Care by Telephone During Covid-19: A Palliative Care Perspective

By: Eve Makoff, MD

Director of Palliative Care

In palliative care we are comfortable with silence and stillness when tears come. We know that anxious moves to change the moment - by rushing for tissues or words – convey that we are somehow not okay with our patient’s emotional state. We have learned to pause and let the moment be what it is, whatever it is, without distraction or judgment. Enabling these intensely vulnerable moments requires finesse under all circumstances. For MedZed’s Palliative Care team, the early days of the pandemic increased this challenge, by necessarily replacing our previous practice - a nurse in the home, joined over our video-based telehealth platform to a Complex Care Provider (MDs or NP), Social Worker, or Chaplain - with an all-telephonic model. Without visual cues, our ability to deftly read and respond to what was happening inside of a patient in the course of a visit was tested . But the insights and skills that we gained during this period remain powerful even as our nurses are now returning to the field and into our patients’ homes.

In the time of Covid-19, we have all had to flex our skills to meet the moment, but learning to intentionally and blindly “take a beat” while addressing devastatingly personal issues entirely by phone presented an immense challenge.  As we allowed the telephone line to go quiet we had to trust that in that absence lived the potential for a deepening connection and relationship. Holding silent in the face of despair tells the person on the other end that you are willing to grant them the space to feel without interference.  By putting aside our own anxieties about an imperfect medium, we learned to hear more deeply between the words and to see more clearly without the visuals.

Palliative care teams regularly share and process unwelcome news with patients. Together we navigate the physical and emotional terrain that often begins with a diagnosis of an advanced disease, progresses through various treatments, and ultimately moves to the stage where the services provided by hospice care are clearly the next best step. Some patients only allow their tears to fall when safely ensconced with a palliative team that is trained to provide comfort at critical junctures. It is not unusual for many to request a hug after every visit. When the opportunity to reflect compassion with the locking of eyes or the stillness of composure does not exist, our power to respond to grief lies wholly in the cadence and tone of a conversation.  And with this knowledge we have deepened our empathic skills.

As we safely move back to video and in-person visits, we relish the relative ease of expressing care with our eyes and our bodies. But we are confident in our new awareness of the power that lives in our breath alone.

Eve Makoff, MD

Eve received her BA and an MA in English literature at Columbia University, and her medical degree from Brown University. She completed a Fellowship in Nephrology, and is Board Certified in Internal Medicine and Hospice and Palliative Medicine. Eve completed her Residency and Fellowship at Cedars-Sinai. In her spare time, she loves road trips with her 3 teenagers, her husband, and his 4 adult children.