LULU GARCIA-NAVARRO, HOST:
End-of-life care is a reality for the thousands of people dying from COVID-19 every week, for their families and for the medical staff keeping them as comfortable as possible. Craig Blinderman is one of those doctors. He runs the adult palliative care services at Columbia Presbyterian Hospital in New York City. During the height of the initial wave of infections, he recorded this audio diary of what his days were like.
CRAIG BLINDERMAN: Just finished rounding on our patients in our palliative care unit. A few patients passed away. We're waiting for a couple more to come in. All of our patients are very near to the end, probably within hours, maybe days - some closer than others - all of whom are getting comfort-directed therapy, getting medications like morphine, hydromorphone and sedatives to keep them sedated, so they're not experiencing any shortness of breath or pain as they begin the dying process.
Has this other patient gotten any bolus doses?
UNIDENTIFIED PERSON #1: He's on a drip already. I think...
UNIDENTIFIED PERSON #1: He's on a drip. OK. Oh, I see it now. OK.
BLINDERMAN: It's hard seeing patients separated from everyone that they care about in their life, isolated, not aware of their surroundings.
UNIDENTIFIED PERSON #1: I mean, I just got two new patients, and I - I mean, I'll have to go there. But...
BLINDERMAN: Just to give a sense of the space here, there are two negative pressure rooms with four patients clustered together in each room. And we basically turned this into a hospice unit - basically just created this unit out of an old surgical space.
All right. I'm going to go in there now and take a look at everybody.
UNIDENTIFIED PERSON #1: (Unintelligible) a better map.
BLINDERMAN: Just examined our newest admission. Also spoke with patient's family members and suggested that they come in and see her sooner rather than later. I'm hoping they can visit today.
UNIDENTIFIED PERSON #1: So you go to the - down to the third floor, and then you go around...
BLINDERMAN: The other day, I had a patient I was asked to see in the emergency department who wasn't doing well. And it was clear the family wasn't interested in the patient going to the ICU and didn't feel that that's something the patient would want. And so trying to have these conversations rapidly under difficult circumstances become even that much more imperfect and difficult. But we try to focus on the basics of, you know, what is someone's values about longevity versus quality?
And I feel like one of the gifts that we're able to give families in this nightmare is some peace at the end that they can visit, say their goodbyes, and we can offer that on our palliative care unit and other parts of the hospital visitors are just not able to get in. It's just too chaotic. It's just not possible. It's not safe. And we've created a little space where that's possible.
GARCIA-NAVARRO: That's Dr. Craig Blinderman's audio diary, produced by Fred Mogul of member station WNYC. And Dr. Blinderman joins us now.
Welcome.
BLINDERMAN: Thank you for having me.
GARCIA-NAVARRO: I imagine the conversations you're having with COVID patients and their families are extremely difficult. Can you take me through what you tell them?
BLINDERMAN: Yeah. Well, it all depends on where we intersect. The patients that we're seeing are either very acutely ill, so are having a very difficult time even breathing. What palliative care generally does is look at, you know, what are the patient's underlying values and goals, and can we meet those goals in the face of a serious illness that they might be dealing with, right? It's not always the case that everybody wants to go and have every life-supportive therapy to stay alive.
The challenge with this pandemic has been a number of things. One is the very fact of our space has been disoriented. In other words, we are wearing protective gear. So family members, even if they are in the hospital, which most of them are not - it would be a barrier, a literal physical barrier.
GARCIA-NAVARRO: Yeah. They can't see your face. They can't touch each other.
BLINDERMAN: Exactly. So the normal kinds of difficult conversations that we might be having with loved ones - let's say in a family member who's in the ICU - we might bring them into another room, sit down with them, you know, maybe hold their hand, maybe touch their shoulder and dive into the difficult business of life and death.
And then there's the acuity. It's not like dealing with someone who has advanced cancer, and you have the time to discuss and say, look - if things, God forbid, get worse, you know, let's think about that together and what makes the most sense. Now we're talking about a virus that we're still trying to understand, how is it affecting people so quickly? How are they rapidly declining right before our eyes? - and having to make life-and-death decisions in that way.
And especially when you know the statistics, and you know the high risk of mortality and the long-term suffering that's involved in long ICU stays - it makes these conversations even that more difficult.
GARCIA-NAVARRO: Let me follow up with something. I had a family member pass away in a palliative care unit before the pandemic of something unrelated to the coronavirus and COVID-19. But what you're able to see under normal circumstances in a palliative care unit is how sick the patient is, how they may or may not be suffering. Is there a disconnect with families because they're not able to visit the hospitals?
BLINDERMAN: You know, we try to do the best we can with iPads and other kinds of video technology to give family members an image. It is, of course, very different, right? It's someone that - they may have visited their loved one in a nursing home a week ago and then heard that they were admitted to a hospital and then never saw them again. And then the images that you might see, either in an ICU setting or something, can be quite horrifying. It's a - it's torture - right? - for family members to not be able to be there.
And I have to say there's something that we've noticed, you know, just anecdotally - the role of human connection and support that one gets when you're sick alone in an ICU setting, and then your family member comes by and holds your hand. We had this very interesting - I don't even know how to explain it from a medical science standpoint - a patient who was on a, you know, very long intensive care unit stay, intubated, which means having a tube down his throat. And the family ultimately decided that it wouldn't make sense to him to live like this - it was not consistent with the kind of life that he wanted - and suggested that he be moved to our palliative care unit and focus exclusively on his comfort.
We did, in fact, move him to our unit, took him off the vent, and he didn't pass away. And his family came the next morning, and it was like he just turned around (laughter), playing his favorite Ecuadorian music and his family at the bedside and this kind of - the love and energy that was there stimulated him back to life. Palliative care is often associated with, you know, of course, the very end of life, but it's not just that. It's looking at, how are we engaging in healing each other when we're facing something really serious?
GARCIA-NAVARRO: Dr. Blinderman, how are you doing, may I ask? Because I cannot imagine how difficult it must have been to deal with so many deaths and so many grieving families.
BLINDERMAN: There are times when I cry. I cry very easily at baseline. I think that's increased. Bearing witness to the pain of families in a way that I haven't seen in this magnitude is - it's a lot. But I think there's a lot of ways in which I personally cope. That's how I do this work in general. We've done some novel things for our team. Just this morning, we had a faculty meeting. We invited some musicians from Colombia to perform for our team - so allowing the arts, allowing meditation to really fill us when there's just so much sadness around.
GARCIA-NAVARRO: That's Dr. Craig Blinderman. He is a palliative care specialist at Columbia Presbyterian Hospital in very hard-hit New York City. Thank you so much.
BLINDERMAN: Thanks so much, Lulu. Take care.
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