JERUSALEM — A few people had already died alone of the coronavirus at Tel Aviv’s Sourasky Medical Center when the hospital spokesman put to his bosses a question that had been gnawing at him.
Why had it been permissible for him to let a few journalists put on protective gear and come see the coronavirus ward, the spokesman, Avi Shushan, asked, but families of the patients were being kept out entirely, denied the chance to bid their loved ones a final farewell?
No one had a good answer.
Across the globe, hospitals have been reflexively refusing relatives the opportunity to visit patients dying of Covid-19, fearful that family members could contract the virus at the hospital or that relatives might unwittingly carry the virus with them when saying their goodbyes, infecting hospital staff.
Shortages of personal protective equipment have only added to the reasons for rejecting deathbed visits.
A New England Journal of Medicine article last week lamented the dilemma for hospitals and described “creative workarounds,” like nurses holding phones up to patients’ ears or using their own smartphones to let relatives see patients over Skype, WhatsApp or FaceTime. But it said these stopgaps sometimes ran afoul of privacy rules or poor connectivity, and called for new national guidance.
Faced with the question from the hospital spokesman, Ronni Gamzu, the chief executive at Sourasky, said Israeli hospitals were neither so overrun, nor their supplies of masks and gowns so depleted, that compassion had to be another casualty of the crisis.
On the spot, the hospital’s management committee unanimously voted to change its policy.
Elisheva Stern, 42, got a call from the hospital a few days later at her home in Bnei Brak. Her father, Simcha Ben-Shay, 75, was on his deathbed. Did she want to come see him?
Ms. Stern hesitated; she has seven children of her own, and feared infecting them. But the hospital promised to cover her in protective gear. She called her rabbi, who urged her to go. And so she went.
“None of us want to say bye to our family,” Ms. Stern said. “But it’s really a gift.”
Mr. Shushan, the Sourasky spokesman, said that as a non-physician, he normally was too shy to offer his opinions at meetings of the hospital’s management. But on this, he said, he could not hold his tongue: “I said, ‘This is the moral thing. Nobody needs to die alone. I don’t understand the logic of this.’”
The hospital’s revised policy, which several other Israeli hospitals have now also embraced, limits visits to one or two relatives per patient and half an hour at bedside. Most are in and out in 15 minutes or less, officials said.
Dr. Gamzu said that in barring family visits entirely before April 2, his hospital, like countless others worldwide, had taken what he called the international “default position.”
But this was not purely rational, he said.
“We had anxiety, narrow thinking, a little bit of hysteria and we were too conservative,” he said. “We’re putting all our energy into medical issues, and too little into loneliness and compassionate care.”
While Israel’s hospitals have not been overrun like those in some countries, Dr. Gamzu insisted that supply shortages were not an adequate excuse.
Family visits, he said, require “less than one percent” of all the personal protective equipment the hospital uses. “You don’t want to invest one percent for being human?” he asked.
At peaks in the numbers of critical patients, Dr. Gamzu said: “You could say, ‘We are sorry, we do not have the capacity now.’ But to take that as a standard?”
At her father’s bedside, outfitted head to toe, peering at him through a clear plastic mask, Ms. Stern said the Shema, the Jewish declaration of faith. She recited confessional prayers on her father’s behalf. And she told her father that she loved him.
He died overnight, and was buried hours later in a minimalist ceremony.
Ms. Stern said she and her father, a retired diamond dealer, had for years shared lunch a few times every week. A few weeks ago, he seemed disoriented on the phone, and she worried he might have had a stroke. She never suspected the virus.
Ms. Stern said she feels more and more grateful for the 10 minutes she spent at his bedside.
“It’s not a nice picture in my head, because you’ve got all the tubes and machines around,” she said. “But just to see my father’s face — it just looked like my father sleeping. It kind of gives it a better closure, rather than, you know, the person just disappears from your life.”
Dr. Gamzu said allowing deathbed visits did not just benefit the relatives, it provided an enormous psychological relief to hospital workers.
“Imagine the stress and emotional burden on people who see the patient dying, and the relatives are outside, and you have only a remote connection with them,” he said. “Once you let the relatives in, then you let your staff disconnect a little bit. They are not the focus of the burden.”
Howard Oster, chief of the internal medicine ward that is handling coronavirus patients, described that precise feeling.
“We had a patient come in who shortly afterward passed away, and I had to tell his two sons that their father had just died,” he said. “We were standing in the hallway with masks on. And I had to tell them, ‘If that’s not bad enough, you won’t be able to see your father.’ That was horrible. That was an experience I will never forget.”
By contrast, Dr. Oster said, watching a relative at a patient’s side “gives me some sense of comfort — not full comfort, because it’s not as it should be, but some sense of comfort that we did our best to ensure the patient didn’t die completely alone.”
Dr. Oster said there could well be some benefits to patients from compassionate family visits, though he was cautious. “Ask me that,” he said, “if it turns out, by some stroke of grace of God, that one of these patients actually rallies.”
But Rinat Zita-Dishlo is convinced of the benefits.
On Thursday, her two siblings visited their mother, Batsheva Zita, 74, after the hospital let them know she was rapidly failing.
On Sunday, her mother was still holding on, and the hospital bent its rules to give Ms. Zita-Dishlo, 41, her own chance to say goodbye.
That is not exactly the message she delivered, however.
“You are not alone, we are here,” Ms. Zita-Dishlo said through tears, bending over her mother’s hospital bed and caressing her face with a gloved hand. “Mom, my life, my beauty — fight, be strong. We’re here for you. Always.”