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I’m a 30-year-old ICU doctor in NYC. I’ve just updated my “living will.” Have you? Let me provide you a short guide. #COVID19 #ACP
I’m a 30-year-old ICU doctor in NYC. I’ve just updated my “living will.” Have you? Let me provide you a short guide. #COVID19 #ACP
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You probably didn’t know this was a thing. Or if you did, you may have thought it was only for people older than you. Or you just never had the time. Well, now is the time. You are likely home on #covidquarantine anyway, so why not?
You probably didn’t know this was a thing. Or if you did, you may have thought it was only for people older than you. Or you just never had the time. Well, now is the time. You are likely home on #covidquarantine anyway, so why not?
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There will be a time in almost everyone’s life where you cannot make medical decisions for yourself.
There will be a time in almost everyone’s life where you cannot make medical decisions for yourself.
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Advance Care Planning is the process of learning about these medical decisions, specifying who will make these decisions for you if you can’t, and helping the person who will make decisions for you understand your preferences and goals.
Advance Care Planning is the process of learning about these medical decisions, specifying who will make these decisions for you if you can’t, and helping the person who will make decisions for you understand your preferences and goals.
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Going through this process will make sure your wishes are followed. It will take a huge burden off of your loved ones when you can't speak for yourself. We hear all the time from families that these decisions are hard, in part because they've never had these conversations.
Going through this process will make sure your wishes are followed. It will take a huge burden off of your loved ones when you can't speak for yourself. We hear all the time from families that these decisions are hard, in part because they've never had these conversations.
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Have these conversations now to spare your family the anguish of trying to guess what you would have wanted.
Have these conversations now to spare your family the anguish of trying to guess what you would have wanted.
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In America, the default course of action is to keep you alive as long as possible.
In America, the default course of action is to keep you alive as long as possible.
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We can hook you up to a breathing machine, give you adrenaline through large IVs in your neck/groin to keep your heart pumping, place a large IV to do dialysis to clean your blood, and put feeding tubes through your nose into your stomach to feed you.
We can hook you up to a breathing machine, give you adrenaline through large IVs in your neck/groin to keep your heart pumping, place a large IV to do dialysis to clean your blood, and put feeding tubes through your nose into your stomach to feed you.
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These are all things we CAN do in the ICU, but what are we trying to accomplish? We need to know what you consider a meaningful life so that we can guide the person who is making decisions for you about the chance of achieving a meaningful outcome for YOU.
These are all things we CAN do in the ICU, but what are we trying to accomplish? We need to know what you consider a meaningful life so that we can guide the person who is making decisions for you about the chance of achieving a meaningful outcome for YOU.
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For example, would you consider life meaningful if you are likely unable to recognize friends and family or if you were likely to be bed bound the rest of your life?
For example, would you consider life meaningful if you are likely unable to recognize friends and family or if you were likely to be bed bound the rest of your life?
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There are no right answers, but it is important to have communicated your preferences in case there is a time when you can't, and someone has to try and communicate what you would want.
There are no right answers, but it is important to have communicated your preferences in case there is a time when you can't, and someone has to try and communicate what you would want.
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With modern medicine we can save people who wouldn’t have made it 10-20 years ago. Watching a person who was critically ill walk out of the hospital cannot be described. It is why many of us become ICU doctors.
With modern medicine we can save people who wouldn’t have made it 10-20 years ago. Watching a person who was critically ill walk out of the hospital cannot be described. It is why many of us become ICU doctors.
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However, modern medicine also lets us prolong the dying process, giving life support to patients who are unlikely to ever walk out of the hospital. We can give life support to patients who may never even wake up, who will remain attached to machines the rest of their lives.
However, modern medicine also lets us prolong the dying process, giving life support to patients who are unlikely to ever walk out of the hospital. We can give life support to patients who may never even wake up, who will remain attached to machines the rest of their lives.
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If your goal is to live as long as possible, no matter the quality of life, we can do that for you. If your goal is to have quality of life for as long as possible, and then be comfortable when you die, we can do that for you too.
If your goal is to live as long as possible, no matter the quality of life, we can do that for you. If your goal is to have quality of life for as long as possible, and then be comfortable when you die, we can do that for you too.
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But there has to be someone who can tell us what quality of life means for you. And, whatever your goals, advance care planning helps us follow what you would have wanted if you were awake and able to speak for yourself.
But there has to be someone who can tell us what quality of life means for you. And, whatever your goals, advance care planning helps us follow what you would have wanted if you were awake and able to speak for yourself.
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Ready to get started on advance care planning? There are several good online resources:
- https://theconversationproject.org/wp-content/uploads/2020/04/tcpcovid19guide.pdf ( @convoproject)
- https://prepareforyourcare.org/covid-19 ( @prepareforcare)
- https://www.practicalbioethics.org/resources/caring-conversations.html ( @PracBioethics)
Ready to get started on advance care planning? There are several good online resources:
- https://theconversationproject.org/wp-content/uploads/2020/04/tcpcovid19guide.pdf ( @convoproject)
- https://prepareforyourcare.org/covid-19 ( @prepareforcare)
- https://www.practicalbioethics.org/resources/caring-conversations.html ( @PracBioethics)
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Most importantly, talk to your doctor for help with advance care planning. Your primary care provider can help you understand these difficult decisions and will be familiar with local forms.
Most importantly, talk to your doctor for help with advance care planning. Your primary care provider can help you understand these difficult decisions and will be familiar with local forms.
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Are you a provider looking to brush up on ACP? A couple good options:
- https://www.vitaltalk.org/resources/ ( @vitaltalk)
- https://respectingchoices.org/covid-19-resources/#planning-conversations ( @RespChoices)
Are you a provider looking to brush up on ACP? A couple good options:
- https://www.vitaltalk.org/resources/ ( @vitaltalk)
- https://respectingchoices.org/covid-19-resources/#planning-conversations ( @RespChoices)
THE END
Thanks to @azaleakim @LawrenceMumm @laurenranard for the peer review and @awatson88 for reviewing.
@snakagawa_md #pallicovid #ACP #covid19 @PAIRCenter @AriadneLabs @NYGovCuomo @NYCMayor
Thanks to @azaleakim @LawrenceMumm @laurenranard for the peer review and @awatson88 for reviewing.
@snakagawa_md #pallicovid #ACP #covid19 @PAIRCenter @AriadneLabs @NYGovCuomo @NYCMayor
