During the height of the pandemic, my colleague and I were consulted to address goals of care for an elderly African American gentleman who I’ll call Mr. D. When Mr. D’s son was informed of his father's rapidly declining condition, he expressed shock and disbelief. We learned that our patient had been living independently prior to contracting COVID-19.
The pandemic quickly changed our approach to our work. We did not have the luxury of meeting the family in person and developing a human connection.
“When we brought our loved one to the emergency department, we did not think we would be discussing code status and end-of-life care.”
“Who are these strangers asking us to place our trust in them when we have never met?”
What I anticipated would be a straightforward discussion took an unexpected turn. A flood of emotions, questions, and concerns ensued for the family as well as for me. In the conversations that followed, I learned the family’s concern was racial inequality in the health care setting. Mr. D’s daughter-in-law expressed fear that hospitals were harvesting the organs of African American patients. This made his family very hesitant to discuss code status and advance care planning because they felt this would increase the patient’s vulnerability.
These were sensitive discussions prior to the COVID-19. However, amid a public health crisis, there were many unforeseen complexities. Faith, race, culture, and socioeconomic status were more relevant than before. As a clinician, I found the family’s fear of harvesting organs to be morally distressing.
We addressed emotions as well as COVID-19 in the conversations that followed. Once the family felt safe to share their feelings, we succeeded in mitigating their fears and concerns and we were able to develop a medically appropriate plan for Mr. D.
Mr. D’s son had a brief end-of-life visit with his father during which he reflected upon the legacy he was leaving behind. Although it felt as though the virus was winning, our victory was developing a positive relationship with the family and meeting the needs of the patient under very challenging circumstances.