Updated: Apr 26, 2020
We have our family members alone in hospital beds. Many of them are sedated and intubated to protect their airways. We have no choice but to put our trust in the healthcare professionals caring for our loved ones, but there are aspects of the patient care that upsets me. To be clear, my statements moving forward have absolutely nothing to do with the amazing doctors, nurses, or hospitals themselves. I am overwhelmingly appreciative for all the extra tender love and care these professionals are exuding to our family and friends in our absence. I thank all of you wholeheartedly for your efforts. But, there is a greater problem and together we can fix it.
April 2 was the first day that I personally experienced loss due to COVID-19. My friend, Alex, lost her mother, Jody. Jody was equally a part of our lives - my kids spoke to her on the phone frequently and we actually FaceTimed with her 10 days prior, just 1 day before she was admitted to the hospital. It’s been devastating, sad, and makes it feel real. Since, I’ve had two more friends lose a parent and a grandparent to COVID-19. The theme is sadly the same. The sick are alone, scared, and have only strangers to care for them. They are isolated from their families on their deathbeds.
I spoke to Alex daily, sometimes multiple times a day throughout this process. As a Physician Assistant, I tried my best to help and reassure her that the medical team was doing all the right things and managing her mom’s care in an appropriate way. The wonderful nurse caring for Jody set up a FaceTime session so the family could say goodbye. When Jody heard their voices, she responded with hand movements even though she was sedated. But, the reception kept cutting out and ultimately, seeing their mom in such a poor state and not being able to be there made them even more upset with very little they could do.
There are three distinct problems occurring here.
1. Even though patients are receiving good patient care, it does not and cannot supplement the positive physiologic effects of interaction with loved ones.
2. Social support has been identified as one of the most powerful predictors of well-being, particularly during times of stress but, we are isolated from our sick and dying family members and have questionable means of communication. There is minimal sense of closure.
3. Cell and WiFi service within hospitals is unpredictable.
So let’s discuss the solution: Increasing your communication with family members through audio and/or video media.
Why is this so important?
First, we should take a quick dive into the science world. What happens when our body is under stress and we are separated from the ones we love? Hormones are released, specifically one called cortisol. Cortisol is the body’s built in alarm system. It will engage the “fight or flight” response. Cortisol can increase blood sugar, blood pressure, and anxiety. Physiologic changes happen to people when they’re “stressed.” Cortisol responses have been used to assess the intensity of separation distress and/or to examine that the presence of a partner may provide a form of social buffering. Our family members are in distress. They are separated from us and it’s affecting their physical state.
This means we need to deliver good feelings to our family members to help them feel secure and loved and counteract the effects of stress. This hormone is oxytocin. Oxytocin not only decreases anxiety but inhibits the secretion of glucocorticoids aka cortisol. Oxytocin is the emergency brake. How do we deploy the emergency brake? Our voices. Hearing the voice of a loved one releases oxytocin.
With the advancement of technology, we have so many, too many, means of communication. So which are most effective in delivering the most benefit to our sick family members and friends? Research from Seltzer et al, 2012 tells us this: "Written words are not as effective in changing these hormones as listening to spoken words. While many written documents are capable of transmitting an emotional signal to the literate (such as great works of literature, love notes or notice of termination from employment), vocal signaling is several hundreds of millions of years older." Therefore, despite the power of the written word, aka letters and more relevant today, texts or emails, "auditory signals are better potentiators of the release of those hormones necessary for the formation of bonds, suppression of stress, mating and other behaviors critical to fitness in many species." In other words, hearing a loved one’s voice is more powerful and actually releases the good hormone, oxytocin. So what are our best options to allow the greatest release of oxytocin?
FaceTime or Video Conferencing
If your loved one is not intubated or sedated, Facetime or video conferencing is by far the most effective option. Seeing and hearing offers the brain the most feedback and most closely simulates in-person communication in terms of bonding. However, you are relying on a strong WiFi and/or cell connection, which is not always the case.
Telephone and/or Audio-Only Recordings
Audio is your second best option. Vocal contact following a “stressor” has the ability to decrease cortisol and increase oxytocin. It takes longer for the effects as compared to physical contact and/or visual contact, but the good news is that over time (approximately 1 hour), the physiologic effects of audio are “statistically indistinguishable” as compared to Facetime or video conferencing.
This means that if you have a loved one that is intubated or one that cannot readily communicate, providing them with audio recordings would provide as much comfort as an actual video chat. Audio can be in the form of files that are uploaded to smart devices (again, relying on WiFi/cell service) or even more simplistically, burned CDs or cassette tapes (granted you can supply them with a player for their hospital room).
Texting provides no change in physiologic stressors and can even increase stress depending on text-response time. Texting is a poor option and could actually be detrimental.
For the Visual Learners: Below are graphs outlining what I have described.
In this study, children underwent the Trier Social Stress Test for Children, a procedure which involves completing a series of timed public speaking and math performance tasks aloud in front of an audience. Afterwards, they were assigned 1 of 3 conditions: 1. Reunited with their mothers (touch and audio) 2. A telephone call from their mothers (audio only) 3. No contact with their mothers
You can see that their stress levels, as measured by salivary cortisol, decreased quickest in the group reunited with their mothers. Unfortunately, this is not an option for us. However, the telephone call offered very positive effects. Audio makes a difference.
The next graph shows the results of “affiliation cues” meaning that the researchers counted how many times a person smiled, laughed, nodded, and gestured within a conversation. The results show that In-person offered the most gestures, then video chat, then audio, and lastly instant messaging.
This final study shows salivary cortisol levels in children communicating via instant messaging following a stressor. The texting had no effects in decreasing the cortisol nor raising oxytocin. It showed the same results as having absolutely no contact at all. On the contrary, oxytocin increased and cortisol decreased when the children heard their parents’ voices.
What's the Take-Home? Get video and audio recordings to your loved ones.
It will be therapeutic for everyone involved in these traumatic situations. As a family member, it gives you something to do: you can read their favorite book or poem, sing them a song, simply talk about your day, hit “play” at the dinner table as if they’re there… anything. You can upload it to an audio platform and the nurses can hit “play” at their hospital bed. It will provide priceless benefits to the patients, our loved ones and to us, a grieving family member. If or when needed, it gives us an opportunity to say everything we want to say and know that it is getting to them. It gives us some closure. We can all begin doing this now. Imagine the tables turned - your loved ones can’t see you and you’re very sick in the hospital. How wonderful would it be to hear their voices?
So what should be said on these audio recordings? It has been shown that the content does not matter as much as the actual sound of the voice and the sound itself will produce hormonally positive effects. Video and audio from a loved one has been physiologically proven to be similar to tactile contact and is a viable alternative.
Hospitals notoriously have spotty WiFi and bad cell service. Increasing communication with staff and even IT within the hospital(s) of your loved ones is imperative. You can discuss with them your options and how to effectively execute video calls and/or audio file uploads. This could help decrease time nurses and assistants need to take dealing with IT issues due to bad cell and/or WiFi service so that they can continue focusing on patient care.
In a new world of isolation, we are having feelings of hopelessness and despair but, you can help hit the emergency brake, even from afar. The goal is to provide you this information so you and your family can be at greater peace during such a scary and devastating time. If you find yourself lost for what to do as your loved one lies alone in a hospital bed, know that you can help them in this way. You can send your voice and it will make all the difference.
Disclaimer: My statements are not medical advice nor should they take the place of specific medical advice for your family member from the treating physician(s). They are suggestions to help the heart during these trying times. Hopefully, we will also see some positive turnarounds in more patients. Humans need connection, specifically connection from their loved ones.