Emergency physicians want you to have the talk about end of life care

By | April 29, 2020

Currently, over 60,000 people in the United States are projected to die from coronavirus.  While this is lower than earlier predictions, it is still an appallingly high number.  As two emergency medicine physicians, we have been steeling ourselves for the grim task that lies ahead of us in the coming weeks and months.  We will continue to go to work to try and provide the best care we can to any patient who seeks our care.  We also have a favor to ask of you: Please talk to your loved ones about your goals of care.

The list of “what ifs” for an emergency physician is never-ending.  It’s woven into how we think.  It is essential to how we prepare.  What if this comes in, and I don’t have that?  What if this and that come in at the same time?  What if I don’t have this medication? What if there is a pandemic?  What if we do not have enough ventilators?  Now, we are asking you to prepare and join us in thinking and talking about the “what ifs” that may approach in the coming weeks.  What if I get too sick to make my own medical decisions?  What if I can’t breathe on my own?  What if my heart stops?

The answers to these questions can help shape your goals of care, a narrow subset of a broader process called advanced care planning.  Ideally, this is a proactive and longitudinal conversation with your loved ones and trusted clinicians.  Right now, we do not have that luxury.  “Goals of care” is the term we use to describe the medical interventions a patient wants.  Some patients want every possible option pursued to try and extend their lives.  Others decide that they would not want certain interventions, such as CPR or being placed on a ventilator, regardless of whether it could potentially be life-saving.  In our line of work, we strive to respect a patient’s wishes to the best of our ability.

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Unfortunately, we do not always know what a patient wants.  Many patients come to our emergency department too critically ill to tell us what their wishes are.  In those cases, we turn to the family to act as the patient’s surrogate.  Often, the family does not know, as they have never discussed it.  We have seen family members struggle enormously as they try to decide what they think their loved one would want from us.  It is stressful, anxiety-provoking, and emotionally tormenting.  It is simply heart wrenching to watch them wrestle with such an enormous decision.

Having the “what if” discussion with your loved ones can help us align our care with your goals.  It can also alleviate the incredible burden put on a loved one during this time.  Imagine, just for a minute, that your loved one has fallen critically ill, and we are turning to you to ask what he or she would want.  There is not much that will make this easier, but knowing that you are making decisions in line with what he or she wants can hopefully provide some peace of mind during an undoubtedly stressful time.

If you are curious about what types of questions you need to ask, here is a start: What if I can’t breathe for myself? Do I want to be put on a breathing machine?

What if my heart stops?  Do I want doctors to push on my chest, trying to get my heart to beat again?  What if I can’t make decisions for myself?  Who do I want making decisions on my behalf?

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We hope you will consider these “what if” questions and discuss them with your family.  Having the conversation now ensures that everyone knows what you would want if you are too ill to tell us yourself.  Regardless of what you decide, we will do everything we can to provide you the best care possible while respecting your wishes.

Gregory Jasani and Rebecca Rubenstein are emergency medicine residents.

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