explainer

COVID-19 has changed the way we live. We can’t let it change the way we die.

I work as a palliative care doctor in NSW. A large percentage of my work is treating patients who are at the end of their lives, keeping them comfortable – as well as complex psycho/social/bio symptom management. The patients we see are still primarily those suffering terminal cancers, and almost all of my patients are, at any given point, sick enough to die.

In Australia at least, we generally have (geography dependent) decent palliative care, and the majority of people under our care are comfortable when they die. Most die comfortably. Most do not suffer. Those who do have symptoms to address, we treat – with medication for pain, for nausea, for breathlessness, for anxiety, for a whole host of things.

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What does this have to do with COVID-19? The introduction of a pandemic changes the way we live, but also the way we die. At the moment, people wish to die where they are most comfortable – and often this is at home. People generally want to die with family or loved ones about. People generally wish to be as comfortable as possible. All of these things are threatened by COVID-19.

For patients who are breathless at the end of life (lung cancer, emphysema, heart disease etc), we would often prescribe medications like morphine to help control the way the brain breathes and the lungs absorb oxygen, as well as medications like valium to take away the panic that comes from not being able to catch your breath. We know roughly what kinds of doses are needed for certain circumstances, and how people tend to respond.

A new disease changes how we manage. Whether we will have enough medication (and as the virus ripples through the workforce, the expertise), is open to question. My friendly hospital pharmacist has already been finding it difficult to source some medications – global supply chain issues. That’s before the wave of the pandemic hits us.

What about going home to die? At the moment in my current area, we provide nursing support at home, sometimes an hour or two here and there to help out with cares and medications, carer training, medication help. If, however, we have a community patient known to be COVID-positive… we cannot provide these things. The risk is simply too high, and so dying at home becomes fraught.

Patients in Italy and in the United States have been dying in single rooms, with no one around, because no one is allowed to be there. Sometimes a visitor can come – wrapped in a spacesuit of protective equipment, for 15 minutes. Sometimes the hospital can find an iPad to do a video chat. Sometimes the staff are so short on protective equipment that they can’t even go into the room to give medication doses, but have a pump with a line running under the door connected to the patient, so they can give extra doses, without going too close.

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Patients who are on ventilators by definition have trouble breathing. If a ventilator isn’t able to save you, then medications are used to keep you comfortable. But what if there aren’t enough ventilators – and we have patients in respiratory distress, needing deep sedatives to maintain breathing comfort, alone and isolated? In the US, there are cities that have already run out of medications like midazolam, which we commonly use – because they need so much more of it in such a short timeframe.

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What do we do when our ability to care is compromised? Will our patients be dying breathless, distressed and alone? What if there are *so many* COVID-19 patients in hospital that *everyone else* who is critically ill and sick enough to die… cannot get the care they need?

The above is not definitive. At the moment, here at least, there are plans in place. We are writing policies and guidelines. We are available. But if the surge comes and doesn’t stop, then the best plans in the world don’t help the numbers that can overwhelm the system. It’s not that hospitals aren’t built to manage emergencies, but there isn’t any fat in the system. New massive events flood the capacity we have – and it’s not just COVID-19 that can lead to death.

COVID-19 can lead to you becoming sick enough to die, and we cannot “save” you. All we can do is try to keep you comfortable – and everyone else who comes in who is that sick, and who the resources are too scarce for. We can keep you comfortable – while we have the ability to do so.

To ensure we maintain the ability – stay home. Keep your distance. Don’t go and get a haircut. Talk to your loved ones about your wishes and needs. Stay safe.

Otherwise, we might be having a different conversation, you and I. The hospital might be overflowing. The resources might have run out.

And you could well be sick enough to die.

This post originally appeared on Benjamin W. Thomas’s Facebook and has been republished here with full permission.

Feature image: Getty.

Read more on COVID-19:

To protect yourself and the community from COVID-19, remain in your home unless strictly necessary, keep at least 1.5 metres away from other people, regularly wash your hands and avoid touching your face.

If you are sick and believe you have symptoms of COVID-19, call your GP ahead of time to book an appointment. Or call the national Coronavirus Health Information Line for advice on 1800 020 080. If you are experiencing a medical emergency, call 000. 

To keep up to date with the latest information, please visit the Department of Health website.

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