Category Archives: From the Headlines

Cheddar News: On the Front Lines of the Coronavirus Pandemic

Dr. Elizabeth Clayborne of the University of Maryland’s Prince George’s Hospital Center talks to Cheddar News about fighting on the front lines of the coronavirus pandemic while being pregnant herself.

“I’d really like to emphasize that in addition to putting ourselves on the line we’re also being prepared for the storm of people that could come and overwhelm our facilities and when that surge arrives we’re often going to have to make important decisions about who to care for what scarce resources like beds and ventilators to use. So, I always emphasize the importance of people having an advance care plan and talking to their loved ones while they’re home to ensure they have an understanding of what you would want done in case you do become acutely ill,” said Dr. Clayborne. “And that’s specifically important so that doctors like me don’t have to be overwhelmed with having to make these difficult decisions if we do indeed become overwhelmed by the number of people that come at one time. So you can go to CDC.gov to fill out advance care plans that are state specific or you can use something like MyDirectives.com, which is an online platform does the same thing.”

New York Daily News | Repeat after me: Old people are not disposable, not during the coronavirus crisis or ever

By Dr. Michael Wasserman

Texas Lt. Gov. Dan Patrick recently suggested older adults should sacrifice themselves amid the COVID-19 pandemic. This brings forth my greatest fear: that ageism in society will lead leaders and others to look the other way while we die of preventable causes in large numbers.

Patrick must not talk to his grandchildren very much. If he did, he would know that they want his love and not his money. Our society is being given the ultimate ethical test.

Would I forgo my own life to save the life of my grandchild? I would. Would I offer my life for the economy, as they claim? You’ve got to be kidding me.

This is America. While we believe in the free market, we also believe in each other. To throw in the towel at this early stage of the pandemic and offer older adults to the altar of COVID-19 is unconscionable.

The important question for anyone over the age of 60 isn’t whether they want to sacrifice their lives, but whether or not they’ve created and shared an advance care plan. That means making our own personal, individualized choices regarding our health.

Those choices are usually related to how we feel about our cognition, function and quality of life. For instance, I may want my family and my health-care providers to know that if I can no longer recognize my family or continue my love of writing, I wouldn’t find value in my life.

Or, to put it in current terms, if I’m at that level of cognitive function and I get hit with COVID-19, then keep me comfortable. Don’t send me to the hospital and above all, don’t waste valuable ICU resources on me.

That’s not just me. It also happens to be the overwhelming majority of the patients whom I’ve cared for over my 32-year career as a geriatrician.

But someone else may well choose to “have everything done,” as is their right. To repeat: This is America. We’re not supposed to ration health care here. During debate over the passage of the Affordable Care Act, the very notion that we might have “death panels” lit conservatives’ hair on fire.

So we all have a right to say how we want our health managed as we get up there in years. We just have to make it clear.

The good news is the government has actually encouraged physicians and health systems to offer advance care plans to patients. Unfortunately, there’s been little public education about creating one.

There are digital platforms like MyDirectives.com that make it easy to do, and at no cost. Because we are isolating older adults to protect them from the virus, the need for an advance care plan to be readily available through the internet is critical.

Such a plan is not a means to avoid treating an older adult. It’s a means to assure that our health-care wishes are heard. It’s a way to assure that we’re treated with dignity and respect.

What I am fearful of in our society is that ageism will define the care that is delivered to older adults in the coming weeks and months. If an older adult gets COVID-19, starts getting short of breath and ends up in an emergency room, what should happen? Right now there are three scenarios.

If I have an advance care plan filled out and available to the emergency room doctor, and my wishes are to not be put on a ventilator if a poor outcome is expected, then I expect to be treated with palliative and hospice care for comfort.

If I don’t have an advance care plan, and the emergency room doctor assumes that I want everything done, I may end up on a ventilator with prolonged suffering until I die.

Alternatively, because I’m old, I could be assumed to have little value to society, or less value than someone younger than me, and be “allowed” to die.

That is not the health-care system that I was trained in. That is not consistent with the Hippocratic Oath, or the country I love.

Wasserman is a geriatrician and president of the California Association of Long Term Medicine.

View the op-ed in New York Daily News here.

The Hard Question with Blanquita Cullum, featuring Jeff Zucker CEO and co-founder of MyDirectives

“The goal is for people to live with confidence, so if you’re ever in a health crisis someone is going to know someone about you and . That is who speaks for you if you can’t speak for yourself, and more simply what are your goals for care.” – Jeff Zucker, CEO and co-founder of MyDirectives on The Hard Question with Blanquita Cullum

How to make farewell conversations more meaningful

Spending time with family over the holiday season can be a joyful reminder of just how much we cherish our conversations with loved ones. Whether it is sharing a meal with a sibling who lives in another city or enjoying quality time with a parent, we all seek these often fleeting opportunities to express ourselves to a loved one in a meaningful way.

What we can take for granted though, is that there will come a time when the ability to connect with family members is taken away from us without warning. That is why many experts tell us to have these important conversations while we are still able.

Bruce Feiler confronted this issue in a recent article in the New York Times entitled, “Exit Lines.”

Feiler writes,

Shelly Kagan, a philosopher at Yale and the author of ‘Death,’ said the odds are so ‘vanishingly small’ that you’ll know when you’re in a final conversation, you should avoid any possibility of regret by initiating interactions earlier. This includes what kind of medical interventions the person might want as well as what that person meant to you…

‘One of the things you can accomplish in these conversations is telling people broadly what it is they’ve done for you. What they taught you. Having an appreciation of that can deepen one’s sense of a life well-lived…’

When his own mother died, Dr. Kagan said, she was not in a position to have a conversation at the end. Later, her children found a letter she had written to them, along with one to her grandchildren, expressing her hopes for their lives. It was her way of having a meaningful conversation while her mind was still strong, Dr. Kagan said…

Dr. Kagan said there is considerable evidence that forcing ourselves to say things out loud helps us clarify thoughts that might otherwise be unformed. ‘It’s a richer experience when the receiving party is able to react,’ he said. ‘But even if they’re not, the vocalization can help in that you now have thoughts you wouldn’t have had anyway.’

People who have lost loved ones suddenly can attest to the power of that ‘final conversation,’ especially when faced with the despair of missing the chance to have that conversation.

Being proactive about recording a message either in writing or on video is significant because it allows you the security of knowing your voice will be heard. And maybe even more importantly, it ensures that your loved ones will never be in the helpless position of not knowing how you really felt.

MyDirectives continues to encourage individuals to record video messages because that is the most effective way of knowing that your voice will be heard if you are no longer able to communicate.

Have you taken steps to leave a message for your loved ones or have you received a message from a friend or family member? Share your story using the comments below, on Facebook or on Twitter.