Death is an unfortunately common occurrence in the hospital. Most of the time, the medical team knows that it is going to happen. We have exhausted all treatment options and realize that the patient is at the end of their life, as will happen to us all eventually. It is sad, but it quickly becomes normal over the course of our training. When we know that the inevitable is coming, we find ways to make meaning out of it — by communicating with the patient and their loved ones, by providing comfort and compassion, and by trying to be respectful of the patient’s end-of-life wishes.
For me, it is the unexpected deaths that linger in my mind.
I remember a particular patient who was admitted overnight for an asthma exacerbation. By the time I met her the following morning, she was breathing well on room air and walking around the room with ease, and her lungs sounded great. My attending, intern, medical student, and I all went to bedside to talk with her.
“You guys are like Charlie’s Angels!” she exclaimed, excited to have an all-female team of doctors. We chatted a bit before discharging her with 30-day inhaler supplies and precautions to return if her breathing got worse.
My attending that month was particularly thorough, and she always followed up on our patients after going off-service. She called me a few weeks later to let me know that our patient had another exacerbation and died at home before EMS could reach her. For a while after hearing this, I kept flashing back to our conversation the morning of discharge. She had weeks left to live, and no one knew.
I feel that same hum of anxiety lately when I enter the hospital. As I check in on my patients each morning, I wonder if some will unexpectedly decompensate and die over the coming weeks. I think about myself and my co-residents who are in the hospital all day swabbing patients for COVID-19 without adequate personal protective equipment. Many of my co-residents are on home isolation as a result of this exposure, waiting for their test results and praying that our government will step up and fund more mask production, or civilians will return the N95s they’ve hoarded, or the set of a TV medical drama will donate their props to us (true story — The Resident dropped a few truckloads of masks to our main hospital last week because we were almost completely out).
When I go home at night, one by one I picture each of my family members and close friends intubated with severe ARDS, desatting, dying. It is quite possible that this will happen to at least some of them.
It is unsettling to be unable to picture the future. What will our country look like this summer? What will our health care system look like? Who will still be here? I think about the 30 million Americans without health insurance who are unable to get tested or treated for COVID-19 or any of their other medical issues. How many of them are particularly high-risk due to untreated chronic illnesses?
What about the people who are being laid off and losing their health insurance? How will they seek out diagnosis and treatment when they develop symptoms?
I think about our homeless population who are unable to “social distance” because they have nowhere to go.
I think of the minimum-wage workers; they receive no benefits and are barely able to make ends meet but are also expected to go out on the front lines every day to provide essential services. When they get sick, many will have to keep working because they don’t get paid leave.
I also think about all the people in power who should be helping to mitigate this disaster but are instead lining their own pockets. Our president has threatened to defy expert recommendation and lift his “social distancing” recommendation due to concerns about the economy. At the very hospital at which I am currently working, one of our board members, U.S. Senator Kelly Loeffler, chose to capitalize off her insider knowledge of this pandemic by selling stocks in order to protect her personal financial assets rather than honoring her duty as a public servant and steward of a struggling safety-net hospital. These are our leaders.
These injustices have been ongoing since the inception of this nation. This pandemic is simply shining a light on them, and not because we have suddenly developed a national moral compass, but because the health of rich and poor is now uniquely intertwined due to a highly transmissible airborne virus. I wonder if we are doomed to never make progress because our national culture of selfishness is too deep-rooted to overcome.
This pandemic has already claimed tens of thousands of lives worldwide and will likely mean the death of many more in the United States. These facts are predictable even if the details of who will live and die are not. My only hope is that it also represents the death of our individualistic way of life. This could be the tipping point for the policy changes that could have mitigated the damage that this pandemic will cause. Universal health care, affordable housing, guaranteed sick leave, a living wage, and an end to mass incarceration and detention camps each could have significantly reduced the death toll of this pandemic had they been in place.
Maybe in the near future, we can agree that everyone should have routine medical care and pay that allows for food, shelter, and other basic human needs. Maybe we will see the value of letting people care for their health when they are ill rather than being forced to come to work. Maybe we can agree that keeping human beings in cages is wrong. Perhaps the only silver lining to being unable to see the future anymore is that it opens us up to alternatives. I hope that the destruction that this pandemic wreaks will finally convince us to take care of each other, both to protect ourselves and in recognition of the intrinsic, equal value of each human life.