Post by louie on Mar 23, 2020 8:00:50 GMT -5
This was copied and pasted from our local doctor who has been keeping us all up on this situation. I've known this doctor for 20+ yrs as the doctor who my PA answers to.
His letter begins by telling us that he has seen several patients that will test positive for Covid-19.
My husband and I have discussed what would happen should he contact the virus. Just Hospice type care at home, no hospital. He is not a well man in the first place and feels as though he only lives day to day. We had this discussion earlier this week too when the Oncologist called saying 'something' showed up and he wanted lots of testing. We decided no treatment other than care to make him comfortable.
Anyway...here it is:
For the frail elderly who survive the ventilator and leave the hospital, this is what they have to look forward to: From being on a ventilator for 2 weeks their muscles will have atrophied severely. Most will not be able to live outside of a nursing home. Many, perhaps most, will not walk again. They may have permanent lung damage from the virus. But their minds are unlikely to come through unscathed. Even if they don’t have a stroke during the illness, the prolonged delirium will take a permanent toll. They will not be the same, will not have the same mind, may not have the same personality. For the frail elderly, this is a “good outcome.”
So what can you do? Have discussions with your parents, your grandparents, your spouse. If you get badly sick, do they want to go to the hospital? For most people the answer will be yes. But if they get severely ill, if they are going into respiratory distress, do you want aggressive treatment, including intubation?
Our goal is to get as many people as possible through this. But often in medicine our heroic efforts amount to torturing people who later wish that we hadn’t. The alternative is comfort care, care that revolves around reducing the pain and distress without trying to extend life when it probably can’t be extended. For many this is the kindest thing we can do. But it is up to the patient, and unless you’ve had the discussion ahead of time, you won’t be in a position to speak for your loved one who is too sick to speak for herself. It isn’t enough to say that there’s advanced directives on file; you need to know what your loved one wants. These are circumstances that aren’t listed on advanced directives or living wills.
And have the discussion about yourself, with your siblings, partner, or grown kids. We are seeing more people in their 20s-40s get severely ill with this, and some are dying.
And finally, be aware that we may refuse to intubate someone or to try heroic measures. If someone has a low probability of surviving we will refuse to do futile care and keep the ventilator for someone who has a chance of surviving. As I said earlier, I’m not interested in torturing people for false hope.
Loving someone means caring about what’s best for them, not how hard it is for you to let go. Loving someone means helping them to face their illness with courage and realism. Loving someone is making sure they are not tormented for no reason.
To my husband who already suffers greatly, to my MIL who is at the end of her life with her kidneys...there is no other choice than to let them go peacefully.
His letter begins by telling us that he has seen several patients that will test positive for Covid-19.
My husband and I have discussed what would happen should he contact the virus. Just Hospice type care at home, no hospital. He is not a well man in the first place and feels as though he only lives day to day. We had this discussion earlier this week too when the Oncologist called saying 'something' showed up and he wanted lots of testing. We decided no treatment other than care to make him comfortable.
Anyway...here it is:
For the frail elderly who survive the ventilator and leave the hospital, this is what they have to look forward to: From being on a ventilator for 2 weeks their muscles will have atrophied severely. Most will not be able to live outside of a nursing home. Many, perhaps most, will not walk again. They may have permanent lung damage from the virus. But their minds are unlikely to come through unscathed. Even if they don’t have a stroke during the illness, the prolonged delirium will take a permanent toll. They will not be the same, will not have the same mind, may not have the same personality. For the frail elderly, this is a “good outcome.”
So what can you do? Have discussions with your parents, your grandparents, your spouse. If you get badly sick, do they want to go to the hospital? For most people the answer will be yes. But if they get severely ill, if they are going into respiratory distress, do you want aggressive treatment, including intubation?
Our goal is to get as many people as possible through this. But often in medicine our heroic efforts amount to torturing people who later wish that we hadn’t. The alternative is comfort care, care that revolves around reducing the pain and distress without trying to extend life when it probably can’t be extended. For many this is the kindest thing we can do. But it is up to the patient, and unless you’ve had the discussion ahead of time, you won’t be in a position to speak for your loved one who is too sick to speak for herself. It isn’t enough to say that there’s advanced directives on file; you need to know what your loved one wants. These are circumstances that aren’t listed on advanced directives or living wills.
And have the discussion about yourself, with your siblings, partner, or grown kids. We are seeing more people in their 20s-40s get severely ill with this, and some are dying.
And finally, be aware that we may refuse to intubate someone or to try heroic measures. If someone has a low probability of surviving we will refuse to do futile care and keep the ventilator for someone who has a chance of surviving. As I said earlier, I’m not interested in torturing people for false hope.
Loving someone means caring about what’s best for them, not how hard it is for you to let go. Loving someone means helping them to face their illness with courage and realism. Loving someone is making sure they are not tormented for no reason.
To my husband who already suffers greatly, to my MIL who is at the end of her life with her kidneys...there is no other choice than to let them go peacefully.