For 33 years, Darsh Takhar has cared for patients who hover on the edge between life and death.

The registered nurse at Brampton Civic Hospital worked during the 2003 SARS crisis and is used to long, demanding days in the Intensive Care Unit. She knows, even with the best medical care, some of her patients will not survive.

Yet, one of the hardest moments in her decades-long career came just last week when she held the hand of a man — a hospital co-worker — who lay dying of COVID-19.

“He was one of our own,” Takhar said of the 58-year-old environmental services associate and long-time hospital employee who died on April 9, becoming the first known Ontario health-care worker to die after getting sick with the coronavirus.

“We were with him. We prayed with him. We held his hand. But his family wasn’t there — couldn’t be there — and that was the hardest part for me.”

Hospitals across Ontario have made the difficult but necessary decision to restrict families from visiting their loved ones in hospital to prevent the spread of COVID-19. It’s yet another, and especially heart-rending, way the highly contagious and deadly virus has upended how hospitals deliver patient care.

Doctors, nurses and social workers are now connecting families and patients by phone or video conference, even when critically ill patients on ventilators can no longer speak. They understand the fear and grief families experience when they can’t sit at their mother’s bedside or touch their father’s hand.

Hospital staff are also ensuring families get regular updates about a patient’s condition, often helping them navigate difficult and possibly life-ending or life-altering decisions around a patient’s care. And, in the days and hours before a patient’s death, they are making sure families get a chance to say goodbye.

Last week, Dr. Brooks Fallis, a critical care physician at Brampton Civic Hospital, set up a video conference for the daughter of the hospital cleaner so she could speak to her father before he died. Fallis said it’s a moment he will never forget.

“I had the privilege of being in the room while she told her father how much she loved him, and that she was hoping he could be strong and that he could get better and that they were praying for him. Myself and the nurse were both crying in the room, quietly, while she was speaking to him.

“While we were unfortunately unable to get him through his illness, I’m really glad his daughter had that moment with him that night.”

Before the COVID-19 outbreak forced hospitals to restrict visitors, Brampton Civic encouraged families to sit at a patient’s bedside in the ICU. Staff got to know their patients’ families and families, in turn, were able to see first-hand how doctors and nurses cared for their loved ones.

Each day, during rounds, families were invited to be in the ICU room while a doctor, nurse and pharmacist reviewed the patient’s condition and made plans for the following 24 hours.

“Normally, we’re interacting with families all the time, getting lots of information from them and communicating information back to them,” said Fallis, Division Head and Medical Director of Critical Care at William Osler Health System. “Now, we are doing as much as we can to emulate that situation in a virtual way.”

During a 12-hour shift, Takhar, who volunteered to nurse patients with COVID-19, cares for a single patient with the disease. She constantly monitors vital signs, the ventilator, medications and IVs, as well as making sure her patient is comfortable and not in distress. Most days, Takhar only takes a single break, around 3 or 4 in the afternoon.

“Our patients are so sick and their condition can change so fast. We don’t want to leave them.”

As of Monday afternoon, Brampton Civic had 12 COVID-19 patients in the ICU. Takhar said it’s unnerving to see so many sedated patients on ventilators, many exhibiting similar symptoms and requiring similar medications and care.

“They all look the same. It’s like something out of a horror movie and we’re just waiting for them to wake up.”

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Takhar was the primary nurse for the hospital worker who died of complications from COVID-19. She spent almost two weeks caring for him and was in constant contact with his family, even giving them her personal cellphone number so they could call or text at any time. She says families waiting anxiously at home are soothed by small details about their loved one’s care, something she’s learned in her decades of nursing.

But sometimes, she adds, families need to speak directly with their loved one, even if their father or mother, brother or sister are unable to hear them or talk back.

“I put the phone by the patient’s head and close the curtain and let them talk to their loved one. It’s moving, but it can also be stressful because they are making plans and maybe you know that patient might not make it … And they say things like, ‘Daddy wake up. Daddy get up. Come home.’

“It’s hard, it’s very hard. I try to keep neutral so they don’t see that I’m upset. But we’re human, too. We are going to get upset.”

As a registered social worker in Brampton Civic’s ICU, Danielle Coffin has had many difficult conversations with patients’ families since the start of the COVID-19 outbreak. She has helped families get support for funeral arrangements, talked through end-of-life decisions and braced families for how different their loved one will look in the ICU while hooked up to life-support machines.

Coffin, who started her job in December, has donned Personal Protective Equipment numerous times to bring a phone or iPad to a patient’s bedside. She says it’s a privilege to oversee these intimate conversations, many of which involve families expressing their love, pleas for a patient to get better and future plans for family parties, trips and outings.

During the last few weeks, Coffin has helped families with end-of-life rituals for patients dying of COVID-19. One family asked for their loved one’s arms and legs to be positioned in a certain way at the time of death. In another case, Coffin arranged for each of the patient’s children to have their own, individual goodbye. Coffin also helped co-ordinate the delivery of holy water to the hospital so a physician could bless a dying patient while his family watched and offered instructions by video.

“At least we could provide some level of comfort during that difficult time. That was a very powerful moment.”

For patients and families for whom English is not their first language, the hospital offers a real-time, virtual translation service with professional interpreters skilled in 170 languages. Between its three hospital sites, the top languages used are Punjabi, Urdu, Hindi, Portuguese and Italian, said Mary Jane McNally, chief patient experience officer for William Osler.

In the last three weeks, physicians in Brampton Civic’s ICU have gained experience treating patients with COVID-19 and have seen firsthand the spectrum of symptoms associated with the disease. Despite their best efforts, Fallis said many COVID-19 patients deteriorate and need advanced life support interventions, including kidney dialysis, drugs to support their cardiovascular system and a high level of ventilator support.

In the absence of bedside vigils, Fallis said it’s critical for families to see by video conference the faces of the hospital staff, the ICU room with its many machines, as well as the condition of their loved one.

“It helps them understand everything we’re trying to do to get their family member to survive this illness and get better, and it allows them to see how sick these patients really are.”

For Takhar, the past few weeks have been among the most challenging in her career. Some days, as she did last week after the hospital cleaner died, she has cried with her colleagues, finding solace in their support. Other days, she’s worried she will get infected with COVID-19 at work and bring the virus home to her family.

But even on her hardest days, Takhar said she puts her fears aside to look after her patients, the way she’s done for 33 years.

“You pull together with your team and carry on and do what you can to the best of your ability.”