Julia Nardi and her family tried to spend as many hours as they could in hospital with her father, Sam, before the strict no- visitor policies due to COVID-19.

But now, in what could be his final days, nobody has been allowed to see him in person.

"We're doing as much as we can with video calls," she said in an interview outside the family's home in Vaughan, Ont..

"But it's just not the same as being able to hold his hand."

After this story was published, the family confirmed Sam Nardi died in hospital on April 2. His family was able to visit him and his wife, Mary, was with him in his final moments.

She understands the tough policies in place at Sunnybrook Hospital, where her father is, and at hospitals and hospices across the province working to fight the novel coronavirus, but it's still difficult.

Sam Nardi, 61, in his bed at Sunnybrook Hospital, where he's in palliative care for cancer that has spread throughout his body. (Submitted by Julia Nardi)

The facilities ban visitors, except under rare circumstances; for palliative patients, an exception is made once that person is assessed as '"imminently dying."

Nardi said her father was healthy until January, when one day he noticed pain in his back while working at his job at a tire factory. He thought he hurt himself lifting a tire, and was off work injured for around a month.

On Feb.22, when he went to hospital, she said they discovered the pain wasn't due to a pulled muscle, but a malignant tumour that had grown so much it fractured his vertebrae.

Later tests revealed the cancer had spread throughout his body. Less than two weeks ago, he was moved to palliative care.

The Nardi family before father Sam's health problems. (Submitted by Julia Nardi)

Nardi said the physical distance can also make it trickier to navigate tough conversations about end of life.

"I think there's something to be said about the human connection and the human touch," she said.

Another challenge for the family is that mom Mary Nardi is recovering from breast cancer, and was unable to visit the hospital even before the COVID-19 restrictions. (Submitted by Julia Nardi)

Another challenge for Nardi and her family: her mother Mary has breast cancer and is going through chemotherapy. Because of that, she was already considered at risk going to a hospital.

That meant even before the visitor restrictions were added and they realized her husband of 38 years was dying, Mary was unable to visit Sam in hospital.

An update to this heartbreaking story on palliative care during <a href="https://twitter.com/hashtag/Covid19?src=hash&ref_src=twsrc%5Etfw">#Covid19</a>: Julia Nardi tells me her dad died this morning. <a href="https://t.co/Gf48rl7oHP">pic.twitter.com/Gf48rl7oHP</a> —@CBCLorenda

Financially, it's also been difficult. Nardi used to work as a bartender, but her employer had to shut down because of COVID-19. Her brother Rocco had left his job to spend more time with their father. Their mother is still unable to work.

Her friends have started an online fundraiser for the family.

Physicians find new ways to connect with patients

It's not only patients and families adjusting to new guidelines.

Palliative-care physicians are relying on more virtual visits and video calls as they work to reduce physical contact.

Dr Denise Marshall is medical director of McNally House hospice in Niagara, where they've used some creativity to allow patients to see relatives through a screen door on an outdoor patio. (McMaster University)

Patients and families "seem to deeply understand," said Dr. Denise Marshall, medical director for the Niagara West Palliative Care Team.

"If we can't physically touch people… we have lots of ways we can demonstrate non-abandonment and abiding," key principles in caring for someone at the end of their life, she told CBC Toronto.

Marshall said at the hospice she oversees, McNally House in Grimsby, Ont., they've found a way to creatively allow face-to-face contact for families.

At the ground floor of the building, the patient stays inside, behind a screen door, with family members visiting one at a time on the other side of the door from the outdoor patio. There's tape on the ground indicating appropriate physical distancing.

Dr Jeff Myers, medical lead for Sinai's Bridgepoint Palliative Care Unit, says patients and families have been understanding, and are adapting to the challenges posed by not being able to see each other in person. (Sinai Health System)

Dr Jeff Myers, who leads the Bridgepoint Palliative Care Unit of the Sinai Health System in Toronto, said he's been inspired by the acceptance from families forced to deal with the new realities, whether it's fewer face-to-face doctor visits or not seeing their loved one.

Myers said he recently walked into the room of one elderly patient, who saw her two sons every day before the COVID-19 visitor restrictions.

"She was FaceTiming one son and had just finished a Skype call with another. And this is a woman in her 80s, who, when I brought her an iPad, looked at me like I was a crazy person."

Looking ahead to a patient's final days or hours, Myers said the definition of "imminently dying" isn't exact and may vary depending on the institution.

The Nardi family, years earlier, during happier times. (Submitted by Julia Nardi)

Nardi said at Sunnybrook, her family was told it would be in what's expected to be the final 48 hours.

"It's really really difficult," she said, her voice breaking "because in these moments, we just want to be with him."

The family is preparing for her father's final days and Nardi said her mom would find a way to visit, despite her at-risk status.

'Gloves, hazmat suit, whatever we can do'

"When that time comes, I don't think she'll take no for an answer," Nardi said, adding that the family would take whatever precautions necessary.

"Gloves, hazmat suit, whatever we can do to get her in there."

Just before this story was set to be published, Nardi messaged to say her father's condition had worsened and she was with him in hospital.

It's not the way they or any other family ever imagined saying their final goodbyes, but now it's the only option.