Coronavirus spotlights unease about end-of-life issues
The coronavirus pandemic has brought inspired scenes of heroic health care providers engaged in an all-out effort to save lives. But what about helping those at the end of life have a good death?
Many of those dying from COVID-19 are elderly patients in hospital intensive care units, connected to ventilators and other life-support technology. It’s become a grim ending for many who have fallen victim to this horrible disease.
It also raises a lot of very difficult questions about death and dying in America, a subject we are not very good at dealing with, said Dr. David Duong on this week’s Codcast.
“I think that we as a society have been quite resistant and quite hesitant to have conversations around death and dying because of our cultural context around it and how it’s the end. It’s the final, it’s a defeat,” said Duong, a primary care physician and internist at Brigham and Women’s Hospital. “In our medical care system, it is giving up. I think we need a reframe or a reshift of that to [the idea] that dying is really the next stage of life and it’s the next chapter, and how do we want to be in control of how that next stage happens.”
He related the story of an elderly patient who lived in a nursing home and arrived recently at the hospital emergency department critically ill with COVID-19. She had multiple underlying conditions, but wound up being intubated and put on a ventilator in the emergency room. Her prospects for survival were very low.
After she was moved to the ICU, where he was working an overnight shift, Duong had a difficult telephone conversation with her family, explaining that without any advanced directive, she would be treated as a “full code,” meaning providers would do everything to keep her alive, including manual chest compressions if her heart stopped. He explained that could very likely result in fractured ribs and considerable pain, and he very much doubted she would ever leave the hospital even if her heart were restarted.
He said it was a troubling conversation for her family, not just because she was so sick, but because they said they never would want her to go through that kind of drastic — and almost certainly futile — intervention.
A study last week in the Journal of the American Medical Association added to the growing literature on the low survival rate of critically ill COVID-19 patients who require ventilators. Less than 20 percent of those on ventilators survived in the report from a dozen New York City area hospitals, and the figure was much lower for those over 65. There were limitations to the analysis and so overall ventilator survival may end up being higher. Meanwhile, the Globe reported over the weekend on the enormous long-term cognitive deficits that can come from a lengthy period of time on a ventilator.
In cases where there are not advanced directives, Duong said, the conversations with family members — especially now, where they are all by phone with busy ICU providers — are extremely difficult. They add to health providers’ stress, but, more significantly, he said, family members who must make life-or-death decisions under those circumstances suffer from guilt and long-term forms of post-traumatic stress.
The Affordable Care Act included a provision providing Medicare reimbursement for clinical visits to discuss end-of-life directives with patients. Duong tries to have those conversations with his older patients, and said they often end up being very positive.
“It was kind of like a weight being lifted. And after that conversation, after it was documented,” he said of patients’ directives, “they could breathe.”
The COVID-19 numbers are still iffy, but Gov. Charlie Baker leaves open the door to beginning the process of reopening the state, with a decision expected sometime this week. (CommonWealth). A new analysis by Harvard researchers suggests Massachusetts will need to do 20,000 more COVID-19 tests a day to reopen safely. (STAT) New York Gov. Andrew Cuomo says construction work and light manufacturing might be able to start in less populated parts of New York after May 15. (New York Times)
Former Democratic Danvers State Rep. Sally Kerans is running for the seat she held between 1991 and 1997, now that her successor, Rep. Ted Speliotis, is retiring. (The Salem News)
The city of Boston and Massachusetts General Hospital announce plans to test the COVID-19 antibodies of 1,000 residents. (WBUR)
Somerville is stepping up COVID-19 testing to assess the extent of community exposure. (Boston Herald)
Holyoke Mayor Alex Morse, based on what he’s seen at the Holyoke Soldiers’ Home, other long-term care facilities in his municipality, and reports from around Massachusetts, calls on the state to take over nursing homes. (CommonWealth) The state is currently trying to do baseline testing at nursing homes. (CommonWealth) Assisted living facilities are facing many of the same challenges as nursing homes. (Boston Globe)
MassLive looks at the new daily routines of Worcester’s first responders during the pandemic.
Four biotech company leaders say they’re cautiously optimistic about finding an effective treatment for coronavirus. (Boston Globe)
Voluntary antibody testing of staff at the Beaumont nursing home in Worcester found that of 80 staff members tested who did not display symptoms of COVID-19, 16 tested positive for antibodies. (Telegram & Gazette)
A Pennsylvania hospital owned by Steward Health Care, which in turn is owned by private equity giant Cerberus Capital Management, used the leverage of a COVID-19 crisis to secure millions of dollars of state funding to stay open. Steward is a big player in the Boston market. (Axios)
Coronavirus creates fraught situation at South Shore nursing homes (Patriot Ledger)
Some form of social distancing recommendation will likely remain in place through the summer, says White House coronavirus advisor Deborah Birx. (Washington Post)
The second Paycheck Protection Program is set to go today. (CommonWealth) US House Ways and Means Chair Richard Neal says another stimulus bill is in the works and could include more direct checks for individuals. (MassLive)
A CommonWealth alumni club twofer, as Gabrielle Gurley takes a look at how bicycling has taken off during the pandemic, with a cameo by inveterate pedaler Andy Metzger, who has a graphic tale from the streets of Philly. (American Prospect)
Nationally, black pastors are saying they are having trouble accessing the Paycheck Protection Program. (WGBH)
Inveterate backslapper Joe Biden has been confined to schmoozing donors from his Delaware basement on video live stream. (Boston Globe)
A new cafe has opened in East Bridgewater- despite the coronavirus pandemic, taking advantage of easy-to-make ordering options, like salads in mason jars. (The Enterprise)
Lucia Hoffman describes what it’s like to have your college life interrupted and return to live with your parents. (CommonWealth) The COVID-19 pandemic is walloping colleges and universities hard, and may prompt an industry shakeout. (CommonWealth)
We have to address the COVID-19/summer slide, say Tim Nicolette of the Mass. Charter Public School Association. and Tom Scott of the Mass. Association of School Superintendents. (CommonWealth) A Globe editorial says state education leaders must do more than they have so far to prevent learning setbacks for K-12 students.
Lynn Schools Superintendent Patrick Tutwiler proposes a collaboration between the KIPP Academy charter school and English High to provide space for the public school’s life skills program. (Daily Item)
More than 20 artists of various types, both nationally and regionally famous, will join forces with the Arts Foundation of Cape Cod for benefit events over three days this week. (Cape Cod Times)
Trails still open but hikers are reminded to keep their distance (Standard-Times)
MGM Resorts in Springfield cancels hotel reservations through May 21. (MassLive)
Federal prosecutors reject claims of bias by suspended Judge Shelley Joseph, saying US Attorney Andrew Lelling’s statements on sanctuary cities were “no more unusual than any of his other public statements.” The prosecutors also denied leaking material to the Boston Globe, saying no one at the US Attorney’s office spoke to the press who did not have permission to do so. (Boston Herald)
Convicted murderer Barbara Goucher, who stabbed a Gloucester resident to death in 1998, will be released a year early due to the coronavirus. (Gloucester Daily News)
Berkshire County Sheriff Thomas Bowler is back on the job after recovering from COVID-19. He says three other staff members have tested positive and a handful of inmates have been tested but no positives. (Berkshire Eagle)
Homicide is an epidemic, too, say US Rep. Ayanna Pressley and Clementina Chéry of the Louis Brown Peace Institute. (CommonWealth)
Fredric Rutberg, the publisher of the Berkshire Eagle, says the paper received a loan under the Payroll Protection Program. He didn’t specify how much the loan was for, but said it was needed to offset a decline in ad revenue of 22 percent in March and a forecasted 42 percent in April. (Berkshire Eagle)PASSINGS
Many of the veterans who died at Holyoke Soldiers’ Home were humble patriots who served their country and their communities. A MassLive editorial tells some of their stories.