Using the Stanford What-Matters-Most letter form and answering some simple questions, any adult can write…
Covid-19 can cause Acute Respiratory Distress Syndrome (ARDS) in which oxygen levels plunge and breathing is impossible without a ventilator. Unless there is an advance directive stating that the patient does not want ventilation, she is heavily sedated and a 10 inch tube is inserted which is connected to a ventilator through the mouth and into the windpipe. This is called intubation and it is done under total sedation.
Not everyone who is being treated in the ICU needs this procedure. (e.g, Britain’s Boris Johnson was in the ICU several days but was not on a ventilator. He is recovering slowly.) Ventilation buys time by keeping oxygen going to the brain, heart and kidneys at high pressure. Meanwhile the virus may be causing serious damage to the lungs, causing the heart to begin to fail and the person to go into shock. The kidneys may also fail causing a dialysis machine to be used for survival. Again, a directive refusing this treatment should be honored.
The best information is that more than 80% of patients on a ventilator do not survive. Death is painless and can also occur after being oﬀ the ventilator and in the ICU, from heart damage. It is important that the doctors keep a balance between too much and too little oxygen, both of which can be harmful. Since the patient is sedated during this process s/he cannot discuss how much treatment they want. (You always want “care.”)
For even the few people who are released from the hospital, recovery can take months or years. Covid 19 patients may need large amounts of sedation which can cause profound complications, damaging muscles and nerves, making it hard for the survivor to talk, move or even think as well as they did before their illness. They may have to go to a rehab center. Older patients may never go home, living out their days bed bound, at higher risk of recurrent infections, bed sores, and rehospitalization.
This potential medical crisis mens we have to ask ourselves questions about what we value about life. Do I want that life support, how long do I want to go on a ventilator, do I want to continue if my kidneys shut down, do I want a feeding tube if I have to be on the ventilator for weeks?
Often these decisions are made instantaneously, while the patient may be on the verge of dying — breathless and terrified. Often there are no loved ones present so the conversations occur by phone with the doctor.
If you don’t want to be put in a coma and placed on life support let your family know. Appoint the person you want to make decisions for you and let your doctor know who the person is and your wishes. Better yet, complete the forms on this website — it is good to have your wishes in hand, and in writing, if you go to the hospital. It is unfortunate when scarce resources are used for people who don’t want them.
“No one can make these choices for us, and no one will know what choices we would make unless we tell them. If you don’t want to be put in a coma and placed on life support, please let your family know.”
(Excerpted from a NY Times article, 4/4/20, by Dr. Kathryn Dreger, Internal Medicine doctor and clinical assistant professor of Medicine at Georgetown University. Faye Girsh, excerptor.)