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Being there

DW Weekly talked to Diana Bartenstein, MD, a PGY-2 dermatology resident at Massachusetts General Hospital, about her work as a responding clinician on an inpatient COVID-19 ward.

For too many COVID-19 patients, the end has not only come quickly, but in a difficult, chaotic, environment. Some patients who do not survive are also forced to be isolated in hospital rooms in their final days, kept at a distance from professional caregivers at times, and worse, left to face death alone without family at their bedside. It’s a heartbreaking scenario. It’s also a scenario that has been rare for dermatologists. Until now.

Diana Bartenstein, MD, a PGY-2 dermatology resident at Massachusetts General Hospital, is

one of many (along with providers from many different specialties) who were re-deployed to work as a responding clinician on an inpatient COVID-19 ward, facing tragic, life and death situations. Just last year, she had been an intern at Brigham and Women's Hospital during her first year of residency, before starting in dermatology. Because she had been an intern so recently, she said it was easy for her to swap back into this role. “I think we're all looking for ways that we can help in this crisis,” she said, “and I felt really grateful that I could give back so readily with a needed skillset.”

Seeing a steady, mounting toll of human suffering and human loss has the potential to sap one’s spirit, particularly in situations that sometimes appear to be insurmountable. Still, Dr. Bartenstein is a positive individual, determined to face life and death situations with courage and compassion.

“I was thinking about how I would want someone in my family to be taken care of if they were hospitalized,” she said. “I’ve lived in the Boston area my entire life, so patients often feel like they could be my grandmother, or someone from my own family.”

Dr. Bartenstein felt that familial tug recently when she encountered a patient who was facing a grim future.

"I was taking care of a COVID-19 patient in our ward, an elderly woman. With no visitors allowed at our hospital until a patient is definitively at their end of life, she was very much alone, facing the decision of whether to focus on ‘comfort measures only.’ It was a decision that could end her life in a matter of hours to days.”

Although she had been encouraged to spend as little time in the rooms of the patients as possible -- to minimize exposure -- Dr. Bartenstein, replete with PPE gear, talked to the patient whenever she could. She talked to the woman about her medical decisions, the disease, and the woman’s family. It would be a brief connection, but a potent one.

“She told me she didn’t think she would be able beat this virus. She also asked me how the virus came to affect so many people. We talked about suspected transmission from animals and what else I had read about epidemiology in the news. Then I asked her to tell me more about her kids and grandkids.”

Nearing the end of her life, knowing that she was going to die soon, the woman fallowed herself a small treat – some comfort food.

“Her nurse and I were both with her, but her nurse left the room so she could shut off the oxygen alarms that would inevitably go off while she was eating, and I stayed to help the patient temporarily remove her oxygen mask, so that she could take food. Then I sat with her while she quietly ate.”

“I spent as much time as I could in her room the next morning to keep her company until her daughter arrived, and then she passed peacefully later that day."

Dr. Bartenstein was grateful to have been able to be there for a patient in need.

"Sometimes there is nothing left for you to do but listen,” she said. “And when there is nothing left to say – you just need to be there."

Diana Bartenstein, MD, is a PGY-2 dermatology resident at Massachusetts General Hospital.

Are you on the front lines managing COVID-19 patients? Share your story with DWW. Email dweditor@aad.org.