I am a resident emergency physician in New York City, and I’ve lost count of the number of times I’ve had to pick up the phone to inform the family of a patient with the coronavirus that their loved one was close to death. Recently, when an elderly woman arrived with what my colleagues and I identified as severe COVID-19, her prognosis was grave. I went to the ambulance bay, away from the cacophony of the emergency department, to call her relatives to tell them that even our most advanced interventions would not help her. The news was understandably difficult to absorb. The family reflexively asked us to “do everything,” rather than heeding the gentle recommendation that we focus on preserving her comfort.
We placed a tube in her throat to connect her to a ventilator, inserted catheters in her veins to administer medications that would sustain her heart, and performed chest compressions to temporarily supply blood to her vital organs. Our team tried for 45 minutes to resuscitate the patient as her lungs and heart gave out.
The number of coronavirus cases in New York City has declined, but COVID-19 is on the rise in many other states. Doctors across the country are in the same situation I was in just a few weeks ago—overwhelmed by a large number of patients whose conditions deteriorate rapidly, and responsible for guiding relatives who must make incredibly important decisions over the phone. I wonder whether people are receiving the type of care they truly wish for in their final moments of life and what can be done to preserve a dying patient’s autonomy during this pandemic. Advance directives are one of the most important gifts people can give to their loved ones before they die. But few people actually have them in place.