Part 2 of our series featuring Dr. Naheed Dosani, Palliative Care Physician and Medical Director, Region of Peel COVID-19 Homeless Response. This episode focuses on the importance of Palliative care and during the COVID-19 pandemic.
Part 2 of our series featuring Dr. Naheed Dosani, Palliative Care Physician and Medical Director, Region of Peel COVID-19 Homeless Response. This episode focuses on the importance of Palliative care and during the COVID-19 pandemic.
OMA Podcast Episode 17: Palliative care and COVID-19 with Dr. Naheed Dosani
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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan. I’m the Director of Media Relations and Social Media for the Ontario Medical Association.
Dr. Naheed Dosani: I’m Naheed Dosani, and I’m a palliative care physician.
Flanagan: We’re here today to talk about palliative care.
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Flanagan: Why is palliative care so important and particularly at times like this when we’re going through the pandemic?
Dr. Dosani: As a palliative care doctor, my everyday is spent helping people with serious illnesses, like cancer or kidney failure or dementia, with quality of life issues as they approach end of life. And the focus is around addressing suffering. While the disease is different, in this context COVID, the focus is the same.
I’m a firm believer that palliative care can address our collective suffering during this time. That can include addressing and treating symptoms, like shortness of breath or gasping for air that people experience as they deal with COVID by using medicines. That can be supporting a caregiver, a loved one who is distraught about what’s happening to their family member. Or that can be sitting down with someone and having an Advance Care Planning conversation about what the future looks like.
It also speaks to system preparedness—making sure that our system, our critical care capacity, our hospitals, our communities—are prepared with the pieces and ingredients to be able to deal with all those people who may pursue a ventilator if they need it, or may not pursue a ventilator because of their personal choice, and everything in between. So I think palliative care plays a really important role amidst the coronavirus crisis.
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Flanagan: A lot of people are afraid because death isn’t something, it’s not a subject people are comfortable with. I think people are afraid and they’re sort of nervous around it. And that’s why support is so important. How do you talk to patients about that? How do you talk them through that? And their families?
Dr. Dosani: When I talk to people about palliative care, particularly amidst the COVID-19 pandemic, it’s really done in the context of a person’s wishes and beliefs and values. We don’t start by talking about death. This is not about death. This is about making sure care is supported in the way that makes sense for you, for how you envision your future, for your faith beliefs, your vision of what family or caregivers look like.
And it’s about documenting that. And while there are workbooks that people work through, for example through Advance Care Planning Canada or the Speak Up Ontario campaign—which I encourage people to look at those websites and download—it’s not so much about the documents although those documents are helpful, it’s about having the conversation with your family. It’s about the conversation with your caregivers. So that, if you are ever in a situation where you’re in the hospital or get sick, those people around you who are speaking for you on your behalf if you’re not able to speak, at least knew what you would have wanted.
The thing about COVID that makes this all so difficult is COVID, and perhaps different than my other mainstream palliative care work, is that COVID also affects young people. Yes, higher age is definitely a risk factor, but young people can get affected by this. And that’s why these conversations are important.
The second reason it’s different is this disease can come on really fast, even over hours you can see a precipitous change in someone’s status, and they can fall very, very sick.
And the third is there’s no real treatment for this other than to support someone with a ventilator and have a tube down their throat so that they could breathe and let the immune system take over.
That’s a very aggressive treatment, and while many will pursue that treatment and some will get better, many will not. And some who do get better will not return to their previous health.
That’s what makes this whole dynamic a little bit different, it’s a definite twist on how we traditionally think of palliative care. But the palliative care community is making that shift to meet the community’s needs.
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Flanagan: The ventilator can be a very traumatizing situation both for you as a patient and your family as well, is that correct?
Dr. Dosani: These are, potentially, machines, in the right situations, that can save lives. But what I think doesn’t always get in the discourse is about how aggressive this form of treatment is, in the sense that people have to be deeply sedated, you need to have a tube down your throat, you’re being kept alive by machines. While the data is still coming in, so the research is kind of here and it’s there, we know that not everyone survives. In fact, some people will survive, but many will not. And those who do survive, they often don’t return to their baseline health.
So there’s no magic bullet when it comes to ventilators, and there is definitely a role, but the aggressive nature of it as a treatment? There’s this whole proportion of people out there, this whole segment who say, or already are saying to us, “I don’t want to be on a ventilator.”
If we have Advance Care Planning done, bringing it back to your point, we would know what these people’s wishes are. And in the event that people do not want to use a ventilator, there’s potentially more ventilators to use that way. So planning has multiple win, win, wins, across the board. From a system perspective, from the health workers on the front lines, and from the patients we care for as well.
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Flanagan: My mother had cancer, and we were able to care for her through the end at home, and it was because of having access—we were lucky enough to have that access—to a really good palliative care program, and we had a lot of support because of it. And it helped us really keep her comfortable.
When we knew she was sick, we knew she probably wasn’t getting better, we really sat down and talked about what she wanted. And as someone who was a healthcare worker in her career, she believed in having a very open conversation. And it was difficult. It wasn’t easy, of course. But what it meant is we knew exactly what she wanted and exactly what she didn’t want. And so, when things got really hard, and emotional, and she couldn’t communicate well, it made our job as a family easy because we knew we were doing the right thing.
Dr. Dosani: That’s right. Wow, you told that story so well. I mean, this is like a champion story of why Advance Care Planning is so important. These conversations are not… they’re not easy. No one’s saying they’re easy. We know they’re sad. We know this is sombre. Our community totally understands that. But they’re necessary. This is pragmatic. This is practical. It’ll happen to all of us.
And that’s why these conversations definitely need to happen, and when you think about COVID, anyone can get impacted by this. We know that age, you know there’s a lot of younger people, and it can happen so quickly, so for those who haven’t heard of Advance Care Planning, it’s so vital to have this content out there.
And for those who have already done their advance care plan, we’re telling those people to refresh or rethink it and re-have that conversation in the context of a pandemic.
I’m so glad we’re spending time talking about this today.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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