Ventilator for coronavirus? You need to make up your own mind ahead of time | Opinion
.JPG "Dr. Harold Cross shown on duty at the Greater Bluffton-Jasper County Volunteers in Medicine clinic.")
The pandemic of COVID-19 and the concern about supply of respirators is causing fear and misunderstanding.
Those who develop severe difficulty breathing due to damage to their lungs in the special case of this kind of pneumonia are put on a respirator (ventilator).
This requires inserting an endotracheal tube through the mouth and into the trachea. They will likely be on a respirator for seven to 20 days.
Prolonged sedation is typically used to cope with the great discomfort of a tube in the throat. With this tube in place, one cannot talk, nor take fluids or food, and the sedation itself is harmful over time.
After seven days, it is usually best to perform a tracheostomy, to preserve the vocal cords. Under those conditions, some fluids and food might be taken in, depending on the severity of overall condition.
The care required in this condition — bedridden, turned to prone position daily for a few hours, IV fluid and parenteral nutrition (food) — requires skilled providers and special equipment to monitor the patient.
The outcome even with this care may not be successful.
These difficult situations have always existed with end-of-life care, long before COVID-19.
Patients need to make their own personal decisions about quality of life while they have the ability to decide for themselves.
The patient’s DNR (do not resuscitate) instructions need to be very specific.
This is especially relevant for those over age 60, those with serious heart, lung and kidney conditions, and those immunocompromised.
It is the patient’s decision, not the physician’s, to make. Each person needs to make their desires known to their immediate family, whoever is named in a power of attorney (POA), and to the physician treating them.
Things happen very quickly in the emergency situation, and once the person is on a respirator, deciding to stop is difficult.
My experience as a Christian physician, in emergency medicine for 20 years and in family practice 30 years before that, and as a parent who has witnessed two of our sons (ages 61 and 69) die with lethal conditions that severely affected their breathing, led me to urge patients to be prepared.
Both my sons opted for comfort, receiving liquid morphine and anti-anxiety meds — given by family members and hospice staff. They were clear in their minds until about 24 hours before their deaths. These meds were used to control their feelings of breathlessness, suffocation. They chose not to undergo intubation and respirator care.
The crisis of “supply of respirators,” while very real, is only a part of the problem.
Another part is that end-of-life patients may not be given appropriate information on what being on a respirator entails, and the difficulty of undergoing the care needed on total ventilation.
If properly informed, some and perhaps many people will opt out of being placed on a respirator. In that event, respirators would be freed up for those who truly want them.
The bottom line for each person is quality of life OR duration.
Sometimes “hanging on” for the last breath is agonizing for both patient and family. We need to make up our mind in advance about our desires, so that loved ones can honor them.
Atul Gawande’s best-selling book, “Being Mortal,” may help in decision-making on issues of quality of life; it is rich in real-life examples.
These end-of-life decisions are spiritual, not medical. For all of us, young and old/older, we are given a spirit to make these decisions:
“For God has not given us a spirit of fear, but of power and of love and of a sound mind.” (2 Timothy 1:7.)
His children can rest in that truth. Those uncertain of their eternal destiny might consider the Apostle Paul’s advice to the Philippian jailor whose life was on the line: “Believe in the Lord Jesus, and you will be saved — you and your house.” Acts 16:31.
Harold Cross MD lives on Hilton Head Island.