by Daniel Whitlock
I’m considered old even though I don’t feel it, and I have a chronic illness as well. These criteria put me at a high risk of dying if I am infected with the COVID-19 virus.
I am also a retired physician and medical administrator, so perhaps I have too much knowledge about medical care, or maybe I’m just a realist who understands the current situation in which our hospital, physicians, nurses and staff find themselves during this pandemic! As I have listened to the news and heard the reality of increasing COVID cases and decreasing availability of hospital beds and resources, I have started to think about the possibility of my own demise. I have decided it’s time to take as much control as possible about how I want my days to end if my family and I should find myself in that situation.
Should I become infected with the COVID-19 virus I will most likely be admitted to the ICU. Here I will encounter the most sophisticated technical care available anywhere in the country; ventilators, multiple IV’s, infusions, medications, synthetic antibodies, procedures and protocols that caregivers are using to save patients from this heinous disease.
Caring for patients in a pandemic is overwhelming when doctors and nurses experience the trauma of knowing they cannot slow down. Their feelings must remain muffled in order to serve the next patient requiring their attention. The emotional toll they feel when overwhelmed by tight resources, too few staff and very sick patients who often die leads to burnout and can rapidly cascade to PTSD, guilt and chronic anxiety. I know this is true because I have walked in their shoes. This is the reality our hospital staff face, heroically and selflessly, each day. Our caregivers are a scarce resource – a resource we must not squander. Therefore, if the unwanted possibility occurs I would become one of their patients, is it possible for me to relieve a fraction of their emotional burden?
Part of the answer can be found in an “advance directive” or “living will,” which I have had for many years. This document lays out the types of care I want, or don’t want, at the end of my life. But recently, I have realized this pandemic has put a new spin on my health-care directive. I have begun to discuss with my wife my wariness of the unknown. As death comes to us all, so I want to make sure my health-care directive identifies what is important to me. An advanced directive is not a document to set my choices in stone. Most of all it sets the stage for respectful and non-confrontational discussions between my family and hospital staff regarding my final care.
Therefore, as I review my advance directive relative to COVID-19, I know a couple of things: first, I do want a ventilator, provided the caregiving team thinks it in my best interest. I trust my family will engage them in this dialogue. And secondly, I do not want “heroic” care that may result in a very difficult rehabilitation or taking precious resources from a patient who may have a much better prognosis. My family and caregivers should know many of their choices may be ambiguous ones and be assured I concur, in advance, with their difficult choices. I am going to ask my family and caregivers trust each other explicitly – no arguing, no blaming, no histrionics!
I encourage all of us to face the facts of this pandemic and its possible consequences; death is one of them. Talk to your partner and family about the stark reality; a reality that should not be faced without adequate forethought and planning.
Daniel J. Whitlock, MD, MBA, retired from St. Cloud Hospital CentraCare after 16 years as its vice president for medical affairs.