On numerous occasions, a family member’s voice had offered hope, helped calm patients, and encouraged them to adhere to recommended medical treatment. Our video messaging initiative has allowed families to see and hear how their loved ones are doing. It has also allowed families to gather, pray, and say goodbye for the last time. If a photo is worth a thousand words, then a video is worth a million to patients’ families.
What Are Your Goals of Care?
Often, patients are too ill to aid in their own care plans. When contacting family is unsuccessful, we believe it is necessary that physicians act as direct patient advocates. We emphasize our concern for causing unnecessary suffering and we advocate for do-not-resuscitate/do-not-intubate (DNR/DNI) orders when the prognosis is poor. Unfortunately, extubation success rates have been low. If a patient lacks medical capacity and has no contact available for medical decision-making, it is at the ethical discretion of the physicians to utilize a two-physician DNR/DNI order to reduce patient harm and appropriate resources. Patients that are on comfort care are taken off cardiac monitors and moved from the critical zone to free the bed for a patient requiring monitoring.
During a pandemic of this proportion, hospice care is limited due to space and isolation restrictions. In rare cases, family members are able to procure oxygen tanks and patients are able to go home. The majority stay boarded in the emergency deepartment under our care. We found it necessary to create a peaceful space for their end-of-life care. There was a silver lining in the no-visitor policy: the ability to repurpose the family waiting room to an advanced comfort care room. Here, one or two patients are cared for and are able to video chat with families in peace away from the chaotic emergency department.
No other health crisis has tested the emergency medicine specialty like COVID-19 has. The field of emergency medicine was developed long after the 1918 Spanish Flu pandemic. We face challenges we have never seen before and we must pave the way. As emergency physicians, we are the specialty created to protect human dignity and provide compassionate care to every patient in times of catastrophe. There may be no current cure for COVID-19, but the human spirit deserves not to be another casualty. In a time where the surge of patients made our resources limited, the most rewarding and abundant thing we could offer was our own compassion.