hospice death vs ICU death Archives - The anesthesia consultant

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Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group

Richard Novak, MD is a Stanford physician board certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
emailrjnov@yahoo.com

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This week Dr. Shirlee Xie, Associate Director of Hospital Medicine at Hennepin Healthcare in Minneapolis, Minnesota, taped an interview in which she described her personal experiences caring for COVID inpatients. I encourage you to watch the video on this link. Dr. Xie was highly emotional as she made the following remarks regarding COVID: (beginning at 2:53 of the video)

“I don’t think that people can really comprehend how horrific this disease is, unless they’ve been personally touched by it. I mean, people are literately suffocating inside our hospitals, and they are dying alone. And truly, my heart breaks for everybody who has lost their jobs or their housing, and for kids that aren’t able to go to school, and for people that aren’t able to see their families. And they don’t get the luxury to complain about COVID fatigue, and their families don’t get the luxury to complain about it, because they’re living in, like, COVID hell.”

I’d like to emphasize two words that Dr. Xie chose: suffocating and alone.

We’re all going to die someday. There are terrible ways to exit this life, and there are dignified, tranquil exits.

As a physician, regarding end of life matters I prefer to see people die without pain and without suffering. Gasping for your next breath is a terrible way to exit this world. I place breathing tubes for a living, and I’ve seen patients gasping for their last breaths in emergency rooms, intensive care units, and other hospital settings. These patients are terrified and panicked. It’s an awful way to die. When I was in college and medical school I smoked Marlboros and enjoyed every puff. When I began my internal medicine residency I worked at the Palo Alto VA hospital, where I first saw veterans dying of emphysema and chronic obstructive pulmonary disease (COPD). Many World War II veterans smoked from the 1940s until the 1080s, and had destroyed their lungs. At their baselines they were unable to walk up one flight of stairs. When one of these patients acquired a respiratory viral infection, they would become acutely ill and need to be admitted to the hospital. These patients were gasping for breath and had to be supported in the ICU on ventilators. Being a patient on a ventilator is an ordeal. When you have a breathing tube in your windpipe, you can no longer talk. When you have a breathing tube in your windpipe, the stimulus of that plastic in your trachea is extreme (your reflex is to cough hard and reject the plastic tube from your airway). When you have a breathing tube in your windpipe, you need to be sedated so that you don’t panic, cough, buck, or pull the tube out of your body. After I’d seen a dozen formerly brave soldiers on ventilators, I quit smoking cigarettes for good. I hope never to die that way—sucking for my last breath.

In the intensive care unit, intubated and ventilated

In the intensive care unit, on a ventilator

When it’s time to die, most of us hope to die with someone we love near us at the bedside. I’ve stood witness to hospice deaths, where family members surround the bed as their loved one drifts off to sleep under the cloak of narcotic sedation and breaths their last. This is a calm, honorable death. No one wants to die alone, staring up at some white ceiling with an array of fluorescent lights as our last image of this world. No one wants to die alone, listening to ICU alarm bells chiming instead of the sound of our spouse’s voice or our children’s voices. Because of social distancing, family members and loved ones are not allowed inside hospital intensive care units during this time of COVID. When you’re dying of COVID, you’re alone, and you may never see the people you love ever again.

Listen to what Doctor Xie says about COVID deaths. Suffocating alone. No one wants to die a premature COVID death. As doctors, we are well aware that the economic downturn of the COVID pandemic is affecting millions of people. An economic downturn such as this is awful. Hopefully Congress will seek to soften the hardship for those without jobs or housing.

But when you’re dead, you’re dead. You don’t want “COVID hell.” You don’t want to die a COVID death. You don’t want your loved ones to die a COVID death. You don’t want your friends to die a COVID death. You don’t even want people you don’t like to die a COVID death.

Hang in there for a few more months. Do what the CDC and Dr. Fauci advocate: Socially distance, wear masks, and stay home as much as possible unless you’re exercising outside with social distance.

Vaccines are on their way. This is just one year of our lives. Long lives, we hope.

Without suffocating alone.