Health
I am a COVID-19 unit doctor. Here are the important steps I would like everyone to take.
A 30 year old patient earlier this week COVID-19 He died of a mechanical ventilator. He did not present his end-of-life wishes, what is called advance directives in the medical field. Shocked by the numbers associated with his condition, his father did not want further treatment to prolong the inevitable. His mother wanted to do whatever he could to save him. What might he have expressed if the patient could speak his Wishes saved his family in a heartbreaking conflict.
But he didn’t mean to die.
This tragic situation is very common and is the result of an inability of the family to discuss prior emergencies and end-of-life hopes. Now that we are in the midst of a coronavirus pandemic, making this type of decision when interest is high is especially stressful. For this reason, it is important to understand end-of-life treatment options and make choices before a crisis occurs. No one wants to imagine the worst, but the worst is a cruel reality.
Of the 55 patients in my COVID-19 unit in Detroit’s Metro, only one had a pre-care plan document. The patient was nonverbal after having a stroke at age 54. I called his sister, his designated legal guardian, and she read me his pre-care plan. “Dr. tell him I love him,” she said. I was relieved to know that this patient had a designated supporter.
Asking another patient about her advance instructions, she was nervous and laughed, asking, “Is this a bad sign?” She was on 4 liters of oxygen. She didn’t intend to make one, so she thought a conversation was going on.
Another gentleman told me, “I’m 62 years old and I have more to do!” He grabbed his chest with both hands to cover his eyes from the high fever and try not to cough . His age was afraid to prevent him from obtaining life support, especially as some have suggested The elderly are not worth saving Or willing to die To protect the American economy.
During the last few nights of the shift, I kept talking to the patient for advance instructions. “Do you want to resuscitate, like wearing a ventilator, an electric shock to your chest, or chest compressions that can destroy your ribs?” I asked. “Do you want feeding tubes?” “If you couldn’t make a medical decision, for whom do you want to make those decisions?”
These questions are not easy to answer, especially if you are already sick and scared of a lonely hospital bed.
As with today, making this type of decision when interests are high is especially stressful. … and this is why it is important to understand end-of-life treatment options and make choices before a crisis occurs. No one wants to imagine the worst, but the worst is a cruel reality.
“I don’t know what he wants. It’s too stressful to make this decision,” one sister, a 37-year-old patient, said in tears. This patient had no prior instructions. His sister now had the emotional burden of taking care of him. She was also fighting COVID-19, but from home. Her brother couldn’t ventilate and couldn’t communicate. It is an understatement to say that it is an overwhelming situation.
As often as we work on advance directives for others, many of us in healthcare don’t think about our own mortality. I didn’t. Too often, this conversation is saved for a Medicare wellness visit with a 65-year-old outpatient doctor. According to the Centers for Disease Control and Prevention, Only a third of Americans have advance directives And 63% of these are people in nursing homes.
But this is not just a magical age of 65, but a story everyone should have. In my COVID-19 unit, the patient’s age ranged from 18 to 103 years. this.
So we are socially at home, but it’s time to have that conversation. Most people either avoided it, or didn’t even know it was necessary. Make an end-of-life plan, write it down, and discuss it with your doctor. Even better, contact a lawyer to learn how to make your wishes sound legal. That way, if there is any controversy between the families, it will open a clear path.
Recently, for the first time, I chose a defender for myself, thought about my wishes for resuscitation, and even thought about my funeral. It wasn’t easy, but it was important to both myself and the peace of mind of my family.
Instead of feeling guilty and regretful- “I wish I knew what he wanted-“, we all have the power to know the wishes of our family right now . Talking about death is terribly offensive, but perhaps this pandemic is the tough nudge we need. By discussing advance directives before you get sick, you can reduce many emotional pain and mitigate the fear of death.
If you don’t do it for you, do it for your family. If God forbids, it will reduce their burden when you get sick.
Dr. Asha Shajahan is a primary care physician in Metro Detroit, treating inpatient and outpatient COVID-19 patients and homeless people who may be infected with the virus. She is a media and medical fellow at Harvard University.
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