I received my COVID-19 diagnosis late Friday morning. My thoughts went first to my medical partners who would need to continue to cover my patient load, then to the well-being of the nursing home residents I had visited earlier in the week. Finally I thought of my family who had been coexisting in the same six feet with me during all this time.
The day clamored on as busy as the next, and when the evening settled down thoughts of my mortality crept over my weary eyes. I read article after article summarizing the events my colleagues around the world were dealing with trying to find a glimmer of medical hope buried in the mounds of unorganized data.
As an internal medicine physician, I frequently talk to patients and their families about death. I have held hands, prayed for more days, laughed over shared stories, and cried over lost futures. As a young physician, I have not faced my own mortality.
COVID-19 will be a defining illness of this era. All of us will be impacted by this life-threatening illness. This is unlike anything we have faced before. There are no known or widely accepted treatments outside of supportive cares. In its most serious form, COVID-19 requires the use of life support, or a ventilator, to survive. In many cases, even with advanced support and technology, COVID-19 will be fatal. We know that as we age and develop other chronic diseases — such as heart disease, cancer, and lung disease — we decrease the survivability of serious medical events such as respiratory failure from COVID-19.
It is difficult to face your mortality. Ask anyone with a chronic life-threatening illness.
However, the thoughts, conversations, and guidance that you can give your loved ones and care team prior to end-of-life decisions allow for a personalized level of medicine we all deserve.
One of my colleagues has a unique holiday tradition. On Thanksgiving, after dinner but before dessert, everyone at the table declares their code status — the level of medical intervention they want if their heart or breathing ever stop — before they are given their slice of pie. I have been thinking about this unusual ritual a lot lately. We are all at a time where we have been forced to stay at home, many of us with our immediate families, gathered around a theoretical Thanksgiving dinner table. We have had more time to virtually connect with loved ones over FaceTime, Zoom, Skype, phone, or text. We have been sharing experiences, photos, and memes on social media.
So, as a physician who soon may be part of a team caring for you or your loved one, I implore you to take this gift of time with your family to talk. Talk about your wishes at the end of your life. Talk about what your desires would be if your heart or breathing stopped. Would you want resuscitative efforts or to be allowed a natural death? Talk about how long you would want to be on a ventilator in the case of severe respiratory failure. What quality of life would be acceptable to you after recovery from a severe medical illness? Would you want a feeding tube? Would you want to be completely dependent on others for care?
And if you have a loved one in the nursing home or in an assisted-living facility, reach out to them and make sure you know what their wishes are.
Your homework before you get your pie is to document these wishes somewhere your family and health care team can access them in a time of need.
The time is now. COVID-19 is here.
Dr. Rachel Gordon is an internal medicine physician with St. Luke’s Internal Medicine Associates in Duluth. She received her COVID-19 diagnosis on March 27 and is quarantining in Duluth with her husband and children while performing telehealth visits as she is able to from home.