Dr. Rob Horowitz heard two very different reactions from two young, immunocompromised men when he asked them what kind of medical care they would want if they got sick with COVID-19.
“One of these young men said, ‘I want to stay out of that frickin’ hospital. I do not want to go back to the hospital. I will not be on a machine, and I will not die on a machine.’ And the other said, ‘I want to do everything possible to live another day.’ ”
Horowitz, the chief of palliative care at Strong Memorial Hospital, said those divergent views are not unusual.
But they illustrate the range of emotions that confronts palliative care doctors, who develop plans for critically ill patients.
Now, as the number of people in intensive care for COVID-19 treatment grows, more doctors are finding themselves grappling with issues that, in normal times, are left to those specialists.
Administrators at both the University of Rochester Medical Center and Rochester Regional Health have begun putting together trainings for non-specialists to prepare them for those conversations.
At Rochester Regional’s Unity Hospital, chief medical officer Dr. Manuel Matos said he wants clinicians to be asking patients about their treatment preferences as part of the routine hospital admission process.
Most people with COVID-19 do get better, Matos said, but patients who deteriorate can do so quickly, ending up on a ventilator before they have time to discuss their wishes.
Ventilators can save lives, but they can also cause lasting damage to cognition and breathing.
Sometimes patients say they want the hospital to do “everything possible” to extend their lives, Matos said. But doctors sometimes should slow down and check: “Do they really understand what ‘everything’ means?”
Matos and Horowitz said good palliative care needs to strike a balance between being realistic and reassuring.
“It’s hard to give bad news, and so practicing giving very explicit bad news compassionately is what we do,” Horowitz said.
For doctors who are not ready for those conversations, it’s tempting to downplay the severity of the situation, he said.
He’s held online training sessions for more than 700 people at URMC since the pandemic began, he said.
“Pretend though it is, it becomes very real,” Horowitz said, describing a recent online class where he and an actor playing the role of a sick patient both ended up crying.
“I’m good with that. I’m OK with that,” he said. “It made it very real for her and for me and for all of us.”
