Category Archives: Personal Stories

Pregnant on the Frontlines

As an emergency physician during the COVID-19 crisis, I have seen the ways in which our ideals of safety and protection have completely changed. Providing care in the historically underserved area of Prince George’s County, Maryland, the coronavirus has become an all-consuming threat dominating my work, especially considering the resounding uncertainty around how the virus will change. The hectic emergency room that I am used to is nothing compared to the chaos that has erupted now.

With tensions high and the severity of the virus ongoing, we have all had to seriously reflect on our own well-being and how this virus may impact us and our families. And as a pregnant physician, these concerns have felt even more real. Not only do I have to consider ways in which the crisis could impact my health personally, but I have to think about how this could affect my daughter to be born in June.

The constant buzz of the emergency department is not exactly conducive to being pregnant under normal circumstances. Now add the intensity of COVID-19 and it requires an introspective look on ways to practice self-care in order to maintain personal health and wellness. I am careful to be conscious of my mood, fatigue and physical needs.

Simple things such as drinking enough water on a shift are more difficult since I’m constantly wearing a mask or a respirator. I have friends and family who want me to outright stop working. But with so much need during this time of crisis, I didn’t feel like I could just sit at home if I have the ability to help people, to make this chaos even a little more bearable. I needed to take myself into account more now than before and be even more vigilant about my physical and emotional needs. After all, I will not be helpful to anyone if I become sick.

I’ve seen firsthand the ways COVID-19 is devastating to so many. Many patients are being thrown into an emergency situation and don’t know how to respond. With such uncertainties, the importance of advance care plans is more essential than ever.

Every day, I make countless phone calls to frantic family members who are scared and shocked and too often cannot answer the question, “What would your loved one want done in this emergency?” This is not just something I tell my patients. It’s something I confront myself.

COVID-19 has made me reconsider my own health care wishes. Upon realizing the magnitude of this crisis, I sat down with my husband to have a difficult conversation about what I would want for myself should I become sick and ways to best protect our baby.

During the pandemic, it is difficult to think about ourselves and our loved ones being individually impacted. However, it is important to be prepared in these situations ahead of time rather than waiting for a crisis to strike. We, as physicians, must lead by example and do for ourselves what we are asking so many of our patients and family members to do in the era of COVID-19.

We have all witnessed how quickly patients can become sick and how this virus can strike people of all ages. You can — and should — make an advance care plan outlining your healthcare wishes. I recommend going to CDC.org for more information on state-specific advance directives or an online platform, like MyDirectives.com for a convenient and easy way to keep wishes up to date and accessible to your family and medical team.

The importance of advance care planning is immeasurable should a health crisis arise particularly for us who are high risk in the emergency department and especially when we must face formidable challenges when creating protocols for scarce resources.

As a mother of an 18-month old and soon to be a mother of a newborn, the pandemic has impacted me in a unique way. The global crisis provided me — and so many mothers-to-be out there — with challenges unthinkable when we first got pregnant. Many hospitals are now preventing visitors during checkups, ultrasounds and in delivery rooms. This sense of loneliness in what should be a time of joy during pregnancy also adds to the fears that come with pregnancy.

However, it is important to remember that even if without friends and family in the delivery room, we are not alone. The medical professionals providing care to pregnant women at this time are there for support, to help combat fear, anxiety and uncertainty. In this time of crisis, pregnant women are strong and are in this together and will get through this with grace.

I made the decision to work until the risk became too great, until I could no longer wear PPE for 12 hours a day and drink enough water, use the bathroom or eat like I should. I recently went on leave after speaking to my OB/GYN and considering my previous risk of preterm labor and the new ACOG guidelines to stop clinical work at 36 weeks. This was a difficult decision. Doctors are notoriously bad patients and I feel guilty for leaving my colleagues on the front lines.

Like most emergency physicians I feel a duty to work and often put others first. My background in bioethics and health policy has provided me with an ability to think of patients in a more comprehensive context. Being an emergency physician has given me the ability to see the human in people, to be present at their lowest and most vulnerable moments and to identify with the common human experience.

The ER is often filled with people who are scared, lonely or lost. But those same people can be hopeful, courageous and optimistic. They are petrified of what is to come, but hold onto the hope that the future will be better. These people I encounter daily are what drive me to move forward. They instill hope within me, especially now during a time of fear and confusion.

Working during this crisis has reconfirmed the sense of faith I have in those in my community. Those working long hours to fight the pandemic. Those following CDC guidelines in order to prevent the spread and flatten the curve. Those making sacrifices in order to protect the vulnerable.

They remind me why I do what I do — and why I love what I do.

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.

“Respecting Choices”

NBC’s Rock Center recently aired a segment featuring the great work our friends at Gundersen Lutheran in La Crosse, Wis, are doing through their Respecting Choices program, which assists patients facing death to have honest conversations with both loved ones and doctors about which medical treatments they would and would not want as their health declines.

The segment tells the story of Paul and Jean Pearson, following Paul’s diagnosis of inoperable lung cancer. Watch their story here:

Paul’s and Jean’s courage to allow cameras in to enable us to witness their conversation is inspiring. We wish them the best and happiness.

We applaud NBC for telling this story and the entire Respecting Choices team for its tireless efforts to transform care for our elderly and frail. We firmly believe all adults, 18 and older, are best served by having an advance directive.  We shouldn’t wait until we are sick to document our treatment values and goals.  Surprises – some good and some bad – happen all the time in life and, as the Boy Scouts say it best: “be prepared.”  

What did you think of the Rock Center segment? Share your thoughts in the comments below or on Facebook and Twitter

Letters about the Difficult Decisions at the End of Life

The letters to the editor in response to the editorial, “Care at the End of Life,”  published by the New York Times on November 24, highlight the increased attention being given to the need to enable individuals to declare end-of-life decisions in advance.

In one letter, Carolyn Conley, a registered nurse with years of experience treating cancer patients, outlined two main advantages for advance directives:

First, it makes it less likely that patients will have unnecessary, unwanted and possibly uncomfortable tests; second, it lifts the burden of medical decision-making from families during a very stressful period, allowing them to spend meaningful time with their loved ones without the additional stress of having to make these difficult choices.

In a second letter, Adina Kay-Gross, who recently lost her father to metastatic lung cancer, wrote of the experience:

Because he was allowed to call the shots, because, when given all the information, he alone chose the circumstances of his death, the end of his life was as loving, as dignified and as human as he was.

We are so grateful that my dad was spared the suffering that no one should have to endure unwillingly.

In today’s world, with a growing number of Americans caring for aging parents, the increased attention to advance care planning is welcome.

But should the focus on advance directives be aimed only at elderly and terminally ill patients?

Interestingly, neither the editorial nor any of the letters to the editor mention the notion of documenting medical wishes earlier in life. After all, no one waits until they’re terminally ill to buy life insurance, or until they’re on their deathbed to think about organ donation.

It’s time to take advance care planning one step further. We should not only be encouraged to decide matters of medical care at the end of our lives, when it may be impossible to communicate our wishes. We should take action to make these tough decisions as we enter adulthood, so that our voices are preserved in all medical situations.

Share your thoughts and join the conversation on Facebook and Twitter.

Don’t Let the Biggest Battle be Over Who Handles Your End-of-life Care

It may never strike someone that a veteran’s greatest battle is not war itself but subsequent battles he must fight in order to return to everyday life. Dennis Henley served in the U.S. military for 26 years before retiring and being diagnosed with Alzheimer’s disease. Prior to retiring, Dennis had a living will but he did not have an advanced medical directive to ensure he received medical treatment the way he felt comfortable. In a blog post for the Alzheimer’s Association, Dennis Henley discussed the steps he’s taken in what he calls his “greatest battle”:

“I was diagnosed in 2008 with early-stage Alzheimer’s.  When I received the diagnosis of Alzheimer’s, it was almost a relief.  It provided an explanation for what was going on.  It also provided a path forward.  There were plans I needed to put in place for the future.

I made my living will before my first trip to Iraq. But after the diagnosis, my wife Mary and I updated our advance directives, power of attorneys and will.

Everything has been documented, so there is no dispute and no questions for my children when this disease progresses.  We dotted all the “I’s” and crossed all the “T’s” to make sure everything is in place. It’s an important thing for anyone who has been diagnosed to do.”

Dennis identifies it perfectly – preparing signing an advanced medical directive is not about feeling guilt over the inevitable. Deciding to sign an advanced medical directive is about fostering the conversation with family; with friends and with the network of support we all have in our lives. Whether a military serviceman about to be deployed overseas, a patient diagnosed with Alzheimer’s or none of the above, the conversation that grows from these life situations allows for a mutual understanding amongst everyone in your life who care how you’re cared for.

How has your life been impacted by Alzheimer’s? How has it changed your outlook on life? Join the conversation on Facebook and Twitter.

Photo: From Henley’s blog post at the Alzheimer’s association. L-R: Henley; Gen. Franks; Henley’s son.

Crossposted from MyDirectives.com