The COVID ‐19 Pandemic: Experiences of a Geriatrician‐Hospitalist Caring for Older Adults

Abstract

In the last few weeks, New York has become the epicenter for the COVID-19 infection. This novel virus, while infecting young and older indiscriminately, takes its most dangerous toll on older adults. Medicare patients now occupy more than 50% of all hospital beds in the United States. As a hospitalist with geriatrics training practicing in the greater New Yok area, I am witnessing in the trenches the immediate impact of this pandemic on geriatric patients and their family members who long for one final good-bye. I have also seen some amazing acts of selflessness and empathy by frontline healthcare practitioners. Identifying details have been altered to protect the patient's confidentiality, but the essence of the stories remains the same. Patient 1: Mr. J. is an 82-year-old man with interstitial lung disease for which he requires 4 L of oxygen at home. He lives with his wife of 50 years. Given his high-risk profile, they have been completely isolated home for the last 3 weeks. His son, the only outside contact, has been bringing groceries once a week. Three days before admission, Mr. J. developed low-grade fever and increasing dyspnea. He was admitted to the hospital and tested for COVID-19. Overnight, his oxygen requirements escalated and a rapid response was called; the patient was deemed to be a poor candidate for intubation. I met Mr. J. the following morning. After putting on my full protective gear, I slowly entered the room. He was lying in bed with his eyes closed, the face mask covering most of his face, taking shallow and rapid breaths. I heard the telephone ring. I assumed it was a worried family member denied visiting rights. I gently woke up Mr. J. and held the telephone to his ear. In between breaths, I could hear Mr. J. softly telling his son that he loved him and that they should keep safe at home. Once they hung up, I spoke to Mr. J. about his wishes, and he stated clearly that he would not want to be kept alive on machines. An hour later, his COVID-19 test returned positive. I called his son and daughter who cried, and they asked my advice on bringing their mother to the hospital. They wondered if they were at fault for perhaps contaminating them during their weekly grocery shopping visit. The daughter also asked about potential risks to her husband, currently undergoing chemotherapy. I listened and felt their pain. I went back to Mr. J.'s room and sat with him a little longer, knowing I would probably be his only visitor that day. The patient died the following morning. The COVID pandemic has built an unsurmountable physical barrier between our patients and their loved ones at the most vulnerable time of their lives. We hospitalists often become the last human connection between our dying patients and their loved ones. Patient 2: Mr. B. is a 78-year-old man with a history of atrial fibrillation, congestive heart failure, and chronic kidney disease. Before admission, Mr. B. ambulated independently with a cane, drove, and had a full life with friends and family. He was brought in to the hospital by his daughter after experiencing fever and shortness of breath. He was admitted to the hospital with hypoxia and found to be COVID-19 positive. On his third day, he was now requiring 100% oxygenation with a non-rebreather mask. The nurse informed me that he had gotten more confused. Shaken from my last encounter, I put on my protective gear and entered the room. Mr. B was lying in bed, restless, trying to position his oxygen mask with one hand and holding his phone in the other. He looked at me and I could see the fear and frustration in his eyes, the only part of his face visible under the mask. With his hearing impairment, my mask, and the noise of the oxygen blowing through the non-rebreather, he could barely hear me. He held his phone up to my face and told me to read his message aloud. He was in the middle of writing his daughter a message indicating that he could not handle this situation any longer. I placed the telephone down and asked him if we could talk. I yelled as loudly as I could, explaining I was his doctor and came to see how he was feeling. He sighed in frustration and told me that he could handle the shortness of breath and the fevers but not another day in the hospital. Due to his oxygen needs, he had been in the same position in bed for the last 3 days and was stiff throughout his whole body. He spoke about his inability to use the bed pan and his dependency. In addition, the noise of the oxygen blowing in his eyes, nose, mouth, and ears all day and night was "driving him crazy." He then apologized and told me that normally he is a wonderful man, funny, smart, always making jokes, "the type of person the nurses love." I promised him that together we would address his concerns. The first thing we did was to dangle his legs off the bed. It took about 10 minutes of slowly working his muscles again to get him in a seated position, and he immediately felt better. I encouraged the s