Coronavirus death: You may not want a ventilator, retired Hilton Head doctor says
Suddenly, America is fixated with the ventilator.
But if you think the ventilator is the great savior for the COVID-19 coronavirus pandemic, think again.
The key word here is think.
Think about whether you want this extremely invasive procedure to begin with.
Think about what comes after the ventilator.
Most importantly, think about it now because you may not have that chance if you end up hospitalized with this virus.
This message is not from me.
It’s from a retired medical doctor on Hilton Head Island.
Dr. Harold Cross of The Seabrook senior retirement community feels so strongly about it, he sent us a letter of warning to the community.
“The crisis of ‘supply of respirators,’ while very real, is only a part of the problem,” he writes.
“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.”
Cross, now 90 but still practicing medicine one day a week at the Greater Bluffton-Jasper County Volunteers in Medicine, brings this to his warning: Yale Medical School, class of 1957; 30 years of family practice in Hampden, Maine; 20 years practicing emergency medicine, including seven years at Naval Hospital Beaufort; and some medical work at the state prison in Ridgeland.
He also sees today’s gut-wrenching dilemma “as a parent who has witnessed two of our sons (ages 61 and 69) die with lethal conditions that severely affected their breathing. …”
He is warning us that we have a responsibility to do more than social distancing and washing hands. It’s a shock to the world, but we must get prepared now to face end-of-life decisions.
Ventilator
Preparation comes in two parts.
First, the procedure.
You may want to turn your eyes, but what you see here is a cold look at the pandemic that has turned our lives upside down.
“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.”
Cross said that, generally speaking, it’s a good option for people under age 60 and in good health. But he said that when most people with COVID-19 reach the point of needing a ventilator, their lungs are already shot.
I bounced this off another doctor, who told me it is important to say that not all who get ventilated have a dismal outlook.
He did a little research that showed that those on ventilators with COVID-19 die on average 66% of the time, “though the answer is unknown, and a lot of those reaching vents are 80-plus years old.
“I cannot find data per age group or underlying disease. I would still be aggressive in 60-year-olds.”
I’m not giving you medical advice. But smart people are telling me you need to think ahead about getting on a ventilator. Talk about it, before the need arises.
Living will
Preparation also includes a “living will” or “advance directive.”
I have used the “Five Wishes” living will, available online.
These documents relieve your family of the hard decisions. You designate the person to speak for you when you can’t speak for yourself. And that person will have in writing specifically what you want.
“These difficult situations have always existed with end-of-life care, long before COVID-19,” Cross wrote.
This requires a frank discussion. Now.
One doctor told me it is not fair to your significant other to be asked to make decisions in an emotional and desperate state, when they could be made now.
“And it is almost cruel to put that decision to a committee of family members who may not agree or might blame whomever makes the decision,” he said. “And worst of all would be asking the state to make those decisions when we have spent most of our lives fighting for the right to make those decisions.”
Cross said: “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.”
Some living wills list “ventilation (breathing machine)” as a specific life-sustaining treatment that you can say you do not want under any circumstance. Or you can say you do want it.
“The bottom line for each person is quality of life OR duration,” Cross said.
And there’s another bottom line. You can spend your entire life’s savings in the last month of your life. For what?
Again, you have to think this through.
“It is the patient’s decision, not the physician’s, to make,” Cross said.
“Things happen very quickly in the emergency situation, and once the person is on a respirator, deciding to stop is difficult.”
This story was originally published April 4, 2020 at 7:00 AM.
