Death in the time of COVID

Coronavirus Disease 2019 Rotator Graphic for af.mil. (U.S. Air Force Graphic by Rosario “Charo” Gutierrez)

This is a guest post by Leslie Mahoney, RN

My sister died from COVID-19 on June 21, 2020.

I can accept my sister’s death. After all she was in her eighties and had plenty of physical ills any one of which was potentially fatal. But in the end she died of COVID-19 and what I cannot accept is the treatment that she received and failed to receive in the 48 hours before her death – adequate pain control and the comfort of family by her side as she approached the end.

Sue was transferred from a skilled nursing facility to an acute care hospital on June 14th; she had been exposed to COVID at the facility and was now symptomatic. I hadn’t been allowed to visit my sister since late February due to the virus, now that she had it I was told I could not see her at the hospital because of CDC guidelines. I searched pretty diligently and found no evidence of any such guideline on the CDC website. My sister may be dying but until she was deemed “critical” I would not be allowed to see her. In other words, until she was unconscious and unresponsive, I couldn’t visit.

On the morning of the 19th, Sue developed a new symptom – abdominal pain. A CAT scan was ordered but when I arrived at the hospital in the afternoon, it still hadn’t been done. I was informed that it couldn’t be done because the cleaning protocol on the machine would take hours and it might be needed for trauma! Apparently in modern hospitals the concept of using plastic sheeting or plain ol’ Saran wrap is innovative. The scan was finally done at 8 PM. This is where bad went to the seventh level of hell.

The scan revealed two perforations of the colon and an abscess (yes, COVID does a number on the bowel.) The surgeon was suggesting an exploratory laparotomy to clean out the abscess and removal of the colon requiring an ileostomy. Now let me remind you that Sue was 82 years old, obese, had a history of emphysema, COPD, congestive heart failure, atrial fibrillation, diabetes, and she’s got COVID. She also had a POLST – Physicians Order for Life Sustaining Treatment – that limited life support such as a ventilator to 3 days only.

Why would a surgeon even suggest surgery at this point? As an RN with a background in ICU and Hospice, I knew that she would never survive. In fact when I backed him to the wall, the surgeon as much as admitted that Sue had about a 1% chance of survival. I refused the procedure as her agent, told him I wanted her kept comfortable, and signed a Do Not Resuscitate order.

On the 20th, I was finally allowed to visit my dying sister. Fifty years of nursing and ten years in Hospice did not prepare me for what I found. Sue was in agony – in her words “11 on a scale of 1 to 10.” She told me she had been calling for me all night. She had no IV in place for medications and was only receiving 1 mg of morphine every 4 hours IM. I knew this was grossly inadequate and my sister was dying in unbearable pain. At the end of 20 minutes trying to comfort Sue I was told my visit was over. When I declined to leave, I was informed that I could no longer visit and security would be escorting me out.

I demanded to speak with a doctor and was granted a hallway consultation. Words cannot convey my emotions – shock, horror, anger and disbelief. Why was she receiving so little pain medication? – well, I failed to use the term “comfort and care only” and without THAT EXACT PHRASE, his hands were tied. Why wasn’t she given the drug intravenously to maximize its effectiveness? – well, staff was unable to start an IV and it never occurred to anyone to maybe call an anesthesiologist or radiology tech to help. Why not use oral morphine to supplement? – well, the pharmacy doesn’t stock it. Why was there no one to guide the pain management? – well, Palliative Care is a contract service and not available on the weekends.

My sister is gone. Thankfully, because I am a nurse and knew the right way to advocate, you can read that as threaten if you will, her last few hours were spent in a peaceful, drug induced haze. But I cannot stop thinking of how many families are enduring this nightmare as I speak. How many terrified people are dying in pain without their love ones at their side? AND WHY? Why are hospitals denying families the right to see patients with COVID? Who does it protect? The community? Right now the “community” is bitching about wearing masks and whining about getting a haircut. Protocols can be put in place. Self isolation is, I know as I’m doing it, not that hard.

Acute care hospitals are not prepared for the dying. I urge everyone to write to your regional hospital and demand that they up their game. Demand administrators to procure end of life medications and prepare their staff to use them. No one in this modern era should have to die in pain.

Editors note: You can sign a petition to the AMA and company to make hospitals allow family visitors at https://www.change.org/COVIDcomfort

#covid19 #endoflife #zerotohero

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