Liz Szabo Profile picture
16 Jul, 23 tweets, 10 min read
I don't want to criticize nurses, b/c they work incredibly hard. But when my dad was hospitalized, it wasn't helpful for them to tell me every day that he was "looking better today." He was elderly, w/ dementia & other comorbidities. He was never going to get better. 1/
His nursing home sent him to the hospital, where he was in the ICU on bipap. (He was DNR and we said no ventilators.) After a few days, his breathing improved, he switched to a nasal cannula for oxygen. That doesn't mean he was 'better." 2/ #hpm
Do nurses feel pressure to keep families' hopes up?I've written about hospice & the end of life for years, but that sort of false hope could keep other families from accepting reality. #hpm /3
When a new doctor came in for her rotation, she was more honest. She mentioned choices of feeding tube, since he couldn't swallow, or hospice. Why do docs still recommend feeding tubes for elderly ppl w/ dementia?#hpm 4/
As a health journalist, I knew that feeding tubes can do more harm than good in elderly ppl with dementia. They don't extend life. If ppl are aspirating with regular eating, they are likely to aspirate w/ feeding tube.… #hpm 5/
This site has a whole list of problems that can result from using feeding tubes in elderly patients with dementia. It may sound morbid when you're young/healthy, but it's good for everyone to have basic knowledge of hospice, end-of-life choices. #hpm 6/…
#hpm The best advice we received was after we requested a meeting w/ hospice team. Doc was unavailable b/c she covers multiple hospitals, but social worker and chaplain were terrific and very medically knowledgeable. 7/
When thinking about what was best for my dad, I thought about my interview w/ @GretchenSchwa10 for this story.
#hpm 8/…
In talking to hospice team w/ Mom, they asked her what she was hoping for. Mom asked incredibly smart, succinct questions. She said ideal would be for dad to go back to the way he was. Chaplain explained how ppl w/ dementia tend to go downhill w. each event like this.

#hpm 9/
Chaplain said you or I might "bounce back" after a hospitalization. But ppl w. dementia sort of bounce lower each time, never getting back to baseline. #hpm 10/
We went through options with hospice team. Could dad go from hospital to rehab? Chaplain said that's unlikely to help, since you need to be able to learn new things in rehab.#hpm 11/
I thought of this terrific paper, which frames choices as the "best-case" scenario, worst-case scenario and most likely case. Sometimes, even the best-case scenario is unacceptable. #hpm 12/…
After talking to hospice, I articulated our choices. Going back to assisted living was not possible. Rehab not possible. Should he stay in hospital as is? Transfer to nursing home w/ basic care, bouncing back to hospital as needed? Or transfer to nursing w/ hospice? #hpm 13/
Before the hospice meeting, my mom started to say, 'I think Dad was giving us a message when he pulled out all his tubes." I cut her off, saying dad has brain disease and can't make good decisions. (I was wrong.) #hpm 14/
During hospice meeting, Mom got to speak her mind. Said maybe Dad was sending signal he was done, that he wanted no more tubes. #hpm 15/
Docs tried lots of interventions to "fix" Dad. But administering Drug A caused harm. So they administered Drug B to fix that harm, which in turn caused a second harm. And on and on... Sometimes, you think, maybe stopping everything altogether is best. #hpm 16/
W/o the medical interventions, but w/ pain relief/sedation, Dad died in 2 days. But unlike the hospital, which limited the number and age of visitors, hospice let us bring in as many kids/grandkids as we wanted. Everyone got to say goodbye, pray together w/ chaplain. #hpm 17/
Afterward, I felt wave of guilt. Did we deprive him of fluids? Was he thirsty? My old friend Sam Goldman, now a geriatrician in N.H., said offering IV fluids would only have "prolonged the dying process" a couple days. #hpm 18/
When people are near death, they're not hungry. Trying to force liquids or food can make things worse, hospice told us. #hpm 19/
Watching an elderly person die is not like in the movies, where they close their eyes and are gone. It's hard. Did we do everything perfectly? I think we made it as good as it could be. Being educated ahead of time really helped. #hpm 20/
And you know what? Even the experts -- people who literally devote their lives to end-of-life research -- say they still second guess themselves. @hgp010162 said she kept "replaying the movie" after he mom died of covid. #hpm 21/…
Throughout this whole process, I felt so fortunate that my dad had "regular" pneumonia, not covid, b/c we could be with him and have a funeral. Millions of people have missed out on that. #hpm 21/…
So. to sum up, I'm glad my years of health reporting gave me some preparation to help make end-of-life choices for my dad. But no amount of preparation is ever enough. Even experts second guess themselves, so don't feel guilty if you do, too. #hpm 22/


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More from @LizSzabo

15 Jul
ICYMI: The @cdc's Dr. Jay Butler talked to the @IDSAInfo this week on the Delta variant and vaccines.

2/3 of all adults have gotten 1 dose of vaccine, including 90% over age 65 have gotten one dose, 80% of those over 65 are fully vaccinted.
@cdc's Dr. Jay Butler says no evidence of waning immunity from covid vaccines.
@AndrewPaviaMD Hospitalizations in Utah have doubled. Case positivity rates have tripled. ICU's are now operating at over 100% capacity. Haven't yet had to create emergency ICUs, which is normally full in summer due to trauma.
Read 17 tweets
17 Mar
@theNAMedicine @PublicHealth LIVE: Speakers at @theNAMedicine webinar on variants include some heavy hitters of science: @CarlosdelRio7, @angie_rasmussen, Dr. David Ho of @Columbia & @MonicaGandhi9 .
@theNAMedicine @PublicHealth @CarlosdelRio7 @angie_rasmussen @Columbia @MonicaGandhi9 Live: @angie_rasmussen: Viruses have smaller genomes but mutate much more than complex cells.
@theNAMedicine @PublicHealth @CarlosdelRio7 @angie_rasmussen @Columbia @MonicaGandhi9 Live: @angie_rasmussen: Mutations are scattered randomly through coronavirus genome, although the ones of most concern relate to the spike protein, which helps virus enter our cells.
Read 26 tweets
16 Mar
Live from International Antiviral Society–USA (IAS–USA)

One monoclonal antibody is good, two is better.
Live from International Antiviral Society–USA (IAS–USA)

Dr. Jonathan Li: Mutations occur between the areas where antibodies bind to virus and the spike protein.
Live from International Antiviral Society–USA (IAS–USA) @DrJLi is talking about variants. Vaccines appears to protect against the B.1.1.7 variant (originally found in the UK) as well as the original virus.
Read 15 tweets
15 Mar
JAMA LIVE. @CarlosdelRio7 notes there will be PTSD caused by the pandemic.
JAMA LIVE: When asked which vaccine she recommends, @PreetiNMalani said to get the first vaccine you can. "They all work beautifully on severe disease."
JAMA LIVE: @CarlosdelRio7 and @PreetiNMalani said the vaccines reduce infectivity, likely protect against infection. "Even if you get infected, you may not make enough virus to be infectious."
Read 4 tweets
5 Mar
LIVE @NC4HR: Dr. Paul G. Auwaerter of @JohnsHopkinsDOM notes that people infected with B.1.1.7 variant are infectious longer -- eight days instead of five days.
LIVE @NC4HR: Dr. Paul G. Auwaerter of @JohnsHopkinsDOM notes effectiveness of mRNA vaccines in Israel as good as in clinical trials.
Good protection in people over 70, who normally don't do as well with vaccines. Image
LIVE @NC4HR: Dr. Paul G. Auwaerter notes Houston has four variants circulating in the city.
Read 18 tweets
3 Mar
This slide includes data that could be used to argue both for/against giving everyone one dose before giving people a second.
Here's another slide contrasting the arguments for/against giving everyone one dose before anyone gets the second. One major point: The one-dose strategy would violate the FDA's emergency use authorization.
CDC advisory panel yesterday also debated whether people who've had covid need 2 shots or 1. Once again, giving only one shot would violate the FDA's emergency authorization.
Read 16 tweets

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