About a month ago when the shutdown was starting and the\nCorona virus was just starting to kill people in serious numbers in this\ncountry we had an uncomfortable conversation in our kitchen. It didn\u2019t go well. I share it with you so\nmaybe you can do it better.<\/p>\n\n\n\n
Two of my grown daughters live just down the street from\nMartha and me. We have dinner together most nights. Sometimes we even play\npinochle after dinner.<\/p>\n\n\n\n
It seems so long ago, but the news was full of the concern\nfor medical supply shortages. I had experienced in the clinic the difficulty with\ngetting tests done, but the shortage of personal protective equipment was hitting\nmy daughter who is an ICU nurse. What got the conversation going was the talk\nof the shortage of ventilators.<\/p>\n\n\n\n
When people get really sick with Covid 19, their lung tissue\nleaks fluid and they can\u2019t get oxygen in. Lungs are delicate sponges and they don\u2019t\nfunction well when those little air sacs are full of your serum. I had read\nabout the seriously ill patients in China and Italy and how many needed\nventilator support to oxygenate. A month ago, I could not find good information\nhow well patients responded to the mechanical ventilation, but I assumed they\nhad a high mortality rate. Indeed, a recent\nreport from New York<\/a> suggests 90% of Covid patient who get intubated and\nplaced on ventilator support do not survive. It\u2019s 97%+ for those of us over 65.<\/p>\n\n\n\n The difficulty in the conversation with my daughters came up\nwhen I said, \u201cDon\u2019t let them put me on a ventilator!\u201d They thought I was saying\nI don\u2019t want to live. But that\u2019s not what I wanted to say. I just don\u2019t want to\nbe treated like that.<\/p>\n\n\n\n I have intubated patients. When a gunshot or car wreck victim\nshows up in the ER and can\u2019t breathe because of chest or lung injuries, we\nparalyze them with drugs and slip a tube past their vocal cords, inflate a little\ncuff near the end and now, their air way is secure and we can pump oxygen into\ntheir lungs, then treat their injuries. <\/p>\n\n\n\n I don\u2019t resent patients who might want this level of care.\nMost patients want to be treated in a way that reflects their values. But\nunfortunately, when doctors need to slip that tube past your vocal cords, we usually\ndon\u2019t have time to have a comfortable, honest conversation about how the patient\nwants to be treated. That\u2019s why it is so important that your loved ones can\nspeak for you about your values.<\/p>\n\n\n\n And that\u2019s what caused the difficulty with my daughters.\nThey don\u2019t want me to die. I don\u2019t want to die either. But I will, and so will\nthey. And I want my life, and my death to reflect my values. Mechanical\nventilation doesn\u2019t suit me. They came to accept this.<\/p>\n\n\n\n It is a hard assignment for family members to speak for the\npatient who can\u2019t. So often, the \u201cDo everything, doc\u201d sentiment is a surrogate\nfor an expression of love. If we don\u2019t do \u201ceverything\u201d it means we don\u2019t love\nthem. I wanted my daughters to know I felt their love, I know their love, but\nthey could best express their love by sharing my values with my caregivers. <\/p>\n\n\n\n I gave the legislature grief this last session for not\nupdating the End of Life document (POST) the state authorizes. If you\u2019ve filled\non out (I have) the piece of paper with your check mark and signature have been\nin a filing cabinet in the Secretary of States office. The legislature killed a\nbill to move this to a secure data base managed by the Department of Health and\nWelfare. But when the Department brought back the same proposal with a 75%\ndiscount on the cost, it passed easily; good job.<\/p>\n\n\n\n I encourage you to fill out the form. But more important,\nshare your values with your loved ones. Let them know. <\/p>\n","protected":false},"excerpt":{"rendered":" About a month ago when the shutdown was starting and the Corona virus was just starting to kill people in serious numbers in this country we had an uncomfortable conversation in our kitchen. It didn\u2019t go well. I share it … Continue reading