Palliative Care & Ethics COVID-19 Story Submissions
Caring for coronavirus patients has brought unforeseen challenges into our practice of emergency medicine. From explaining visitor restriction policies to having daily goals of care conversations over the phone, COVID-19 has changed our practice and challenged our sense of what it means to do the “right thing” for our patients. AAEM wants to hear about your successes and struggles while caring for your patients during the pandemic. We are hoping to compile and share voices from all different practice environments in hopes of processing and learning from our experiences together as physicians.
Writing prompts include but are not limited to:
- How has COVID-19 impacted your interactions with patients and their families?
- What are your goals for initiating care conversion during your patient care?
- Have you experienced any personal or professional struggles as a result of COVID that you’d like to share?
- Has your patient care practice changed during this period? Are there any other thoughts or experiences you’d like to share with your AAEM colleagues?
“I f@#$ing hate COVID!” This is what is being screamed at me as I’ve just informed a daughter that her Dad just died. She saw him alive an hour ago. I take her hand and lead her to his room for one last embrace. She will be the only family member allowed in the room. Her mother, who likely already has the virus and is chronically ill, can only glance at her husband of 45 years through the tiny window as we pass by on the way out of the ED.
Death in the ED is not a new occurrence. Limiting a family’s ability to say goodbye is certainly novel and something that I’m extremely uncomfortable enforcing. This virus has changed how we handle this end of life ritual. Am I really protecting these family members from COVID by not letting them see their dad one last time? Does her risk of exposure from one final kiss or hand squeeze outweigh the benefit of closure? More questions without solid answers.
Think of the last time you met that impossibly young 85 year old woman. The moment I walked into Mrs. B’s room, I could tell she wasn’t your average octogenarian. Her smile was warm, her joints still nimble and she was as sharp as a tack. Unfortunately, Mrs. B was having a hard time breathing. She said she had taken all of the protections she could to avoid catching COVID-19 but two days before she became my patient, she started coughing. As the days went by, she began feeling more and more short of breath. Eventually, she decided it was time to go into the emergency department.
When I first met Mrs. B, she was saturating in the low 90s on 6L NC with an elevated respiratory rate. I was worried about her. I obtained a history, listened to her eerily clear lungs, and sat back down on my stool next to her bed to start a conversation that was becoming all too familiar. “I’m sure you’ve seen a lot about coronavirus in the news, Mrs. B. Have you thought about what might happen if you were to get sick?” Over the next five minutes we talked about what was important to her. She told me she worked hard as a single mother to raise her daughter who went on to become a nurse. She said she lived a full life and felt proud of what she had accomplished. If she happened to get worse, she said she didn’t want to be intubated.
This was hard for me to hear. She was 85, but she was a young 85. I never imagined I’d be in a position where I was tempted to convince an 85 year old woman to be intubated; she looked so healthy. She was also resolute. We finished our conversation, completed her POLST form and she was admitted to the hospital. I remember passing her in the hallway as she was transferred upstairs. She looked at me, waved and smiled in a way that made me feel like things were going to alright.