Compassionate, informed advice about healthcare decision making

Archive for the ‘Covid / Coronavirus / Pandemic’ Category

Could COVID Be the New “Old Man’s Friend”?

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Here’s the question: Should a nursing home resident with dementia get the COVID-19 vaccine?

There is no question that nursing home residents are at a high risk of dying should they get the coronavirus. That also goes for the underpaid and overworked staff who care for these vulnerable patients. One might think, “Of course, vaccinate them all.”

Not so fast.

I started thinking about this after reading a recent article from the bioethics think tank The Hastings Center, “Too Taboo to Contemplate? Refusing COVID Vaccination for Some People with Dementia.”

Just a month ago I wrote a blog post, “Making End-of-Life Decisions for Dementia Patients.” In it I wrote, “Here’s the question families of dementia patients face as they consider end-of-life decisions: Shall we save his life so he can become more demented and slowly decline further or shall we let him die peacefully?

Dena Davis, J.D., Ph.D., takes a similar approach in her Hastings Center article. She states the obvious: that if a person had declared in an advance directive that in the case of advanced dementia, they would refuse vaccines for flu or pneumonia, then that would also apply for COVID-19 vaccine. But, what of the patient who does not have a written advance directive or has failed to give such specific verbal directions?

Dr. Davis refers to several surveys where people expressed their preference to die sooner rather than spiral down with dementia. In one survey, more than half of the respondents were either “very unwilling” or “would rather die” than live in a nursing home. In another study of seriously ill but cognitively competent people a majority believed that either incontinence or “being confused all the time” were states equal to or worse than death.

We hardly need a scientific study to convince us that losing our minds and being totally dependent on others is a state almost all of us want to avoid. Now, a novel coronavirus comes along that is especially hard on elderly nursing home patients. It is also hard on the caregivers and vaccinating patients is partly to protect these folks and their families.

I agree with Davis’s personal preference that if she had dementia and was confined to a nursing home, she would give her surrogates instructions to withhold vaccines. Me too.

Once, pneumonia was thought of as “the old man’s friend” – a relatively peaceful way for the elderly to die, a welcome visitor. Dr. Davis speculates, “Could the novel coronavirus be today’s old man’s friend?”

Remembering COVID-19 While in the Midst

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me·mo·ri·al| məˈmôrēəl | noun 1 something, especially a structure, established to remind people of a person or event.

A memorial to COVID-19 surprised me at first. Is it too soon?

We usually think of memorials being erected long after the fact. World War II ended in 1945 and its memorial on The Mall in D.C. opened in 2004. At the other end of the reflecting pool stands the 1922 Lincoln Memorial honoring a president who died in 1865.

Also nearby is the Vietnam Veterans Memorial built in 1982 for the war that ended in 1975. This memorial is a particularly moving display of 58,320 names of the war dead. Initially, the design of two granite walls sunken into the ground was highly criticized with one official calling it “a black gash of shame.” It has become a pilgrimage site for families and brothers-in-arms to touch the names of those they have loved and lost. Here, grown men weep at the sight of the name of a fallen comrade.

On a recent walk I was surprised to see a metal engraved marker remembering those who died of COVID-19 and honoring the heroes. It stands in a small park in Leesburg, Virginia, right next to the rails-to-trail bike path. A local Girl Scout troop planted a tree and set the marker at the end of December. The marker reads: “This tree was planted in memory of those we lost during the COVID-19 Pandemic, and in gratitude for the heroes who emerged.”

 

COVID-19 memorial in Georgetown Park, tree and plaque installed by Girl Scout Troop #2718

My surprise stemmed from the fact that this pandemic is far from over. People are still dying in great numbers. We are still wearing masks as a daily reminder to be vigilant. We have been warned deaths could spike again. How can we gain the benefit of a “remembrance” when this event is still unfolding?

Do we need to be reminded?

Hospital staff take a moment of silence to commemorate the year anniversary of the start of the pandemic in Fort Worth

Of course, there have been temporary memorials like the candles at the White House the evening we passed 500,000 deaths. A story and photos appeared in my Facebook newsfeed with medical staff kneeling in prayer next to white flags at the Texas Health Harris Methodist Fort Worth hospital. I am sure they would like to put this all behind them, but they had to go back inside and care for more COVID patients.

Do we need to be reminded about the pandemic? No, but I think we want families of the dead to know that we noticed. What must it be like to have lost someone to a plague that the country is so ready to forget ever happened? Or, at least, we want things to “get back to normal.” The bereaved will never get back to pre-pandemic normal.

Perhaps the Girl Scouts are too young to realize that this pandemic is a once-in-a-century event (hopefully). Do any of us know the long-term effects of months of isolation and remote learning? Does this memorial remember children’s grief over the lost memories of events (like a prom) that could have been but never were?

What about the effect on the elderly isolated in nursing homes who, we know from research, are being prescribed increasing amounts of psychotropic drugs? How do we mark the loss of the mental health of those elders who have just months to a few years to live?

My guess is it will take a generation to memorialize this time. My hope is that we, as a people, will be better because we allowed ourselves to grieve…and to remember.

Human Kindness is Overflowing

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When I saw it, I felt in my heart, “Isn’t that a wonderfully kind thing to do?”

It was our last hour at the beach, so my daughter Katie and I decided to walk down the sand one more time. Some very generous friends let us stay in their condo about a half mile from the beach at Marco Island on Florida’s Gulf Coast.

As we headed north, walking next to the water, I noticed a stick in the sand holding up some car keys. Obviously, someone had lost the keys. Also, obviously, someone else had found them and took the time to find a stick to sink into the sand so the keys would be on display for any passerby to see.

Katie and I continued our walk enjoying the birds, people, sand, and sun. She picked up a live starfish she found in a pool of water and returned it to the sea.

On our way back, heading south, we came upon the stick in the sand and the car keys were gone. When we got up next to the stick we saw, in large letters written in the sand, a very simple, “THANK YOU.”

Isn’t that a wonderfully kind thing to do? Kind of the person who found the keys and took the time to display them — and kind of the owner of the keys to write, “Thank you.”

Immediately, I thought of a line from a Randy Newman song, “I Think It’s Going to Rain Today”:

 “Human kindness is overflowing, and I think it’s going to rain today.”

I think I first heard that song sung by Judy Collins on her 1966 album, In My Life. Bette Midler also sang it on the soundtrack for the movie, Beaches.

“Wait a minute,” I thought. Sure, it was kind act…but it was a kind act that served a very first-world problem. I didn’t notice the make of the car keys, but in this part of Florida luxury cars are common. Who knows, they could have been to a Ford Pinto. (But probably not.)

Regardless, someone had the means to have a car and the leisure time to hang out at the beach. Someone else also had the leisure time to rescue the keys. And here I was, lucky enough to have the leisure time to take note of all of this.

Photo I took of a sunset on Marco Island

I couldn’t help but think of this past year and the strain the pandemic has put on our kindness to one another. The keys on the beach proved that kindness is still out there, but what about the folks who don’t have a car right now? The folks who can’t drive to get a COVID vaccine? Or those who can’t pay their bills, let alone have leisure time at the beach? What about all of the families with children struggling with school during the pandemic? Those who have lost loved ones?

The list of those who could use a little kindness is endless.

I looked up the lyrics to Newman’s song and had totally forgotten that several of his lines were a call to care for those in need. Get this:

     “Bright before me the signs implore me

     “To help the needy and show them the way

     “Human kindness is overflowing

     “And I think it’s going to rain today…”

So, yes, let’s return the keys to our first-world friends. But then let’s extend the kindness beyond.

Signs of Hope Amid COVID

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When will our lives get back to “normal?” Is there hope this will ever happen?

I had cable news on the other day and saw this in the crawl at the bottom of the screen: “For the first time, vaccinations outnumber new hospitalizations 10 to 1.”

I took that as a very hopeful sign.

Think about it. Each time a person goes into the hospital with COVID-19, ten more just got a vaccination. And right now, those getting the shots, are the ones most likely to end up in the hospital if they were to get infected — the elderly and those with pre-existing conditions.

I must say, just seeing that crawl lifted my spirits slightly.

And then, there was the day I got my first dose of the Pfizer vaccine. (Yes, I qualified.) I got in the line of cars, filled out paperwork, inched the car along until it was my turn, received my shot from a National Guard member in fatigues, and joined the wait line for observation. My fifteen minutes were up, and I was on my way home.

My spirits lifted a little more.

Zoom brought out his feelings like nothing else

Laura Fraser (in San Francisco) and her 92-year-old father, Dr. Charles Fraser (in Denver) pose for a portrait via Zoom (Carolyn Van Houten/The Washington Post)

Stories continue to be told about the good that has come out of the pandemic. Just the other day the Washington Post ran a great piece about how Zoom has changed a family’s life. Laura Fraser writes about her 92-year-old father, Dr. Charles Fraser, a former physician living in a retirement facility with limited visitation.

Between his flip phone and clunky old computer, Dr. Fraser did not have the capacity to participate in an online chat. So, Laura writes:

“My husband and I bought a cheap laptop, loaded it with his email account, photos, Zoom and a password written in indelible ink on the keyboard, and mailed it off. After many tries, voilà! There he was on Zoom, with his crooked nose from the time a horse kicked him, and the familiar warm brown eyes. I hadn’t been sure I would see that face again, and I teared up.

“That’s all there is to it?” Dad asked. My sisters and their kids dialed in, and Dad held a smile so long I thought his computer had frozen.”

“Before he signs off, he tells us he loves us.”

Laura’s dad had never been one to talk about his feelings, his childhood, how he felt about his children,  or even how much he missed his wife, now gone ten years. On Zoom he has opened up for the first time. She ends her hope-filled story with this:

“A few weeks ago, over Zoom, Dad was able to see his great-granddaughter for the first time. He was delighted to learn that my nephew and his wife have named her after my mother, Virginia. ‘I just can’t wait to hug her,’ he says. His mood has lifted. He laughs as little Ginny burbles and coos. He does something else that’s new for him. Before he signs off, he tells us he loves us.”

Another little sign of hope in a time that needs so much.

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