West End Healthline by Courtney Klinkhammer, MD
Among all the surprises 2020 brought us have been new challenges for getting the care we want. Every morning, as I walk into the hospital and report to work, I pass a sign on the entrance — “No Visitors Allowed.” Like other healthcare providers, we have been forced to ask our patients to battle illness without the nearby help of those that love them, support them, and can speak for them.
Given that, it is more important than ever to determine what a patient would want if the worst-case scenario were to happen. Asking whether a patient would want a breathing tube or CPR are difficult and uncomfortable conversations. My job is to help people to start to think about whether they would want to be placed on a breathing machine or ventilator. Although every person is unique, we know that those who are more frail oftentimes struggle to get off breathing machines when they have COVID-19. Those who have the coronavirus rarely survive CPR if their heart stops. As we brace for the next surge—hopefully the last with vaccinations having already begun for certain populations—it is important to have these really tough conversations while we are healthy. With COVID-19, problems with breathing sometimes progress so quickly that providers don’t have a chance to talk about these wishes with our patients.
I like to refer my patients to the conversation guide created by Ariadne Labs called Being Prepared in the Time of COVID-19: Three Things You Can Do Now. The first step is identifying which person in your life could stand in for you to make important medical decisions if you became too sick to do so. This person needs to know you and your preferences well enough to choose on your behalf—and to not make choices based on what they would want for you. When patients come the hospital, we will ask you to identify a person to serve this role. You can also make this an official decision by filling out an advance care directive.
So let’s say you have identified who you feel would best make medical decisions for you—now what? For starters it’s important that, they know you have identified them to make decisions on your behalf should that be needed. Then make sure they know what is important to you regarding your medical care. Maybe your greatest fear is being on a breathing machine for a long time. For some patients and their proxies whom I speak with, the most important thing to you at the end of their life is to be at their home. For some being pain free is more important to than anything else at the end of life. Most of us have stories about family or friends that we have seen at the end of life, and what we liked or didn’t like about their experiences; these can be a place to start thinking about your own wishes.
Lastly, it is important to think about and discuss your medical preferences specific to COVID-19. Would you want to be brought to the hospital if you had COVID-19 or stay at home if possible? Would you want to be placed on a breathing machine or would you want a greater focus on comfort and non-invasive treatments?
As vaccines begin to be administered to health-care workers and qualifying elderly people in Minnesota, many are hopeful that we will begin to make progress beating the pandemic. But we are not out of the woods yet, and even then care directives will remain important for people affected by all sort of unforeseen illnesses. Take the time today to start these critical conversations with your loved ones and make sure they get the care they desire.
Courtney Klinkhammer, MD is a resident physician at the Allina Health United Family Medicine Residency Program. To schedule an appointment with her, call 651-241-5200.