The novel coronavirus pandemic (COVID-19) has drastically increased the number of critically ill and dying patients presenting for hospitalized management of dyspnea, acute respiratory failure and other serious complications. The emergence and spread of SARS-CoV-2 has created unprecedented demands on all avenues of inpatient hospitalist medicine. One of the many services in high demand includes palliative care, with increased need for complex end of life planning.
When I first met Rita, she didn’t make things easy. She fired a barrage of questions at me, punctuating her litany with the dreaded blow to every resident’s ego — “Are you a student?” — before slouching back on her bed, sweat glistening on her gray-streaked temples as though she had run a marathon.
Caffeine’s effect waned, stomachs rumbled, attention spans faded after rounding on nine acutely ill patients on university wards. It was nearing lunch. I was the senior resident, so I chose the order in which we saw patients. As we arrived at our last patient’s room, I snapped out of my under-caffeinated daze and realized I had made the rookie mistake of leaving our newest and sickest patient for last.
A smear of what I assumed was cat poop obstructed a narrow asphalt path that led to a mobile home. It was raining. I tiptoed around the sopping heap of excrement. Behind me, the wound care attending physician followed.
Mrs. Red Jacket sat at the bedside in her isolation gown which covered her red jacket. She had left her walker outside her husband’s room. Mrs. Red Jacket held his hand and gazed out the window while he was sleeping.
“Goddamn doctors,” says a voice down the hall, slightly muffled through the curtain of the exam room where I lay. “What now?” comes another voice and they both grow louder, batting back and forth gripes. “They make the worst damn patients, know exactly what’s wrong with them and exactly what to do and you’re not doing it quick enough.”
While there is always an intrinsic desire to root for patient recovery and ultimate survival, I struggled immensely with the decision to pursue invasive measures. This is a poem that helped depict my feelings for this patient encounter.
Have you ever had that experience when you think what you’re doing is futile, and that thought goes through your mind: “Why am I doing this? I’m torturing him. This feels wrong.”
In an ideal world we would all die at home with our loved ones caring for us, slowly slipping away in our sleep into the placid beyond. But why doesn’t it happen this way? There’s a dignity to that way because of its organic simplicity. It’s how people used to die prior to modern medicine and before we started needing to always “fix the problem.”