By Steve Haner
This is how we solve the coming hospital bed crisis. This is how we stretch our ventilators supply. No politician is going to say this, neither Donald Trump nor Andrew Cuomo, and doctors won’t start this conversation. Lester Holt won’t bring it up on Nightly News.
It is called a “do not resuscitate” order. DNR. It can stand on its own or be part of package of advance medical directives and powers of attorney. If you don’t have one, sign one. If you are 40 and think yourself healthy, consider one anyway. Today.
It may not solve the problem but it surely will help.
Most people who are dying are not dying of COVID-19, they are dying with COVID-19. Yes, there are outliers, but most people who cannot survive this virus already had an underlying problem. It might be a 65-year-old with COPD from smoking, two by-passes, or half a lung removed for cancer, or it might be a 30-year-old who vapes or who has already eaten themselves into diabetes and hypertension.
Say you have signs of this infection but are late calling for help, you are in the ambulance on the way over to the hospital or are already there, and your heart stops. The medical people, absent a DNR, will immediately start CPR. Pressing down on your chest will expel air ripe with live virus. You have infected them while they save you. Do you want that?
A DNR doesn’t mean you don’t get a ventilator (unless that is your directive); it means you don’t keep it beyond the point where hope has faded. It means they don’t revive you from a heart attack, then leave you comatose on the ventilator. Again, there are outliers, but the docs and nurses know pretty quickly which patients no longer have a real chance. With an advance directive, they will start the conversation. With a DNR, if you suddenly “code” with cardiac arrest or pulmonary collapse, no efforts are made to bring you back.
You know this would free up desperately needed ICU beds all over the world, right now, this minute, yesterday. Unless the patient comes in and the DNR or advance directive is on their charts or communicated by a family member with power of attorney, our medical culture goes into overdrive to save them. I would be terribly upset if such efforts were made for me when a ventilator could save somebody else. If a family member says the same to you, honor it.
My daughter is not on the front lines of this crisis but has spent quite a bit of her career with patients fighting for life against cancer, and their families who won’t let them go. No, friends, that fourth round of chemo that costs $200,000 and buys you 60 days, 40 of them miserable in hospital, is not a good idea. This is where our medical system is most insane, at the very end of life.
This medical crisis has revealed many weaknesses in our system, often problems that people really didn’t anticipate. Those fancy N-95 masks were developed mainly for dealing with tuberculosis, all but eradicated in many parts of the world. The fact that doctors cannot get them while Internet pirates sell them on eBay can solved by arresting the pirates and confiscating their goods.
What it has revealed about our politics is sickening.
But this crisis is also revealing a weakness in ourselves, an unwillingness to face cold reality about our own finite existence. COVID-19 is a nasty bug, but it is mostly killing people who are already in trouble from other things, sometimes not their fault and sometimes entirely their fault. (If Altria doesn’t reopen, that won’t bother me one bit.) The worst strains on the hospital system may come from maintaining life after there is no reasonable hope for recovery.
Sign the DNR. Fill out an advanced directive. If you have grown kids, tell them about your decision. If you don’t, tell the sibling most likely do go screaming to the doctors seeking every effort to revive you. If every emergency department admission for COVID-19 from now on is accompanied by that kind of advance permission to withhold treatment known to be ineffective, it will make a difference between now and the peak.
Most of us geezers have faced this (some face it and still refuse to sign, but we’ve all thought about it.) We’ve seen what our grandparents, parents, aunts and uncles went through at the end, long before this crisis. This particular disease pushes the conversation to earlier stages of life, but that’s a good thing, too. Our lousy lifestyle means age is no longer the only risk factor. (And now we can’t go to the gym at all….)
Don’t waste an ICU bed or ventilator. Sign that DNR today. If you already have one, pull it out to be ready.
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