On April 20, Donald Spitko’s family gathered together to watch him take his last breaths over FaceTime.
Spitko, 81, of Trooper, Pennsylvania, had contracted COVID-19 in March and spent more than three weeks on a ventilator.
Around noon, doctors removed the machine that had been breathing for him. His family expected it would take just a few minutes for him to die. But at 6:30 p.m., they were still holding their digital vigil.
Finally, “my mom, we sat her down, and my dad said goodbye to us, really,” Tammi King, one of Spitko’s daughters, said in a Zoom interview. “The iPad went dead right after that.”
At the outset of the pandemic, many doctors had never imagined a world without hospital visitation, said Chris Murphy, a critical care medicine fellow at Washington University Medical Center in St Louis. “It was a simple as, come on in and we’re going to have this conversation at the bedside.”
But the novel coronavirus has upended end-of-life customs globally, from how we memorialize the dead to how we grieve. Perhaps most poignantly, it’s left many COVID-positive patients to recover—or die—alone, as hospitals have mostly closed to visitors to prevent the disease’s spread.
“For many people, [a hospital iPad] is kind of their lifeline to the outside world,” said Chaplain Kathy Riegelman, a Unitarian Universalist minister at the University of Kansas Health System. But their connection to friends and family is only as strong as the Wi-Fi.
“People are pretty clear it’s not perfect. I think that goes across the board among staff and patients and families,” Riegelman said. “I hear people say, well, it’s better than nothing.”
As cases across the country spike again, hospitals are expanding their digital armaments, or gearing up for the first time.
Ken Starnes, a rural emergency room doctor, recently tweeted a viral image of dozens of mounted iPads for end-of-life visits on behalf of an anonymous palliative care doctor in another state.
The “Black Mirror” quality of the image, which has since been retweeted almost 40,000 times, serves as a reminder of the dangers of the virus and our failure to contain it. It also shows the unnamed hospital’s commitment to connection despite strict social distancing measures.
But Starnes’s facility in Missouri, like many healthcare providers across the country, hasn’t made the same investments.
“We don’t have an official policy, and we don’t have [a hospital-owned device] that we use,” Starnes said. “Usually, we’ll have a patient call their family members. If they don’t have a phone, we’ll use ours.”
That’s the situation the Spitkos found themselves in when their father was hospitalized in March. Early in the pandemic, few healthcare systems had systems in place for patient-family communication, and providers had to improvise.
“Most of the time for that month we relied on the phone,” King said. “We would call into the room and they would hold the phone to my dad’s ear and we would all take a turn. But that had pitfalls. If the nurse left the room, we didn’t want my dad having a dead ringtone to his ear.”
“When they were doing the phone conversations, they were like, your dad’s eyes were flickering,” added Sharon Spitko, another one of Spitko’s daughters. “But we couldn’t see that. We were taking their word for it.”
About half-way through their father’s hospitalization, a palliative care doctor at the hospital suggested Spitko’s family call him on FaceTime.
“The hospital at the time had two iPads,” King said. “One of them didn’t have audio and one they were sharing with other patients—and there were a lot of patients… If you didn't get it at a certain time, it had to charge, and [on] old iPads, that took forever.”
Despite the challenges, King said the iPads were her family’s “saving grace.”
At the University of Kansas Health System, Riegelman said the administration recognized the need for virtual communication and acted fast to secure the resources patients needed. Now, every unit has an iPad, as does every palliative care worker. If Riegelman needs to reach a family, she borrows a phone.
“I sit right outside the patients’ room where I can see the patient and I call the family members,” Riegelman said. She provides an update and, when appropriate, offers prayer.
Mounted iPads aren’t the only way to connect patients to the outside world, but they have to be connected to friends and family one way or another, Riegelman said.
“I notice people are really distressed if their phone is running out of battery, or if they were brought to the hospital really quickly and they don’t have their phones,” she said.
At the same time, some methods for communication are more successful than others.
“Just hearing someone’s voice is wonderful, but if people can do FaceTime on their phones, it seems to bring them a deeper level of comfort,” she said. “I think they feel more connected.”
While the device can never replace in-person contact, Riegelman predicts these tools will be in use long after the pandemic.
“I think we’re over the hump of being intimidated by using [these devices] and wondering what it’s going to be like with the family,” she said. “We know it’s not perfect, but look at what we can do with this.”
In the future, iPads could connect patients with far-flung members, or loved ones whose own health conditions prevent them from visiting a hospital.
When Donald Spitko died, his children started a GoFundMe to raise money to donate iPads to local healthcare facilities. In the months since, they’ve distributed about 35 iPads, each engraved in memory of their father, who they described as a generous handyman and avid outdoorsman who hunted elk and panned for gold throughout his retirement.
Throughout the pandemic, hospital iPads have been things to many people, from the bane of their existence to a saving grace to a warning of what could come.
“We can’t show what the inside of the ICU looks like, we can’t show the huge lines of the waiting rooms at the big emergency departments, we can’t show you what happens when you’re admitted and being cared for,” Starnes says. “But maybe that [image of the iPads] will strike home with somebody who still questions, should I wear a mask? Should I go home for Christmas? Should I go to a party? Should I go to a restaurant? Maybe they’ll look at that and think they could be looking into the iPad.”