They say if you want to remember something, you should write it down.

For Helen D’Couto, MD, sending handwritten cards to the families of patients who have died in the intensive care unit (ICU) during the COVID-19 pandemic has been a way to remember their individual stories.

The cards have also helped D’Couto and her team process the feelings of loss and distress they’ve experienced as the pandemic continues to take a heavy toll.

D’Couto is a pulmonary critical care fellow splitting time between Massachusetts General Hospital and Beth Israel Deaconess Medical Center (BIDMC).

She and her team began sending cards to patient families in March of 2021, after a particularly tough weekend in the Mass General ICU. 

“It was a period where vaccines were available, but we were seeing a huge amount of disparity in who was getting them,” D’Couto recalls.

“The people in the ICU were largely young people of color—mostly men in their 40s—who hadn’t been vaccinated and did not have information about vaccines or access to vaccine centers.”

The distress caused by the surge in critical—and often fatal—cases of COVID was compounded by the pandemic-based restrictions on visitors to the ICU, D’Couto says.

“Typically, I spend a lot of time connecting with my ICU families and that’s a big part of what we do—we take care of the patient, but also take care of their family,” she explains.

“But in this period of limited visitors, I felt like I barely knew these families and it seemed almost callous how quickly we had to turn things around for the next patient.”

“That—in combination with how distraught my team was—made me realize we needed a way to acknowledge these deaths,” she says. “I felt like they were becoming just another COVID statistic. We were losing who they were as a person and who the family was as a family.”

The next day, D’Couto brought in cards to send to each of the families, so she and her team could write something about the patients they cared for. It’s a practice that they’ve continued ever since.

“I generally still try to know something about the patient and their family, so the cards are usually personalized,” D’Couto says. “We say that we’re deeply sorry for their loss, that we understand the pain that they’re going to face in the coming months and that we hope for healing for them.”

“Oftentimes we say we wish we knew that fun father who coached baseball and we’re sorry that we only met them intubated in the ICU.”

D’Couto, now at BIDMC, posted a thread about the cards on Twitter in February, after her team had endured another wave of deaths during the omicron surge.

“Last month, there were a lot of cards to send. Not all of these were COVID [patients], but a good percentage of them were. Out of all those COVID deaths, all but one was likely preventable with vaccines,” she wrote.

“So much preventable trauma for these now-shattered families,” D’Couto added. “I just want fewer families to have to receive my cards. Get vaccinated and boosted.”

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