Kenny: It’s time to have the hard conversation

Headshot of Deborah Kenny
Deborah Kenny

No one likes to talk about dying.

No one likes to talk about emergencies before they happen, either. No one wants to go to the hospital without family there in their most vulnerable time. No family member wants to get medical updates by phone or say goodbye via FaceTime.

As a nurse for more than four decades, I can definitively say we’ve never faced a crisis like this in our lifetimes. Normally, in intensive care units or with those facing other terminal illnesses, we can make end-of-life decisions with family. We can do our best to keep someone comfortable until a loved one makes it to the bedside to say “I love you” and hold one’s hand for the final time.

But these are not normal circumstances. As a part of my career, I worked as an Army nurse. Though I never deployed, I spoke to nurses in field hospital emergency rooms who sometimes had to make the call on who had the best chance of survival, and who would be placed on a morphine drip with a corpsman at their side to make their final moments more comfortable. I spoke to nurses who were firm in their belief that no one should die alone. As an ICU nurse, there were sometimes patients with no family members. I made it my mission that no patient would ever die alone. In these “not normal” circumstances, I have every confidence that nurses in the hospitals caring for COVID-19 patients whose family are not allowed to visit are just as compassionate in their care.

However, making decisions on who gets the last ventilator is one that no one in health care wants to make. We are driven to save lives and give our patients more birthdays and more time with families. I work with a team of nurse ethicists who discuss these decisions at length and the angst among providers over having to make them. Today, these discussions are no longer in the abstract.

My spouse and I are in a higher-risk group. For me to leave him at the doorstep of a hospital and be told I couldn’t go in would be devastating. We know we may be triaged out of care in a dire situation. We have spoken about that scenario at length. We made a hard decision to stay home together, each knowing the other may get sick. We chose comfort over futility. Maybe, because we have made that decision, someone else who has a better chance of survival can have the ventilator we otherwise might have used, and the hospital’s providers can save precious time. That’s why it’s critical to have these conversations now.

If you don’t know how to begin, you can access the website called “The Conversation Project.”  It has a downloadable starter kit to fill out and bring to your doctor or nurse practitioner. It has questions to help begin this tough conversation.

I’m now part of a team of faculty who are preparing nurses to graduate and join the fight. I know the resources it takes to care for the very sick. I know the heartbreak every provider goes through when caring for someone who has little chance for survival, despite family members wanting to pull out all the stops.

Please talk now. Please decide for yourselves how you want to handle this incredibly important decision, before it’s made for you.

Deborah Kenny is an associate professor of nursing at the UCCS Helen and Arthur E. Johnson Beth-El College of Nursing and Health Sciences.