Earlier this week, a 30-year-old patient with COVID-19 passed away on a ventilator. He hadn’t laid out his end-of-life wishes ― what in the medical field are called advance directives. His father, devastated after seeing the numbers related to his condition, didn’t want any further treatment that would prolong the inevitable. His mother wanted to try everything that could possibly be done to save him. If the patient himself had been able to speak, he might have expressed what his wishes were and saved his family a heartbreaking conflict.
But he hadn’t planned to die.
This tragic situation is all too common, a result of families failing to discuss emergencies and end-of-life wishes ahead of time. It’s especially stressful to make this kind of decision when the stakes are high, as they often are now amid the coronavirus pandemic. This is why it’s important to understand end-of-life treatment options and to make choices before a crisis occurs. Nobody wants to imagine the worst, but the worst is a callous reality.
Out of the 55 patients on my COVID-19 unit in metro Detroit, only one had an advance care planning document. That patient was nonverbal after having a stroke at the age of 54. I phoned his sister, his designated legal guardian, and she read his advance care plan to me. “Doctor, tell him I love him,” she said. It was comforting to know that this patient had a designated advocate.
When I asked another patient about her advance directive, she laughed nervously and asked, “Is this a bad omen?” She was on four liters of oxygen, breathing heavily, but stable. She thought the conversation was taking place because she wasn’t going to make it.
Another gentleman told me, “I’m 62 years old and I have a lot more living to do!” His eyes were