My turn for a social media break friends. I thought I had last year packed up in a box but the covid ad is circulating, and keeps knocking that box off the shelf without my permission. But first, a rant. Content warning: avoid if youβre HCW or have lost someone to covid.
The ad you saw does not represent young people (in a functioning health system, which we have). They would never be left like that. For older people, it is a different story.
Ventilation, ICU, things drugs ending in β’β’mab, these all help us wait out diseases in well bodies. In unwell, ageing bodies, these things make the underlying problems worse, they accelerate the complications of ageing. Older bodies canβt tolerate the drugs used for ventilation
What this means for the older covid sufferer, is that they donβt go to ICU, because their bodies get worse from the interventions there. They never wake up, and if they do, their minds are gone forever, to a terrible new dementia. This is the reality of geriatric medicine.
But a professor of oncology once told me as a junior, there is never nothing we can do. Whether itβs medicine or surgery, morphine or ice cream, there is always something we can do. Futile is a dirty word in geriatrics.
Instead, we change our goal from trying to cure the incurable (old age), to supporting through illness, and if the illness starts to irrerversibly take hold, we change our goals to prioritising comfort and dignity above all else.
At our subacute outbreak last year, there was no ICU for our patients who caught it inside the hospital walls. There was no high flow nasal prongs.
There was 5L/min of nasal prong oxygen only, steroids, and faceless people in blue, holding their hands through an endless supply of blue gloves. And patient, after patient, after patient, all breathing like the young woman in that ad.
And for us and families, impossible decisions, and impossible discussions. Morphine to settle their symptoms and relieve their distress, at the expense of their oxygenation? Ie let them go?
Or hold their hands through that endless suffocation knowing they would likely not make itβ¦but they might? If you chose the former, did you let them go too soon? If you chose the latter, were their last hours needlessly in distress?
We had over a hundred older patients at our outbreak. We rang their families every single day. Often more than once in a day. Had a spectrum of discussions I never imagined I would have in my career. That ad was our reality for too many. I cannot watch it.
I have held that hand more than I ever want to. No matter your age, no one deserves that. Those who say to let it rip and let the elderly die have never held that hand, and they know that they never will.
Our mortality rate was 30%. Subacute patients are special. They are with us for weeks, sometimes months. We make friends with them. We all said goodbye too many times, watching that ad play out. All the covid HCWs, turn off Twitter for a while now and protect yourselves.
Iβll be back in a week which in media time is like ten years. I hope itβs been replaced with something more human by then. That box shouldnβt get unpacked at random like that. Thanks for listening friends (I am okay, but in the interests of remaining that way, off I go). ππ
β’ β’ β’
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