White Coat, Black Art

Health-care workers face wrenching decisions on how to care for COVID-19 patients

Doctors and other health-care professionals are grappling with the difficult job of caring for patients who won’t survive, tough decisions about who will get a ventilator when equipment runs short and whether they’d want one themselves in the event they become severely ill from novel coronavirus.

Doctors grapple with which patients get ventilators and whether they'd want one themselves

Maureen Taylor, a physician assistant specializing in infectious diseases, says health-care workers are making difficult judgment calls about how best to care for patients who can no longer benefit from treatment. (Submitted by Maureen Taylor)
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Doctors and other health-care professionals on the front line of Canada's battle with COVID-19 are facing some of the most challenging decisions caregivers have to make.

Maureen Taylor, a physician assistant specializing in infectious diseases, is caring for COVID-19 patients at Michael Garron Hospital in Toronto. 

The ward is normally dedicated to respiratory and oncology patients, but these days it's given over to COVID-19 patients who aren't receiving intensive care — including those who aren't well enough to benefit from a ventilator or other intensive treatments.

That leaves Taylor, a former health reporter on CBC's The National, making difficult judgment calls about how best to care for patients who can no longer benefit from treatment, and when to call their families in to say goodbye. 

"So when we've stopped antibiotics, if we were even giving them to them, and I have nothing more medically to offer, I still go in and look at those patients every day and try to see if they can communicate with me," Taylor told White Coat, Black Art's Dr. Brian Goldman. "Because the hardest thing about all of this is they don't have family who can come in until death is imminent."

Maureen Taylor in COVID-19 protective gear. (Submitted by Maureen Taylor)

"We have to try to guess, you know, they're going to die in the next five, six hours, and then we phone family and I think they can have one or two, at the most, family members come in.

"Otherwise we're trying, the nurses especially … to help the patient communicate with family on a cellphone, or the phone that's in the room."

New guidelines to aid tough decisions

Emergency physicians in Canada have been watching closely as the tragedy in New York City unfolds, where doctors are faced with making difficult decisions on which patients receive potentially life-saving treatment, including ventilators.

The Canadian Association for Emergency Physicians has just published new guidelines to help doctors make those gut-wrenching calls.

Dr. Merril Pauls, an emergency physician at Winnipeg's Health Sciences Centre and chair of the association's bioethics committee, helped shape those guidelines.

He told The Current's Matt Galloway they're designed to give doctors a kind of formula they can use to determine things, such as who receives access to a bed in an intensive care unit or use of a ventilator. 

Though age is not the lone deciding factor, it's one of several used to determine the number of "life years" the treatment is likely to produce, Pauls said.

Many places in the United States have triage physicians or triage committees dedicated to making those decisions that are so hard for the physician who is caring for the patient in question.

"It's so difficult for a physician to turn from our traditional ethical stance that we do all that we can for a patient, and now … denying our patient something that could benefit them," Pauls said. It's distressing for physicians, patients and their families, he said.

Making their own wishes known

It's not only patients and their families who will grapple with these choices. Front-line caregivers, who are at high risk for developing COVID-19, are making their wishes known.

Vancouver emergency physician Dr. Joseph Finkler, who is recovering from a mild bout of COVID-19, got a bad cough and suspected that he had some pneumonia in his lungs as well.

But he decided not to have an X-ray, either while awaiting his COVID-19 test results or after he tested positive.

Extended interview with Vancouver ER physician Dr. Joseph FInkler who is now recovering from COVID-19. He admits thinking that he was "invincible" before he got the virus, and describes what it was like to come to terms with testing positive, and what that has meant for him and his family. He tells Dr. Brian Goldman that testing positive has led to him facing some stigma from neighbours and even other healthcare workers who are anxious about him returning to work. 19:47

"I did not want to, you know, transmit this to my colleagues, and obviously the vulnerable patients that we see," said Finkler, who works in the emergency department of St. Paul's Hospital.

He also worried about spreading the virus to his family — and they had their own concerns.

"My wife was very, very concerned I might deteriorate and end up in intensive care and on a ventilator like some of the stories you hear. That was the most fleeting concern of mine, but I'm happy — it was a good spark to get us to sort this out in case anything would happen."  

Vancouver emergency room doctor Joseph Finkler talks about not wanting to believe he had COVID-19 and when it finally sunk in. 1:21

After watching her husband die from brain cancer in 2013, Taylor said she doesn't want to end her life hooked up to a machine.

"If I thought my outcome was going to be poor, I don't think I want to be intubated in the first place," said Taylor, who is 59.

"It's not just because I don't want to put my colleagues through the [infection risk of] intubation, because I think they can do it pretty safely. It's because I know how I want to die, and that's not how I want to die. And the outcomes in these patients on ventilators who are at my age are not great."

Dr. Goldman has also publicly shared his resolve to refuse a ventilator if he becomes critically ill from the disease.

 

But although front-line workers carry the heavy weight of decisions made both for patients and themselves, the long days in Canada's COVID-19 wards are also punctuated with some good moments.

"There's one particular patient who we didn't think was going to do well," said Taylor. "He was in a higher risk age group and he just needed a lot of oxygen when he first came in, and there were a lot of discussions about whether he would be a good candidate for intubation."

But his care was managed with just oxygen alone, and after a few days he started to feel better.

"We high-fived because he's going home."


Written by Brandie Weikle. Interviews produced by Jean Kim and Sujata Berry.

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