GERIATRIC EMERGENCY MEDICINE
Dealing With Family Disconnects and Disrupted Social Networks in End-of-life Emergency Care SAEM PULSE | JULY-AUGUST 2021
By Anita Chary, MD, PhD on behalf of SAEM’s Academy of Geriatric Emergency Medicine
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One of the hardest aspects of the pandemic as a health care provider has been the absence of family and caregivers from the bedside. Loved ones who used to be immediately accessible for face-to-face conversations are no longer at bedside. Often, they are present only remotely, with facial expressions, body language, emotional urgency, and nuances becoming diminished, or even lost. Recently, a patient in his late 80s was signed out to me overnight,
having been admitted for aspiration pneumonia. He was a bony elder, living at a nursing home with dementia and many comorbidities. His code status was DNR/DNI. Initially he was stable on a few liters of oxygen, but over several hours of waiting for an inpatient bed in the emergency department, he became floridly septic. His oxygen requirement escalated to high flow nasal cannula. He became hypotensive and hypothermic. He seemed ready to die. Whenever his nurse or I would check on him he would pull at the nasal cannula tubing, rip
off the Bair Hugger, and beg to be left alone. He was not responding well to the pressors and his core temperature actually decreased, despite active rewarming. Had I been able to reach his family I would have communicated that this was likely the end of life for this patient, but I was unable to reach his family or health care proxy overnight, who I’m sure were exhausted and asleep after a day of phone calls, care coordination, and worry about their loved one.