Life may never be the same after COVID-19. With tens of thousands of Americans having succumbed to the coronavirus in the United States, some of us are considering our own mortality. Life insurance companies have plenty of new customers. Estate planning attorneys are busier than ever. Many of us are thinking about how our loved ones will be taken care of in the event of our own death.
Death is always on my mind. I’ve worked as a physician assistant in a large hospital system in Dallas, TX for the past five years. Patients dying is normal part of my practice. Most patients are older and have multiple medical problems, but I do see many middle-aged and young adults dying of trauma, metabolic syndrome, AIDS, alcohol abuse, overdoses, cancer, etc.
This is a tough time in all our lives. Many of us have recently become unemployed, are working from our homes, can’t go out to eat in restaurants, are becoming our children’s primary teacher, are changing our shopping habits, and are much more conscious of our monthly expenditures. We are starting to also consider how our children will afford life if we leave this planet prematurely. Who will take care of them? What burdens will I leave my spouse? Does my family understand my wishes in the event I can’t speak or take care of myself?
Two years ago, my father, Richard Quinn, lost his life suddenly to a ruptured brain aneurysm. He was awake one minute and having a seizure-like episode another minute. He was intubated by EMS and brought to the local hospital. After speaking with the neurosurgeon on the phone, I knew how severe his condition was. I jumped on the next flight, and when I arrived, I knew my father was already brain dead. By midnight that night, with his wife, his children, and his nephews by his side, we withdraw life support, and he died a few minutes later. It was a hard decision, but one that we easily made. My father made his wishes known that he wouldn’t want to be on life support. My experience and knowledge of working in the ICU helped me to understand that there was nothing modern medicine could do to change my father’s condition. If we hadn’t made a decision, a brain death test would have confirmed his diagnosis, and his physicians, nurses, and respiratory therapists would have taken him off life support, even if it was against our wishes. When you are declared brain dead, you are dead, and you have no rights. Often times, while working in the ICU, we would give family 1 to 2 days to say their goodbyes, but it wouldn’t have changed the outcome.
Many patients in the ICU get better, recover from their condition, and walk out of the hospital. Many become brain dead like my father. Then there is a large gray area in the middle that is difficult for families to know what to do. This is where a living will helps the medical power of attorney, usually the spouse or an adult child, make the decision for what the patient would want. Does the patient want CPR? Do they want a tracheostomy (a plastic tube surgically placed in the airway)? Do they want dialysis? Would they want to live if they couldn’t talk, or walk, or eat? What happens to these people in the gray area? Families sometimes decide to withdraw care, or they go to an LTAC (long term acute care) facility where they slowly attempt to get weaned off the ventilator and maybe do lots of physical, occupational, and speech therapy. For every day you are lying in a bed, it takes three days of physical therapy to recover. For example, if you are bedbound with no other problems for one month, it takes another 90 days to potentially recover. The problem with being bedbound is your increased risk for ventilator-associated pneumonia, pressure ulcers, UTIs, an ileus (where your GI system shuts down), etc. Most people that need an LTAC and have been on a ventilator, may make a partial recovery, but often don’t recover 100 percent.
I ask you to educate yourself and consider your wishes if you can’t speak for yourself. Most physicians, physician assistants, nurse practitioners, nurses, and respiratory therapists that work around the ICU will tell you that they wouldn’t want most of what we do to our patients, to be done to them if they were in that situation. Many patients will want an initial effort, but if things don’t go well quickly, they want their power of attorney to “pull the cord.” We need to learn to accept death in the United States. Sometimes the best thing I can do for my patients is to make their family feel OK with letting them go.
James A. Quinn is a physician assistant.
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