SEATTLE _ Seattle mourned the news: Elizabeth and Robert Mar died of COVID-19 within a day of each other. They would have celebrated 50 years of marriage in August.
But their deaths at the end of March were not the same. Liz, a vivacious matriarch at 72, died after two weeks sedated on a ventilator. Her analytical engineer husband, Robert, 78, chose no aggressive measures. He was able to communicate with their adult children until nearly the end.
Clinician Darrell Owens helped the Mar family navigate this incredibly difficult time.
"You cannot underestimate the stress on family members who cannot visit and are now in a crisis mode trying to talk this through over the phone," said Owens, a doctor of nursing practice who runs palliative and supportive care at the University of Washington Medical Center-Northwest in Seattle.
Owens, like other palliative care specialists in COVID-19 hot spots around the country, has seen his professional duties transformed by the deadly coronavirus. Patients and their families face abrupt decisions about the kind of care they want, and time for sensitive deliberation is scarce. Conversations once held in person are now over the phone, with all the nuances of nonverbal communication lost. The comfort of family at the bedside of the dying is all but gone.
This is the new reality for those who practice palliative medicine _ a specialty focused on relieving pain and symptoms, improving quality of life, and providing support to patients and families during severe, chronic or fatal illness.
Doctors and nurses trained in this branch of medicine are in high demand as hospitals treat thousands of terribly ill patients who may end up on life support with only a small chance of survival.
"This is a horrible virus that we don't have a cure for," Owens said. "As much as we are obligated to save people's lives, we are as obligated to save their deaths."
Before the coronavirus, Owens rarely worked in the emergency room. Now he's there regularly, called in whenever a suspected or confirmed coronavirus patient at high risk of complications comes through the doors.
"It is a totally different atmosphere in an emergency room," Owens said. "The conversations are more abbreviated than they would be because you are behind a mask, you are in a loud room, completely gowned up."
It's a tough way to talk through sensitive and crucial questions about a patient's chance of survival and what they want.
"This is completely unprecedented," said Dr. Diane Meier, director of the Center to Advance Palliative Care and a professor at the Icahn School of Medicine at Mount Sinai.
During the surge of coronavirus patients in New York City, Meier said, her hospital system set up a palliative care hotline for family members of patients.
"You can't see their facial expression, all the cues you normally get with face-to-face communication are very hard to pick up over the phone," Meier said.
Nonetheless, she said, these conversations _ especially with such a fast-moving and poorly understood virus _ are an essential piece of the pandemic response.
"Palliative care specialists are a scarce resource, just like ventilators and ICU beds," she said.
Dr. Hope Wechkin, medical director of EvergreenHealth Hospice and Palliative Care in Kirkland, Washington, said palliative medicine is fundamentally about "being with patients during times of profound uncertainty, and continuing to place comfort and enhanced quality of life front and center."
"We now have this new player (coronavirus) _ as we are evaluating a patient's goals of care," she said.
