As the world steps back, healthcare professionals from around the globe are going above and beyond to serve those in need during this COVID-19 crisis. Dr. Kristofer Smith, naviHealth’s President of Home-Based Medical Care, is one of these dedicated workers, tirelessly answering the call to volunteer for the cause despite not practicing acute care medicine in over a decade. These are his daily stories – uncut and untouched, as told from the front lines.
Day 4 – Final moments
Everyone in the unit understood that we would bear witness to patients’ final moments. For hundreds each day across the city, COVID 19 overwhelms fragile bodies and, sometimes, there is no more that can be done.
On our unit, we receive daily transfers of patients whose goals are now comfort only. For the staff on the unit, care of this type is new and uncomfortable. The questions are many: How will I know if someone is uncomfortable? Will I cause someone’s death if I increase the narcotics? What do I tell the family? What happens when someone actually passes?
In the first few days, we learn together. We review how to tell if a patient might be uncomfortable. We look for tachycardia, tachypnea, grimacing or groaning. We learn how to dose for breakthrough pain. We discuss the ethics of increasing morphine in patients who have inadequate respiratory effort already. And we role play how to talk to families.
Then, we get the call.
Patient in bed #129 is no longer breathing. A small group of us gown-up to go to the bedside. Anxiety is high.
“That patient reminded me of the grandfather who raised me,” sighs one of the clinicians. These moments are hard and sad and each clinician brings a lifetime of experiences with death to the bedside. We go to the room, the patient is indeed no longer breathing, a heartbeat cannot be auscultated. Time of death is announced at 1:25 p.m. We pause. We acknowledge the passing of someone who we never knew, but who was loved by others. We sit together and call the family. Tears on both ends of the phone. The family is grateful that the suffering is over and that people of kindness surrounded their loved one at the end.
Then, we keep moving. There are others who need our help.
Catch up on the entire series of “Trials and Triumphs” featuring Dr. Kristofer Smith.