through his tears he thanked me and wished me well, the barrier very briefly broken between professional and friend-to-friend encounter.
Telehealth during COVID fulfils a unique role. Patients are isolated at home and vulnerable; often, the physician is the only person the patient has seen since becoming ill. Although a limitation of telehealth is the inability to perform a traditional physical exam, the interaction feels intensely close, even intimate, and the connection feels oddly deep. Time is unrushed, almost limitless, allowing a unique elicitation of a history in the patient’s private space without distraction. Instead of the physician leaving the exam room first, as in an ED encounter, the patient retains the power to end the call. This often follows many rounds of ‘One more thing, doctor’, fearing the pending disconnection and return to isolation.
Our ED has in the past provided urgent virtual care with minimal provider buy-in largely due to physician belief that the platform lacks the warm connection of an in-person visit. COVID has changed that. Irrevocably transformed, the landscape of medicine now features the inevitable increased reliance on telehealth. Here, encounters are nurtured and connections are made in a less sterile, less chaotic and less rushed environment than seen in the ED. What telehealth has ironically shown us is that technological advancement doesn’t have to mean the dehumanisation of medicine.
Authors’ Addendum: On follow-up, to acquire patient consent for this narrative, it was discovered that the toddler’s father died of COVID, having never been discharged from the intensive care unit. The gentleman in the third vignette is recovering.
Handling editor Ellen J Weber
Contributors All authors (MS-R, LRS and JB) met ICMJE requirements for authorship, including substantial contributions to the conception of the work, drafting and revising for important intellectual content, final approval of the version to be published and agreement to be accountable for all aspects of the work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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