Contemplating Mortality During a Pandemic

Steve Lund, MD | Kansas

I am a 72-year-old retired Emergency Medicine physician who spent 43 years working in Emergency Departments. I retired last October just shortly before the appearance of Covid-19. I have great empathy for my colleagues that have been so courageous in their resolve to fight this Pandemic. Words cannot express my sadness at the loss of many colleagues who have risked their health and lives to provide for their patients.

After spending 43 years in the medical field taking care of patients, I came to the realization that the biggest change needed in how we deal with our patients is to have an honest conversation with them about their mortality. I call it “The Contemplation of Their Mortality.” This is not a discussion that should start in the Emergency Department. What does “Contemplation of Your Mortality” mean? It’s an honest and compassionate discussion between the patient, their family, and the attending physician regarding the “Quality of Their Life.” We would talk about what they would want or not want to have done if an acute medical crisis causes a rapid deterioration of their health. These discussions are particularly important in a Skilled Nursing Facility when the patient’s physical or cognitive abilities have deteriorated to the point in which they need 24-hour assistance for their daily living needs. Amid the pandemic, this conversation is nearly impossible with social distancing and masking.

It is the true tragedy of modern medicine that due to the lack of honest conversations between patient, family, and attending physician prior to a life-threatening medical condition, the legal requirement is to proceed with a “Full Code.”  Without a proper discussion, patients are “doomed” to go through a painful and futile medical intervention in the Emergency Department including aggressive medical procedures such as a final “Code Blue” with the use of respirators and chest compressions. A tragic enough occurrence when the patient has the support and presence of his family near them – and catastrophic in the present COVID situation when family are not allowed into the hospital or the Emergency Department.

In 2020, that acute medical event that has caused the deterioration of the patient’s health is frequently COVID. There is no treatment, there is no vaccine yet, and particularly in the elderly with severe comorbidities, the rapid fall of their oxygen level requires that they be put on a ventilator. Would the patient really want to have this done if their “Quality of Life” is to be sustained in a Skilled Nursing Facility until their death? This is what “Contemplation of Your Mortality” is all about. It is not a conversation that should be started in an Emergency Department when the patient’s vital signs are deteriorating from an acute medical condition. To “Save a Person’s Life” is the ultimate goal of modern medicine and when successful, is “Medicine at its Finest.” To “Prolong a Person’s Death” is “Medicine at its Worst.”

Even more tragically, when these people die in the hospital, they die alone and in pain as their family is not allowed in the hospital. Is there a worse death? My father stopped eating and drinking at age 83 on a Tuesday. He had six children at his bedside on Wednesday. He died on Friday in his own bed and his own home. He was a physician. He had had his “Contemplation of His Mortality” and had the appropriate “POLST” form filled out so he was able to die at home, peacefully, surrounded by the people that he loved. It is still possible to honor the wishes of your loved ones—but you have to have the “Conversation” and decide what that person’s wishes are.

There are two resources that I have found that were truly enlightening for me as I contemplated my morality. The first is a book called “The Conversation” by Dr. Angelo Volandes. The second book is “Extreme Measures: Finding a Better Path to the End of Life” by Dr. Jessica Zitter.

COVID has devastated the Medical Community and the country as a whole. We need to decrease the spread of the disease with science, social distancing, masks, and continued therapeutic modalities until a vaccine is developed. National Mandatory Masks is an imperative to try to slow this Pandemic. It is essential to have rapid, readily available testing to try to identify the carriers of the virus and mandate a method to manage those carriers in order to try to prevent further spread.

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