“Do you know where my father is?” I looked up and saw a woman, frantic and terrified. It was 3 a.m. and I was in the last hours of an overnight shift reviewing the chart of the next patient to see. After directing her to the clerk, I returned to the computer.
I would soon learn that my next patient was her father. A man in his late 80s, living comfortably at home with his wife, and managing high blood pressure and diabetes with medications. He had been suffering with a cough for the past several days, and over the past 24 hours had developed fevers and shortness of breath. His wife called the ambulance when his lips began to turn blue. As the critical-care physician on call, I had been called to admit him to the intensive care unit.
Normal lungs appear dark on a chest x-ray. His were white, a sure sign of severe pneumonia. He was struggling to breathe despite a mask delivering a deafening flow of oxygen. Without a ventilator, he would be dead within a few hours.
I turned to his wife and daughter and asked whether he had ever spoken to them about a situation like this. A situation when he was critically ill, and when heroic, aggressive and uncomfortable measures would be needed to sustain life, with no guarantees of success. They looked at each other. These discussions had never happened. He had completed an advance directive many years ago; it was in a safe deposit box.
These heart-wrenching tragedies unfold every day in emergency rooms across the country, and are occurring at an alarming rate in the midst of the COVID-19 crisis. COVID-19 kills when it travels to the lungs and causes pneumonia. Each of us is now faced with the stark reality that we may need to make these same decisions for ourselves and our loved ones.
What is intubation and mechanical ventilation?
Intubation and mechanical ventilation go hand in hand. Intubation is the procedure of placing a plastic tube through the vocal cords and into the windpipe. Mechanical ventilation is a treatment that delivers life-saving breaths through the endotracheal tube. There are many reasons why people may need these, but in the case of COVID-19, it is to support the failing lungs of those with severe infections. The virus ravages the lung by causing inflammation that floods them with fluid. The tiny air sacs in the lungs are no longer able to exchange oxygen and carbon dioxide — the fuel and exhaust of the human body. The mechanical ventilator cycles oxygen-rich pressurized air to sustain life when otherwise a person would succumb quickly to dense, fluid-filled lungs.
These are truly heroic treatments. They are invasive and uncomfortable. In order to tolerate them, many people require powerful sedative medications, resulting in what many people refer to as a drug-induced coma, and in some cases a chemical to paralyze the entire body. Despite the critical-care team’s best efforts, these individuals are bedbound for most or all of the day. It is these harsh realities of life support that result in a long list of complications.