On paper, it’s not a problem. Fuck Around and Find Out. These are the natural consequences of making stupid choices, just like losing your feet from uncontrolled diabetes, or dying of liver failure after the millionth detox visit. Bad decisions are literally my bread and butter, and I like it that way. That’s why I’m not in peds.
My antivax patients start off in the category of “well I guess we’re finding out today, aren’t we?”. They come in with their bravado intact, and usually find that all the verbal abuse, snark and conspiracy theories in the world do nothing against a bunch of nurses who have done this for almost 2 years. We are blunt, honest, and quick to offer AMA papers. Their feelings on covid’s existence doesn’t change the treatment course or their prognosis, and we aren’t going to waste our time arguing about it. You have the right to refuse any treatment, I’ll document and be on my way. You can try to demand nonsensical treatments, but you’ll have to go home for that. Here’s the papers.
Then, inevitably, it comes as the edges of a person start to crumble and crack. “Am I going to be ok?” “I’m so tired.” “I’m not getting out of here, am I?” “I don’t think I’m getting better.” I give them the only kind answer: “I don’t know, but I hope so,” even though we both know I’m talking to someone who is already on Death’s list. And then, even worse, comes the inevitable question: “How’s this gonna go, then?” We talk about the paths - one path is them turning around and recovering. One path is them being intubated and dying. One path is them being intubated and recovering, including the possibility of a trach and peg, lost fingers and toes, permanent disability.
I encourage them to talk to their family, to share their wishes and what they were willing to live with and not live with. I encourage them to say what needs to be said, just in case. Then the blunt nurse comes back and tells them to prone their ass if they want to avoid the what-ifs becoming the happening-nows. And I leave them to make those calls, think about their wishes, and think about what they want to do.
There’s nothing satisfying about saying “I told you so” to a person who is confronting their own death. It’s like kicking someone when they are down. There is no comfort in telling myself “fuck around and find out” when literal children come in to wave goodbye to their parent through the door or through the phone. There is nothing OK about watching kids turn into orphans because of their parents’ belief in lies fed to them through the media. It’s not OK that people my age with kids the same ages as mine are going from bravado to bagged in a week’s time. It’s not that we lose every time - hell, right now we have a whopping 5 covid patients on the unit. The problem is that all 5 are probably going to die. Maybe 1 will make it. And they are so young, leaving behind children or young adults; people who still need their parents. When I’m at work I compartmentalize just fine. I have a job to do, after all. But later, when I realize there’s a 17 year old playing his last high school football game tomorrow and his dad, who had resigned to watching it through a screen, won’t be watching at all, I can’t help but grieve for an asshole who played the odds and lost. And I don’t know how many more sucky people I can grieve for.
