Could We Use a Little Logic in Virus-Fighting?

This space tries hard to avoid overt political issues. But today, with the novel coronavirus sitting in front of our eyeballs on waking and hanging out in our brains throughout the day – whether we happen to be infected or not – it’s almost impossible to avoid how politics impacts the reality of the pandemic. The following is offered just because it seems such a ridiculously obvious way to address the problem.

Recently, this letter of mine appeared in the New York Times:

“At 86, I am absolutely fine with dying — although I’m healthy and active and would not turn down another five or 10 years. So if I wind up with Covid-19, give the ventilator to someone else.

“What bothers me is that if our national leadership had just a fraction of Gov. Andrew Cuomo’s brain, they would follow his very rational advice to send all available ventilators to New York until the curve begins to bend, and then ship them to the next crisis area. Under that system, San Francisco would get an adequate supply in time for my neighbor and me both to survive.”

Covid-19 globeAbout that “give the ventilator to someone else” line. I should say up front that this is not some lofty altruistic declaration. Ventilators are not a lot of fun, and many older patients (one physician friend suggested a scarily high percentage) wind up dead on them anyway. Even for just a few days, lying still with perhaps a hole in my windpipe and for sure a tube down my nose for nutrition approaches torture, in my considered opinion. Lying still would additionally involve being unable to write, communicate or do anything else that makes life meaningful. Thus, compromised with a dangerous virus and probably soon dying alone without loved ones of any sort nearby – no thanks. Shoot me with all the morphine on hand and let me go.

I am a grateful and enthusiastic board member of End of Life Choices California. As such I’m a firm believer in Medical Aid in Dying: the right of terminally ill, mentally competent adults to ask their physicians for life-ending medications. Now legal in nine states and the District of Columbia, MAID will, I hope, eventually be “best practice” for the medical professions. Refusal of a ventilator falls in the category of mechanical aid in dying, of sorts, and why not?

The second, less esoteric issue addressed in my brief letter is simply a plea for national response to the next pandemic – which Dr. Anthony Fauci, may he long survive and prosper, tells us is likely to come with a reappearance of the novel coronavirus in the fall. Assuming it doesn’t start somewhere they’re still convinced it’s a hoax – hello, Mississippi? – maybe we as a nation could adopt a fast and sensible strategy: throw everything we’ve got at the first peep-through, and try to snuff out subsequent peeps-through as fast as supplies can be diverted from the first. My degrees are in Art and Short Fiction, not medicine or policy, and I admit to having only a rudimentary left brain. But how does this not make sense?

I’m just saying.

For more about MAID, and a lot of other good information you can use, I encourage you to visit https://endoflifechoicesca.org/

 

 

Life, love and palliative care

My greatly beloved sister Jane died this morning, a peaceful end to 84 years of a life extraordinarily well lived. For a few days she had been on palliative care.

Palliative care. File that term away for yourself, your parents, your friends and family. It’s the new best thing, even though for centuries it was the old best thing: keep me comfortable and let life come full circle. For centuries we believed that life was a cycle: birth, Stuff, death. Some people’s stuff was better than others, but there was a general agreement that death happened, so it made sense to ease it along when the time came. Usually it didn’t take long. Often, if ease was not to be had, the family doctor invited everyone in briefly to say goodbye, closed the door and administered a shot of morphine.

Then we invented chemotherapy and ventilators and feeding tubes and miracle drugs and adopted the national attitude that one is supposed to live forever. Plus, we invented lawsuits. So dying turned into something horrid and often painful, something one is really not supposed to do. Physician aid-in-dying for the terminally ill became illegal; even talking about it gave Sarah Palin the death panel willies.

My sister Jane was a gifted artist who told me, a few days before she died, that she’d reached the apex of her career because one of her recent paintings was stolen from a show currently on view. (She was also delighted that others were selling well.) She was a remarkable mother, hostess, book-lover, friend, and about the world’s best big sister. The day after our last conversation she had respiratory failure (quit smoking, please, if you haven’t already) and began to die.

Jane was briefly on a ventilator, which I hated as much as she, but one does what needs to be done. Very quickly she moved from that to palliative care. Her husband, four daughters and assorted grandchildren gathered around to sing songs, hold hands, administer foot rubs, report to her remaining two sisters and innumerable friends that all was well.

This is not an argument against miracle drugs or aggressive interventions when appropriate, or even against feeding tubes and ventilators — although if you catch my children approving such things after I conk my head on the curb please remind them of my explicit instructions to the contrary. But it is an argument to confront mortality, complete your advance directives, talk to family and friends about your own wishes no matter how young and immortal you feel yourself to be, support compassionate and humane dying. Advocating for decent health care for the living wouldn’t be a bad way to start.

Palliative care is a valuable new/old thing. So are big sisters like Jane, although they are hard to come by.