Planning
We’re tired!
So very, very tired!
Of the virus news!
Of the daily numbers!
Of the claustrophobia-inducing voluntary and involuntary quarantine!
And, almost certainly, no one wants to think about the possibility of death tomorrow or tomorrow’s tomorrow!
You can pretend all you want. You can pretend as hard or as much as you need to pretend but each day’s headlines reflect the moral necessity of planning – regardless of our ages or physical condition.
Perhaps more than any time in recent memory, we have a moral obligation to choose the quality of our end-of-life days and our deaths. And those are decisions that must be made by everyone over 18 years old – especially since COVID-19 is not a respecter of age or health. These decisions become all the more pressing for men and women fifty and older, and even more critical for those with coexisting medical conditions – cancer, diabetes, being over-weight, or simply having lived a good life.
The Issue: Determining the quality and amount of care you want in the event of life-threatening illness or injury, whether or not you wish to be resuscitated in the event of brain or cardio-pulmonary failure – especially if you already have a fatal diagnosis.
National Public Radio boasts its “driveway moments” – those that keep you in your car because you want to hear the entire segment. In an October 12, 2012 Morning Edition, Dr. Boris Veysman described an emergency room incident: “[T]oday the triage nurse is yelling ‘not breathing,’ as she runs toward us pushing a wheelchair. A pale, thin woman… slumped over and looking gray…. ‘Her daughter dropped her off with a chief complaint of weakness and went to park the car,’ the triage nurse says. ‘I think she has cancer and is on chemo.’… Without concrete proof of a DNR [Do Not Resuscitate], there’s no hesitation.”
Only after extreme measures – an external pacemaker, breathing tube, medications – does the doctor learn from her family “She has DNR orders.”
“I think there’s a god chance she is fixable in the short term…” he assures them and noted to himself “I think she can probably get at least a few good weeks.”
“Nobody makes this choice [DNR] unless the burdens of living have so consistently, day after day, outweighed all benefit… They are dying. They are on a dying trajectory. The only choice they have is the circumstances of their death and what kind of disability they will be suffering as they approach that time.” Nonetheless, the family decided on comfort care only. No dialysis.
“She died peacefully several hours later. The best resuscitation of my career turned into my most memorable professional disappointment…
“Folks who say, ‘When I get that sick, unplug me, don't let me suffer’ have never learned how the end of life can be done better.
“And they should hear it from a medical professional before making up their minds about something this important. So here are my educated instructions:
“Life is precious and irreplaceable. My version of DNR is "Do Not Resign." Don't give up on me if I can still think, communicate and enjoy life.
“Treat my depression, dehydration, malnutrition and pain. Even severe, incurable illness can often be temporarily fixed, moderated or controlled, and most discomfort can be made tolerable or even pleasant, with simple drugs.
“Surround me with people; bring the kids so I can teach and talk to them. Let me use my e-mail.
“Recall the great people of our time who thrived with disability. People like Stephen Hawking, who has ALS and quadriplegia. People like Christopher Reeve.
“Only after you make every effort to let me be happy and human, ask me again if my life is worth living. Then listen and comply. At that point, if I wish to die, let me die.
“But until that happens, none of us realize what I can accomplish with another day, another week, another month. So, do it all for me. Then ask someone to do it all for you.”
Beside marriage and religious vocations, our end-of-life decisions may be the most personal we will ever make. They must be based on our knowledge of ourselves and our deepest soul-wishes; they must be addressed in consultation with family members – to the extent that they are willing to discuss them and agree to respect our decisions. They must be discussed with our personal physician and, perhaps, our attorney. And, they absolutely must be documented – make certain your physician and your attorney have signed and notarized (if notarizing is required in your state) copies.
A good place to start may be The Five Wishes. The Five Wishes documents are legally valid in most states and can provide guides to appropriate conversations with family, physician and others. The Wishes include: The person I want to make care decisions for me; the kind of medical treatment I want or don’t want; how comfortable I want to be; and how I want people to treat me. A downloadable version – in more than 20 languages - five dollars for the first copy - is available at https://fivewishes.org/
Don’t pretend the issue will go away or “will never happen to me.”
Consider: A 2016 report in the Annals of Surgery indicated that one in four Medicare beneficiaries “have surgery in their last three months of life, which may be inconsistent with their preferences. How patients make decisions to have surgery may contribute to this problem of unwanted care.” For frail and elderly patients, it may be difficult to prolong life or reestablish the quality of life they enjoyed before surgery. A 2011 report in The Lancet indicated 18 percent of Medicare patients have surgery in their final month of life and eight percent in their final week.
One must ask whether or not in these few post-operative weeks these patients experienced a quality of life that was equal to or balanced by the additional quantity of life.
Yes! Everyone is virus-exhausted even though it is less than eight months since the first confirmed case of local transmission and less than seven months since the first known death in the U.S.
Nonetheless, it is critical that we recognize that on July 14, 2020 the University of Washington Institute of Health Metrics and Evaluation, an independent global health research center at the University of Washington, put the number of “deaths specific COVID-19 patients” at 136,614 and projected total deaths by November 1, 2020 without a nationwide universal mask policy and depending on the degree of mandate easing) at 240,572. That’s almost a quarter of a million American deaths within hours of Election Day 2020.
The science of COVID-19 is still in its infancy.
What we know is that, while in most people, the coronavirus causes only mild symptoms, in others it leads to serious lung inflammation and, if left unchecked, the inflammation starts to cause lung damage and scarring, known as fibrosis, that is irreversible. Present research also indicates that severe COVID-19 makes blood prone to clotting in the lungs, in small blood vessels, deep vein thromboses in the legs and stroke-causing clots in cerebral (brain) arteries. These clotting issues have been observed even with high doses of blood thinners.
But what we do know is not only frightening but an especially significant reason for every adult American to make and document end-of-life decisions.
We know children – even infants – are not immune from the virus. Children of all ages can be infected by COVID-19; their symptoms may include fever, runny nose, cough, fatigue, muscle aches, vomiting and diarrhea. Moreover, the most recent research appears to indicate that teenagers are as effective as spreaders as adults.
Johns Hopkins Medicine and the Center for Disease Control and Prevention report that symptoms can appear as soon as two days after exposure or as long as 14 days later, with a median time of about five days. That is why the CDC recommends a 14-day quarantine period for people with likely exposure. Early symptoms of COVID-19 can be recurring – alternating with periods of feeling better. These varying periods of fever fatigue and breathing problems can persist for days or weeks.
The most common symptoms in humans include:
Cough
Fever or chills
Shortness of breath or difficulty breathing
Muscle or body aches
Sore throat
New loss of taste or smell
Diarrhea
Headache
Fatigue
Nausea or vomiting
Congestion or runny nose
In early July 2020, the CDC recommended “cell- or recombinant-based vaccines” for four different flus that, in addition to COVID-19, are expected to make their appearance in the 2020-2021 flu season. Two new vaccines have been licensed for use during the upcoming flu season. High dose flu shots and shots made with adjuvant are recommended for people 65 and older.
THERE IS NO VACCINE FOR CORONA – COVID-19 - VIRUS AND IT IS HIGHLY UNLIKELY THAT ONE WILL BE AVAILABLE UNTIL WELL INTO 2021.
We’re all tired of virus news and the claustrophobia-inducing voluntary and involuntary quarantine. But the truth is we are all going to have to live with it for a long time to come.
And, there’s a few things we all must do:
Wear masks. It’s a moral obligation! Not masking is sinful!
Maintain social distance. It’s a moral obligation! Not social distancing is sinful!
Schedule our 2020-2021 flu shots now for September. It’s a moral obligation. Not getting vaccinated against the 2020-2021 flus may be sinful!
Make our Advanced Directives, Medical Power of Attorney and Final Wishes documents, sign them and make certain our family and physicians have copies. You owe it to your family and to yourself. Not doing so is sinful!